The Director General of Health Services (DGHS), Ministry of Health and Family Welfare, Government of India and World Health Organization (WHO) have laid down a series of recommendation and guidelines for clinical use of blood for Safe Blood Transfusion Practices. It ensures active collaboration between the blood transfusion service and clinical management of patients who may require transfusion. The recommendations emphasize the importance of education and training in the clinical use of blood for all clinicians involved in the transfusion process. The specific clinical indications for transfusion should be considered. The decision to transfuse should be supported by the need to relieve clinical signs and symptoms and prevent significant morbidity and mortality. Transfusion should be prescribed only when the benefits to the patients are likely to outweigh the risks of transmitting HIV, Hepatitis B and C or other infectious agents through blood products. Everyone involved in the clinical transfusion process must ensure that the right blood gets to the right patient at the right time.
CLINICAL DECISIONS ON TRANSFUSION
- Used correctly, transfusion can be life saving but inappropriate use can endanger life.
- The decision to transfuse blood or blood products should always be based on a careful assessment of clinical and laboratory indications that transfusion is necessary to save life or prevent significant morbidity.
- Transfusion is the only element in the patient's management.
- Prescribing decisions should be based on national guidelines on the clinical use of blood, after taking into account individual patient's need. However, responsibility for the decision to transfuse ultimately rests with individual clinician.
ASSESSING THE NEED FOR TRANSFUSION
Factors determining the need for transfusion:
- Blood loss: External bleeding; Internal bleeding—non-traumatic, traumatic; Red cell destruction.
- Hemolysis: Malaria; Sepsis; DIC.
- Cardio respiratory state and tissue oxygenation: PR; BP; RR; capillary refill time; peripheral pulses; urinary output; consciousness levels.
- Assessment of anemia.
- Patient's tolerance to blood loss/anemia: Age; cardiorespiratory disease; diabetes; treatment with beta blockers.
- Anticipated need for Blood: In surgery or anesthesia; in bleeding or hemolysis.
Prescribing decisions should be based on national guidelines on the clinical use of blood.
CHECKLIST FOR CLINICIANS PRESCRIBING BLOOD
Before prescribing blood or blood products for a patient, ask yourself the following questions:
- What improvement in the patients' clinical condition is aimed for?
- Can you minimize blood loss to reduce this patient's need for transfusion?
- Are there any other alternative treatments I should give before making the decision to transfuse, such as intravenous replacement fluids and oxygen?
- What are the specific clinical or laboratory indications for transfusion to this patient?
- What are the risks of transmitting HIV, hepatitis, syphilis or other infectious agents through the blood products that are available for this patient?
- Do the benefits of transfusion overweigh the risk for this particular patient?
- What other options are there if no blood is available in time?
- Will a trained person monitor this patient and respond immediately if any acute transfusion reaction occurs?
- Have I recorded my decision and reasons for transfusion on the patient's chart and the blood request form?
- If the blood was for my child, or myself, would I accept the transfusion in these circumstances?
REQUISITION FOR BLOOD/ BLOOD COMPONENTS
Requisition Form completely filled with the followings:
- Details of patient
- Complete identification of the patient with name, age, sex, CR. No. ward, etc.
- Diagnosis
- Pretransfusion hematological values
- Indication of transfusion
- Type of request routine, urgent, emergency
- Required blood/component type and quantity
- Relevant previous history of transfusion, transfusion reaction, pregnancy, etc.
- Details of clinician
- Clinician's full name
- Stamp
- Registration no.
- Signature
- In case of previous transfusion, blood group should be mentioned in the request form.(Refer Appendix-I)
- Time and Date of blood transfusion must be mentioned so that the required component is not wasted. For requests made at night, the blood should be replaced in the morning, so as to avoid serious donor reactions.
- Incomplete form is not accepted.
