Safe Blood

Transfusion
Practices
Communication
between
clinicians and
the Blood Bank
is vital!
 Role of the
Clinician
•Ensure that the right
blood gets to the right
patient at the right time
•Follow the correct
procedures for the
ordering, collection and
administration of blood/
•Complete the blood
request form
•Order blood in
advance,
if possible
•Provide clear
information on blood
products being
requested, #units 4
 Compatibility
The clinician should;
2.complete all required
details on the blood
request form
2. accurately label blood
sample tubes
3. check the identity of
the patient, the product
and the documentation
 Safe Transfusions
•Depends on avoiding
incompatibility between the
donor’s red cells and the
antibodies in the patient’s
plasma
•Severe acute hemolytic
transfusion reactions are
nearly always caused by
transfusing red cells that are
incompatible with the patient’s 6
 2 Main
Reasons for
Transfusing
Blood
•Restore or maintain
body’s
oxygen-carrying
capacity
•Maintain the volume of 7
 Storing Blood
•The storage
temperature for
blood is +2ºC and
+8ºC
•Red cells or whole
blood must never be
allowed
 Plasma
Fresh frozen plasma
(FFP) – plasma that has
been separated from a
unit of whole blood within
6-8 hours of donation,
maintained at a
temperature of -20ºC or
lower
(given to a patient to 9
•For plasma volume
replacement crystalloids
and colloids are
recommended.
(FFP should be given
only when these are
unavailable, and as a
life-saving procedure)
•Plasma contains water,
electrolytes, clotting 10
•Factors VIII and V
deteriorate if plasma
is not stored at -20ºC or
less
Other clotting factors stable
at refrigerator
temperatures.
•Plasma must be frozen solid
at all times
There is no lower limit for
storage of frozen plasma. 11
 Transporting
•Temperature must be
maintained at negative
20 degrees Centigrade
or lower

12
 Thawing
•Before use, fresh frozen
plasma must be thawed in
water which is between
30ºC and 37ºC (Use a
thermometer)
Do not heat to more than
37ºC. (destroys clotting
factors and proteins)
While thawing, put inside 13
 After Thawing
•Store in refrigerator at
+2ºC and +8ºC.
Infuse within 30
minutes… if not,
transfuse within 24
hours.
•Unused thawed unit,
should be discarded, 14
 Warming Blood
•No evidence that
warming blood is
beneficial to the
patient when infusion
is slow
•Cold blood can cause
spasm in the vein used
•On average, it takes
30 minutes for a unit
of blood to reach 10
degrees Centigrade

16
•Blood should be warmed in
a blood warmer with visible
thermometer and audible
warning alarm.
•Should not be warmed in a
bowl of hot water as this
could lead to hemolysis of
red cells and liberation of K+
which could be life-
threatening 17
Warmed blood is most commonly
required in:
•Large volume rapid
transfusions
Adults: infusion of
greater than
50ml/kg/hour
Children: greater than
15ml/kg/hour
•Exchange transfusion in
18
If ambient temperature is
greater than +25ºC or if
there is a chance that the
blood will not be
transfused immediately,
blood should be placed in
a refrigerator or should
be issued in a cold box or
insulated carrier that will
keep the temperature 19
 PLATELET CONCENTRATES
Must be kept at a temperature
of 20°C to 24°C on a platelet
agitator to maintain platelet
function
Storage life is restricted to 3
or 5 days (risk of bacterial
proliferation)
•Platelets held at lower
temperature lose blood
clotting capability 20
Time Limits for Infusion
Blood/ Start infusion Complete
infusion
blood product

Whole blood/ within 30 min. of within 4 hour

red cells removing pack (less in high

from ambient temp)

refrigerator

Platelet immediately within 20 min

concentrates

FFP within 30 min within 20 min

21
There is a risk of bacterial
proliferation or loss of
function in blood products
once they have been
removed from the correct
storage conditions

22
 CHECK THE PATIENT’S
IDENTITY AND THE
BLOOD PRODUCT BEFORE
TRANSFUSION

23
 IDENTITY CHECKLIST
•Ask patient to identify himself by
family name, given name, date of
birth and other information
•If unconscious, ask a relative or a
second member of staff to state
patient’s identity
•Check patient’s identity and gender
against:
identity wristband or label
medical notes
•Check that details on compatibility
label attached to blood pack exactly
match details on patient’s
documentation and identity 24
RECORDING OF TRANSFUSION
Consent from patient and/or relatives
Reason for transfusion
Signature of the prescribing clinician
Pre-transfusion checks of :
patient’s identity, blood pack,
compatibility label
signature of the person performing
the check
Transfusion
type and volume of component,
donation number,
blood group, time at which
transfusion commenced,
signature of person administering the 25
 BLOOD CHECKLIST
• No discrepancies between ABO
and Rh group on: blood pack,
compatibility label
• No discrepancies between unique
donation number on: blood pack,
compatibility label
• Check expiry date on blood pack.
• Examine pack before transfusion.
Do not administer if pack is
damaged or there is any evidence
of deterioration.
•leakage
•unusual color 26
Monitoring the
Transfused
Patient

27
Monitor the patient
•Before starting at
the infusion
•As soon as the infusion is
the following
started
stages:
•15 min after starting the
infusion
•at least every hour during
the infusion
•on completion of the
infusion
•4Monitor carefully
hrs after ESPECIALLY during
completing the
the first 15 minutes to detect early
transfusion
signs & symptoms of adverse effects
28
At each stage, record the
following info in the patient’s
•Patient’s general
chart: appearance
•Temperature
•Pulse rate
•Blood pressure
•Respiratory rate
•Fluid balance
•Oral and IV fluid
intake 29
 RECORD
•Time transfusion is
started
•Time the transfusion
is completed
•Volume & type of all
products transfused
•Unique donation no of
all products
30
 PHARMACEUTICALS &
BLOOD
•No meds andPRODUCTS
infusion
solutions other than normal
saline should be added to
any blood component .
They may contain additives
such as calcium which can
cause citrated blood to
clot.
•Dextrose solution (5%)
Last word of advic
31