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PROTOCOLS FOR BLOOD

TRANSFUSION

FOLLOWED AT PAREKHS

HOSPITAL

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CHECK-LIST

1.Ask the patient to identify herself/himself

by

Family name give name, date of birthand any appropriate

If the patient is unconscious ask a

relative or a second member of staff to

state patients identity.

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2. Check that patients identity and gender

against.

Patient's identity wristband or label.

Patients medical notes.

3.Check that the following details ofcompatibility label attached to the blood

pack exactly match the details of the

patients documentation and identify

wristband.

Patients name.

Hospital reference number

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4. Check that there are no discrepancies between

ABO group and Rh D group on Blood pack

Compatibility level.

5. Check that there are no discrepancies betweenthe unique donation number on

Blood pack

Compatibility level6.Check that expiry date on the blood pack has

not passed.

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7.Examine the pack before

transfusion. Do not administer

the transfusion if the pack is

damaged or there is any

evidence of signs ofdeterioration.

Leakage Unusual Colour.

Signs of heamolysis.

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Monitoring the Transfused Patient

1. For each unit of blood transfusion,monitoring the

following stages.

Before starting the transfusion.

As soon as the transfusion is started.

15minutes after starting transfusion.

On completion of the transfusion.

4 hrs after completing the transfusion.

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2. At each of these stages the following

information on the patients chart.

Patient's general appearance

Temperature.

Pulse. Blood Pressure

Respiratory rate.

Fluid balanceOral and IV fluid intake.

Urinary Output.

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3. Record

Time the transfusion is started.

Time the transfusion is completed.

Volume and type of all products

transfused.

4Monitor the patients particularly

carefully during the first 15 minutes ofthe transfusion to detect early sign

and symptoms of adverse ill effects.

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TIME LIMIT FOR INFUSION OF BLOOD COMPONENTS

Start infusion Complete infusion.

Whole Blood/Red

cells

Start infusion

Within 30 minutes

of removing pack

from refrigerator

immediately.

Complete infusion

Within 4 hours

(or less in high

ambient temperature)

Platelet concentrates Immediately Within 20minutes

Fresh frozen plasma Within 30minutes Within 20 minutes.

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TRANSFUSION REACTION

Category Signs Symptoms Possible cause

l-MildLocalized cutaneous

reactions

Pruritus Hypersensitivity

(mild)

ll-Moderately Severe

Flushing

Urticatria

Rigors

Fever

Restlessness

Tachycardia

Anxiety

Pruritus

Palpitation

Mild Dyspnoe

Headache

Hypersensitivity moderately

severe)

Febrile non-hemolytic

transfusion reaction.

Ab to protein, including Ig

Possible contamination with

pyrogens and/or bacteria

Ill-Life threatening

Rigors

Fever

Restlessness

Hypotension

(fall of 20% of

systolic BP)

Tachycardia

(rise of 20% of

heart rate)

Hemoglobinuria(red

urine)

Unexplained

bleeding

(DIC)

Anxiety

Chest pain

Pain near infusion site

Respiratory Distress

Loin/Back pain

Headache

Dyspnea

Acute intravascular hemolyisis

Bacterial contamination and

septic shock

Fluid overload

Anaphylaxis

Transfusion associated lung

injury

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NOTE

If acute transfusion reaction occurs, first check theblood pack labels and the patients identity. If there isany discrepancy, stop the transfusion immediately andconsult the blood bank.

In an unconscious or anesthetized patient,hypotension and uncontrolled bleeding may be theonly signs of an incompatible transfusion.

In a conscious patient undergoing a severe hemolytic

transfusion reaction, signs and symptoms may appearvery quickly within minutes of infusing only 5-10 ml ofblood. Close observation at the start of infusion ofeach unit is essential.

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IMMEDIATE MANAGEMENT

Category1:-Mild

1. Slow the transfusion

2. Administer antihistamineIM(eg.Chlorpheniramine 0.1mg/kg or

equivalent).

3. If no clinical improvement within 30min or ifsigns and symptoms worsen,treat as

Category2.

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Category 2: Moderately Severe.

1. Stop the transfusion. Replace the giving set andkeep IV line open with normal saline.

2. Notify the doctor responsible for the patient andblood bank.

3. Send blood unit with giving set, freshly collectedurine and new blood samples (clotted andanticoagulanted) from vein opposite infusion sitewith appropriate request form to blood bank andlaboratory for investigation.

4. Administer antihistamine IM(eg.Chlorpheniramine

0.1mg/kg or equivalent) and oral or rectal anti-puretic (eg. Paracetamol 10mg/kg 500mg-1 G inadults). Avoid aspirin in thrombocytopenicpatients.or equivalent).

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5. Give IV corticosteroid and

bronchodilators if there are anaphylactic

features(eg. Bronchospasm,stridor)6. Collect urine for next 24hrs for evidence

of haemolysis and send to laboratory.

7. If clinical improvement restart transfusion

slowly with new blood unit and observe

carefully.

8. If no clinical improvement within 15min

of it signs and symptoms worsen,treat ascategory 3.

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Category 3:-Life Threatening.

1. Stop the transfusion.Repalce the giving set

and keep IV line open with normal saline.2. Infuse normal saline (initially 20-30ml/kg) to

maintain systolic BP; if hypotensiv,give over

5mins and elevated patients legs.3. Maintain airway and give high flow oxygen by

mask.

4. Give adrenaline(as1:1000 solution) 0.01mg/kgbody-weight by slow intramuscular injection.

5. Give IV corticosteroids and bronchodilators if

there are anaphylactoid features

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6. Give diuretic eg. Frusemide 1mg/kg IV or

equivalent.

7. Notify the doctor resposible for the patient andblood bank immediately.

8. Send blood unit with giving-set fresh urine

sample and new blood samples( 1clotted and1 anticoagulatted) from vein opposite infusion

site with appropriate request form to blood

bank and laboratory for investigation.

9. Check a fresh urine specimen visually for signs

of heamoglobinuria(red or pink urine).

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10. Start a 24hrs urine collection and fluid

balance chart and record all intake and output.

Maintain fluid balance.

11. Assess for bleeding from puncture sites or

wounds. If there is clinical or laboratory

evidence of DIC,give platelets (adult 5-6 units)

and either cryoprecipitate (adult 3 units). Use

virally inactivate plasma coagulation products

whenever possible.

12. Reassess if hypotensive

* Give further saline 20-30ml/kg over 5mins

* Give inotropes if available

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13. If urine output falling or laboratory evidence of

acute renal failure(rising K+,Urea,Creatinine)

Maintain fluid balance accurately. Give further frusemide

Consider dopamine infusion, if available.

Seek expert help, the patient may need renaldialysis.

14.If bacteremia

suspected(rigors,fever,collapse,no evidence ofhaemolytic reaction), start broad spectrum anti-

biotics,to cover pseudomonas and gram

positives.