INFORMING THE PATIENT
Informed consent for transfusion of blood/component should be taken after explaining to the patient or its responsible relatives, the risks and alternatives of transfusion by the physician. This should be documented in the medical record in the patient's notes. One time consent for repeated transfusion will suffice. (Appendix-II and III)
Some patients, e.g. Jehovah's witnesses, may refuse transfusion and require specialized management to survive profound anemia following blood loss.
ORDERING BLOOD
Protocol for ordering blood is categorized into emergency, urgent and routine depending on the clinical condition (Flow chart 1.1).
CM—cross-match; GSH group, screen and hold; MSBOS—maximum surgical blood ordering schedule.
Ordering Blood in an Emergency
The procedure before ordering blood in an emergency is clear, simple and everyone knows and follows them. Insert an IV cannula. Take a blood sample for compatibility testing, set up an IV infusion of normal saline or balanced salt solution, e.g. Ringer lactate, send the sample to the blood bank after labeling the sample with patient's identity, write an emergency admission number or patient's name only if known. Use the same identity for another request for the same patient within a short period. Tell the blood bank how quickly the blood is needed. Communicate using words that have been previously agreed with the blood bank explaining the urgency. The policy of release of blood in emergency is given in Flow chart 1.2. The blood bank may send group O RhD negative blood, especially if there is any risk of errors in patient identification. This is the safest way to avoid a serious mismatched transfusion in an acute emergency.
Ordering Blood for Elective Surgery
The timing of requests for blood for elective surgery should comply with local rules. The local blood ordering schedule should guide the quantity requested.
Blood Ordering Schedule (Maximum Surgical Blood Ordering Schedule) (MSBOS)
Each hospital should develop a blood ordering schedule, which is a guide to normal transfusion needs for common surgical procedures. The blood ordering schedule should reflect the clinical team's usual use of blood for common procedures. It is a table of elective surgical procedures, which lists the number of units of blood routinely requested and cross-matched for them preoperatively. The schedule is based on retrospective analysis of actual blood usage associated with the individual surgical procedure. Important factor in establishment of an MSBOS is the identification of those procedures that can be accommodated by group, antibody screen and hold (GSH) procedure.
For cases where blood is not likely to be transfused, group screen and hold (GSH) is done.
- Patients ABO and Rh D type determination
- Patient's serum is tested for clinically significant red cell antibodies.
- Blood bank ensures that blood can be provided quickly if it is needed.
Using this method
- Blood can be issued in 15 to 30 min.
- It is unnecessary to hold cross matched units of blood as insurance for a patient who is unlikely to need them.
- It will reduce the workload and minimize the wastage of blood.
Where blood is likely to be transfused, a full cross-match (CM) is done.
Procedure where blood usage is < 30 percent GSH is done.
Other procedures are allotted a tariff based on the average number of units transfused.
MSBOS as per DGHS is given as follows Table 1.1.
BLOOD SAMPLES
Two blood samples of 2 ml each (clotted and EDTA), of the patient/recipient in clean, dry screw capped containers with gum pasted labels with:
- Name (Legible)
- CR No.
- Ward
- It is the responsibility of the physician to collect the sample.
- Name, signature of the doctor taking sample and date of collection should be mentioned on the sample label and requisition form.
- Sample is not accepted in syringes and colored vials.
- For every additional unit, 1 ml blood in plain vial should be sent.
- For neonates and very anemic patients, only EDTA sample may be accepted.
- For double vein exchange transfusion (DVET), 3 ml of mother sample in plain vial along with neonatal EDTA sample is required.
- A new sample is required after 3 days /72 hours, with day on which sample was taken as day zero, in order to detect the antibody/ antibodies which might have been produced recently.
- Samples can be collected from infusion line. To avoid interference from the residual intravenous fluid, the tubing should be flushed with saline and 5 ml or a volume of blood approximately twice the fluid volume in line should be withdrawn and discarded before sample collection.
- Blood bank laboratory staff should ensure that the sample is not hemolyzed or unlabeled.
DONOR
- For routine cases, a healthy donor should be provided at the time of sending requisition.
- For replacement donation, name of donor, its identification mark and signature/thumb impression attested by the requesting clinician should be mentioned in the blood requisition form. Donor form is given in Appendix-IV.
- A donation is valid for 3 months for the same patient only.
- If a donation has already been made for the patient, it should be documented on the form.
- For planned surgeries/ transfusions, the requisition should be sent 24 hours in advance.
- Ensure that blood has been donated/cross-matched before the routine procedure by verifying donation/cross-match slip.
PROTOCOL FOR APHERESIS DONOR
- Healthy group specific donor is required.
- Donor should not have taken aspirin within 72 hours/ 3 days.
- Samples are collected for blood grouping, hemogram, screening for transfusion transmitted infections (TTI) and antibody screening.
- The procedure can only be started after donor testing is completed.
- Duration of procedure is one to one and half hour.
- Venous access is important.
- The validity of mandatory tested infectious markers is taken up to 30 days, if repeat procedure is done with in that time frame.
CROSS-MATCH OF BLOOD
Routine Cross-Match
- Routine planned hemotherapy or elective surgery: Routine cross-matching including antihuman globulin (AHG) testing is done. It takes minimum 114 hours.
Emergency/Immediate Cross match/Spin Technique
- It should be requested for only when the patient cannot wait for 2 hours and requires immediate transfusion. It should be marked “urgent” or “immediate” or “emergency”.
- It is done by immediate saline spin technique and blood is ready within 15 to 20 minutes after receipt of sample.
- The treating physician should sign a requisition stating that the clinical condition of the patient is sufficiently urgent to require the release of blood before completing ABO and RhD tests and compatibility testing. Records of such requests shall be retained for 5 years.
- The routine cross match procedure is still followed in these cases even after issue of blood and only in case of any problem, the concerned doctor is intimated by the blood bank.
- Table 1.2 shows the cross-match policy in emergency.
- Comparison of emergency and routine cross-match is given in Table 1.3.
Table 1.2 Cross-matching policies in emergency release of blood Time of release of bloodPolicyWithin 5 minutes of receipt of sampleo negative packed red cellsWithin 15 minutes of receipt of sampleType specific uncross-matched bloodWithin 45 minutes of receipt of sampleType specific cross-matched bloodTable 1.3 Comparison of immediate (spin) cross-matching vs. routine cross-matching Immediate spin cross-matchingRoutine cross-matching including AHG testingDesigned to detect compatibility of IgM type of antibodies in patient's serum against antigen on donor's red cells in saline phase, i.e. ABO compatibility testing.In addition to saline phase compatibility testing (IgM antibodies detection), AHG testing is designed to detect compatibility of IgG type of antibodies in patient's serum against antigen on donor's red cells.Also detect anti-Lea,-Leb, -I, -P1, -Mand N but not some other clinically significant antibodies.AHG testing detects anti-D, -C, -E, -c, -e, -K, -Jk, -Fy, -S, -s, -Lea and Leb Hence, most of the clinically significant antibodies are detected. - Cross-matched blood is stored in the blood bank for a period of 3 days from the date of cross-match. This date can be extended upto 7 days only, after request from physician/surgeon in-charge. They should specify time period to reserve the units. In the absence of information from the attending doctors, these cross-matched units are utilized for other patients to avoid wastage and outdating of units.
ISSUE OF BLOOD UNITS
- Blood unit should be issued from the blood bank immediately prior to transfusion, since storage conditions outside the blood bank are suboptimal and cause deterioration and bacterial contamination.
- Ice boxes meant for transportation of blood/component, should be used for carrying blood/component from the blood bank to the ward/ OT.
- Ideally transfusion should be started within 30 minutes of issue of unit from blood bank.
- In case of nonutilization of blood, the unit should be returned to the blood bank within 30 minutes to prevent bacterial contamination and wastage.
- In no case the issued units should be stored in domestic refrigerator kept in wards and OTs.
- If the unit needs to be stored for 24 hours, then it should be sent to the blood bank before 30 minutes of issue (as the same unit cannot be issued to the patient if received after 2 hours).
- Blood is issued only after a written request for issue.
COLLECTING BLOOD/ PRODUCTS PRIOR TO TRANSFUSION
The common cause of transfusion reaction is the transfusion of the incorrect unit of blood that was intended for a different patient. This is often due to mistake when collecting blood from the blood bank. Written document to identify the patient must be there. The details on this document should exactly match the details on the compatibility label on the blood unit before collecting the blood /product.
COMPONENTS
- Diagnosis, type of component required and its indications should be mentioned in the requisition form.
- For platelet concentrate/platelet rich plasma (PRP), report of platelet count must be mentioned on the requisition form.
- For fresh frozen plasma (FFP), report of prothrombin time index (PTI) should be mentioned on the requisition form.
- For cryoprecipitate (Cryo), report of activated partial thromboplastin time (APTT) must be mentioned on the requisition form.
- PRP/Platelet conc./ FFP/ Cryo once issued are not taken back.
DOSE/OUTCOME OF BLOOD/BLOOD COMPONENTS
The doses of the blood/blood components and their outcome/effect after transfusion are given in Tables 1.4 and 1.5.
STORING BLOOD PRODUCTS PRIOR TO TRANSFUSION
Whole blood (WB) or Packed red blood cells (PRBCs)
- The temperature for storage of whole blood/Red Cells is 2°to 6°C. It should be stored only in monitored refrigerators (with temprature display and alarms).
- WB/PRBCs in citrate-phosphate-dextrose with adenine (CPDA-1) shall have the expiry after 35 days. While red cells with additives like SAGM or ADSOL can be stored up to 42 days.
- They should be issued from the blood bank in an insulated box which will keep the temperature between 2°C to 4°C.
- The upper limit of 4°C is essential to minimize the growth of any bacterial contamination in the unit of blood, while the lower limit of 2°C is essential to prevent hemolysis, which can cause fatal bleeding problem or renal failure.
Table 1.4 Doses of the blood component Packed red blood cells(PRBCs)Platelet concentratesFresh frozen plasma (FFP)Cryoprecipitate (CryolCP)Adults• 350 ml ↑ Hb ≃ 0.7 gm%• 450 ml ↑ Hb ≃ 1 gm% Children(10-15 ml / kg body wt)• Platelet concentrate (Random donor platelets)- Adult – 1 unit/10 kg body wt. (minimum 6 units)
- Neonate – 1 unit/2.5 kg body wt.
• Apheresis platelets (single donor platelets)- Adult
- 1 unit ≃ 6 Platelet Conc.
• PRP (not encouraged)• Adult (15 ml/kg body wt.)Minimum four bags in 60 kg patient.• Amt. of factor IX = factor IX increment x body wt.• 1 unit ≃ 6 packs of FFP• One pack of cryo contains- Factor VIII = 80- 100IU/ pack
- Fibrinogen = 150-300 mg/ pack.
• Amt. of factor VIII =Factor VIII increment x Body Wt ÷2Table 1.5 Effect/outcome of component transfusion Packed red blood cells (PRBCs)PlateletsFresh frozen plasma (FFP)Cryoprecipitate (CryolCP)Adult• 350 ml ↑ Hb ≃ 0.7gm%• 450 ml ↑ Hb ≃ 1gm%• Platelet concentrate/RDP- Adult - 1 unit raises 5,000-10,000 platelets/μl
- Child (18 kg)-1 unit raises 20,000 platelets/μl
- Infant - 1 unit raises 75,000 - 1,00,000 platelets /μl
• Apheresis platelets- Adult
• 1 unit raises 25,000 -30,000 platelets/μlOne bag of FFP raises the level of• Factor VIII by 4%• Factor IX by 3%•1 u/kg of factor VIII or factor IX raises the factor VIII levels in plasma by 2% and factor IX by 1% respectively• Factor IX is replaced every 18-24 hrs.• 1 iu / kg body Wt of factor VIII will ↑ Factor VIII activity in patient plasma by 2% (0.02 iu/ml)• Half life of factor VIII is 10-12 hrs. - The administration of whole blood or red cells should be started within 30 minutes of issuing from the blood bank. Transfusion should be completed within 4 hours of starting the transfusion. These time limits have been 11determined for temperate climates where temperature in the hospital building are generally between 22° to 25°C. If the ambient (room) temperature is higher, shorter ‘out-of—refrigerator times’ should be used (as per directions of DGHS, Ministry of Health and Family Welfare, Govt. of India).
- If not required for transfusion, return the unutilized blood bag in fully preserved conditions as soon as possible to the blood bank with reasons.
- Change the blood transfusion set after 12 hours, if the patient requires ongoing transfusion support.
Platelet Concentrates (PC)/ Random Donor Platelets (RDP) Apheresis Platelets (Single Donor Platelets)/Platelet Rich Plasma (PRP)
- These should be issued in insulated boxes that will keep the temperature at about 20°C to 24°C.
- Platelet concentrate should be administered as soon as received.
- Infusion should be completed within about 15 to 20 minutes.
- Should be kept at room temperature 22°C to 24°C in platelet agitator in the blood bank.
- For 3 days in case of PC/PRP
- For 5 days (Apheresis platelets).
- They should never be stored in refrigerator as they loose their blood clotting capability at lower temperature.
- Should be administered with a fresh transfusion set with a filter, primed with normal saline.
- Platelets once issued, are not taken back in the blood bank.
Fresh Frozen Plasma (FFP) and Cryoprecipitate (Cryo/CP)
- FFP is stored in the blood bank at —20°C for 1 year.
- It should be thawed and issued in blood transport box in which the temperature is maintained at 2° to 4°C.
- FFP should be infused within 30 min after thawing to avoid loss of labile clotting factors.
- If not required for immediate use, thawed plasma should be stored in the refrigerator at 2° to 4°C and should be used within 12 hours.
- In adult, I unit of FFP should generally be infused within about 15 to 20 minutes.
- Thawed or partially thawed plasma once issued is not taken back in the blood bank.
- Factor V and factor VIII deteriorate rapidly if not frozen at —20°C or less. Factor VIII falls rapidly over 24 hours and is of no use for the treatment of hemophilia, while factor V declines slowly.
ADMINISTERING BLOOD PRODUCTS
Each hospital should have written standard operating procedures (SOPs) for administration of blood products. Before starting the infusion, final identity 12check should be done at the patient's bedside by two people, at least one of who should be a registered nurse or a doctor. This is the last opportunity to detect an identification error and prevent a potentially incompatible transfusion, which may be fatal.
- Final identity check of the patientName, CR. No. and blood group:
- From the records of the patient.
- Ask the patient himself/herself the name
- If the patient is unconscious identify the patient with wristband.
- Check compatibility label attached to the blood product for the following details:
- Patient's name
- Admission No/CR. No.
- Blood group
- Donation No.
- Collection and expiry dates—for whole blood/RBC's—35 days.
- RBC's in SAGM/Adsol Bag—42 days.
- Platelet concentrate/PRP—3-5 days.
- Apheresis platelets—5 days.
- FFP/SDP at -20°C or below—1 year.
- Check the blood bag for:
- Green sticker showing nonreactivity for HIV, HbsAg, HCV, STS and MP before transfusion.
- Any sign of damage or leakage of the blood/components
- Collection and expiry date on blood bag
- Hemolysis in the plasma
- Hemolysis on the line between the red cells and plasma
- Sign of contamination, such as change of color of the red cells, which often look purple/black when contaminated.
- Any clot, which may mean improper mixing of blood with anticoagulant during collection or bacterial contamination due to citrate utilization by bacteria.If the bag appears abnormal in any way, the unit must not be transfused and the blood bank must be informed immediately.
- Do not warm the blood by putting the blood bags directly in unmonitored water bath or in direct contact with hot water bottle.
- Use fresh, clean, sterile and pyrogen free disposable transfusion set with filter to transfuse blood.
- Blood transfusion must be started within 30 minutes of issue and should be completed within 4 hours.
- Do not add any medication to the blood.
- Shake gently before use.
- Do not transfuse blood simultaneously with IV dextrose or ringer lactate.
- A doctor or a qualified nurse should administer blood and blood products.
TIME LIMITS FOR INFUSION
There is risk of bacterial proliferation or loss of function in the blood products once they have been removed from the correct storage conditions. Table 1.6 shows the time limits for infusion.
DISPOSABLE EQUIPMENT FOR TRANSFUSION
- Must be sterile and must never be reused.
- Whole blood, red cells, platelet concentrates, plasma and cryoprecipitate are infused through sterile blood administration set containing 170-200 micron filter.
- Use flexible plastic cannulas, if possible, as they are safer and preserve veins.
- Leukocyte-depleting filters are expensive but they are effective in reducing the febrile nonhemolytic transfusion reactions and the development of antileukocyte antibodies in multiple transfused patients.
- For platelet concentrates use fresh administration set or platelet transfusion set primed with saline.
- Change the set at least 12 hourly during blood/component infusion. In a very warm climate, change the set more frequently and usually after every four units of blood, if given within 12-hour period.
BLOOD WARMING
Routine warming of blood is not needed; infusing 2-4 units of refrigerated blood over several hours causes no harm. Patients who may need benefit from warmed blood include:
- Adults receiving multiple transfusions at rates greater than 50 ml/kg/hr.
- Children receiving transfusion at rates greater than 15 ml/kg/hr.
- Infants receiving exchange transfusion.
- Patients receiving rapid transfusion through central venous catheter.
- Patients with cold agglutinins.
The rapid and massive transfusion of cold blood (2-6°C) is associated with an increased risk of ventricular fibrillation and cardiac arrest.
Procedure
- It is carried out using approved blood warmer devices, such as the Level 1 Hot line attached to the transfusion set.
- Blood is not warmed above 37°C. Excessive warming can cause hemolysis and endanger the patient. If blood warmers are being used they should be tested before use to ensure that the temperature regulators are operating properly. The temperature of the blood should also be monitored.
- Do not immerse whole unit of blood or red cells in a water bath, or run blood through extended tubing or coil in water bath.
PRESSURE DEVICES FOR RAPID INFUSION
Pressure devices or pumps are sometimes used to achieve very fast flow rates in rapid transfusion:
- Transfusion with 18 gauge needle or cannula is recommended.
- A device of a pressure bag with a sphygmomanometer is required in emergency situation when blood has to be transfused rapidly (about 5 minutes per unit). The bag should be inflated to about 200 mm Hg till blood flow through the drip chamber is continuous. Pressure of 300 mm Hg may cause the red cells to hemolyse and the blood bag seams to split.
RECORDING THE TRANSFUSION
Before administering blood products, it is important to write the reason for transfusion in the patient's case-notes. If the patient later has a problem that could be related to the transfusion, the records should show who ordered the product and why. This record is your best protection if there is any medicolegal challenge later on. The following information should be recorded in the patient's notes.
- Whether the patient and/or relatives have been informed about the proposed transfusion treatment.
- The reason for transfusion.
- Signature of the prescribing clinician.
- Pretransfusion checks of:
- Patient's identity
- Blood pack
- Compatibility label
- Name and signature of the person performing the pretransfusion identity check.
- About the transfusion:
- Type and volume of each product transfused
- Unique donation number of each transfused unit
- Blood group of each transfused unit
- Time of commencement of transfusion of each unit
- Name and signature of the person administering the blood component
- Monitoring of the patient before, during and after the transfusion.
- Any transfusion reactions.
MONITORING THE TRANSFUSED PATIENTS
It detects any adverse event as early as possible and ensures that potentially lifesaving action can be taken quickly. Before commencing the transfusion, it is essential to encourage the patient to notify a nurse or doctor immediately if he or she becomes aware of any reactions, such as shivering, flushing pain or shortness of breath or begins to feel anxious. Ensure that the patient is in a setting where he or she can be directly observed. Severe reactions most commonly present during first 15 minutes of a transfusion. All patients and, in particular unconscious patients should be monitored during this period and for the first 15 minutes of each subsequent unit.
- For each unit of blood transfused, monitor the patient at the following stages:
- Before starting the transfusion
- As soon as the transfusion is started
- For first 15 minutes after starting transfusion
- At least every hour during transfusion
- On completion of the transfusion
- Four hours after completing the transfusion.
- At each of these stages, record the following information:
- Patient's general appearance
- Temperature
- Blood pressure
- Respiratory rate
- Sign of any adverse reaction:
- Fever with back pain (acute hemolytic reaction)
- Fever alone (febrile nonhemolytic transfusion reaction)
- Dyspnea with basal crepitations (volume over load)
- Any rash (allergic transfusion reaction).
- Monitor the patient carefully during the first 15 minutes of the transfusion to detect any early signs and symptoms of adverse effects.
- The adverse effects of transfusion are usually dose-related, therefore, transfusion is done at a very slow rate at the beginning, 15 to 50 ml is given during the first 15 minutes.
- Once the transfusion is progressing satisfactorily, the infusion rate can be increased so that the product is transfused within a reasonable time depending on the clinical condition of the patient.
- Only isotonic (0.9%) saline or 5% albumin should be used to dilute blood components or can be infused with the transfusion set used for blood product transfusion, because other IV solutions like dextrose solutions such as 5% dextrose in distilled water may damage the red cells and cause hemolysis or calcium containing solutions such as lactated Ringer's solution initiate coagulation in the infusion set. In addition, many drugs will cause hemolysis if injected through the blood infusion set.
The transfusion of each unit of the blood/component should be completed within 4 hours of the pack being punctured. If the unit is not completed within 4 hours, discontinue its use and dispose of the remainder through the clinical waste system.
ACUTE TRANSFUSION REACTIONS
In case of adverse reaction, stop the transfusion, follow the protocol for adverse reactions, and record the vitals regularly and actions taken in the patient's case-notes (Refer Chapter 12 on Transfusion Reactions).
PROTOCOL FOR ADVERSE REACTION OF BLOOD TRANSFUSION
Institution of immediate resuscitative care as per the nature of transfusion reaction.
- Discontinuation of the transfusion immediately.
- Start IV line.
- Closely monitor vitals.
- Contact doctor in blood bank and send the following immediately to the:
- Blood bank/department of transfusion medicine:
- Blood bag with blood transfusion set
- Post-transfusion sample from the vein of opposite side:
- ‑ 2 ml of blood sample in EDTA vial
- ‑ 3 ml of blood sample in plain vial
- First urine sample
- Completely filled and duly signed reaction form, clearly mentioning the S/S of adverse reaction.
- Department of microbiology—collect samples for bacterial culture directly from blood or blood component bag (not from BT set) at the patient bedside and send to the department of microbiology.
- Department of hematology/clinical pathology:
- Complete hemogram
- Plasma hemoglobin
- Urine hemoglobin
- Coagulation profile.
- Department of biochemistry:
- Serum bilirubin (Unconjugated/conjugated)
- Blood Urea
- Serum creatinine
- Serum electrolytes.
The results of all investigations should be sent to the blood bank. This will help the blood bank to come to some logical inference on the type of reaction and act further.