Blood Transfusion

BLOOD TRANSFUSION

MAXINE BOYD
HOSPITAL TRANSFUSION
PRACTITIONER


HOSPITAL TRANSFUSION
TEAM
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CONSULTANT HAEMATOLOGIST – LEAD
FOR TRANSFUSION MEDICINE
BLOOD BANK MANAGER
HOSPITAL TRANSFUSION PRACTITIONER
CHAIR HOSPITAL TRANSFUSION
COMMITTEE
PATHOLOGY QUALITY MANAGER





COST OF BLOOD
PRODUCTS

Packed Red Cells = £136.05
 Fresh Frozen Plasma = £35.37
 Platelets = £226.18
 Cryoprecipitate = £221.38
 Albumin = £20
Special requirements – additional cost
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Emergency Blood Management
Plan
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July 2004 DoH issued summary version of the
‘National Contingency Plan for Blood Shortages’
Each Trust expected to have their own EBMP
based on this guidance
Based on traffic light system –Trust running on
green under normal circumstances
In cases of shortage – some elective ops. will be
cancelled – patients with greatest clinical need
are prioritised


Blood Conservation
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Adhere to guidelines and policy including
MSBOS
Autologous transfusion
- intra-operative cell salvage
- post operative cell salvage
Pre-operative assessment
Education and Training
Pharmaceutical alternatives e.g
erythropoietin


RED CELL TRANSFUSION
TRIGGERS
Guidelines for the clinical use of red cell
transfusions (BCSH 2001)
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Hb > 10g/dl – Transfusion not indicated
Hb > 7-10g/dl – Transfuse only if clinically
indicated
Hb < 7g/dl –
Transfusion generally
indicated

Red Cell Transfusion Triggers
cont…..
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Critical Care:
transfuse to maintain Hb >7 g/dl
Post-chemotherapy:
transfusion threshold of 8 or 9 g/dl
Radiotherapy:
transfuse to maintain Hb above 10 g/dl
Chronic anaemia:
Transfuse to maintain Hb just above lowest conc.
not associated with symptoms of anaemia (usually
patients asymptomatic with Hb >8 g/dl)


Indications for Transfusion
Platelets (BCSH, 2004)
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To prevent spontaneous bleeding when the
platelet count <10 x 109/l
To prevent spontaneous bleeding when the
platelet count <20 x 109/l in the presence of
additional risk factors such as sepsis or
haemostatic abnormalities
To prevent bleeding associated with invasive
procedures


Platelets cont…
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Massive blood transfusion
Bleeding, not surgically correctable and
associated acquired platelet dysfunction
Acute disseminated intravascular
coagulation (DIC) in the presence of
bleeding and thrombocytopenia
Inherited platelet dysfunction with bleeding
or as prophylaxis before surgery


Indications for Transfusion
Fresh Frozen Plasma (BCSH

2004)
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Replacement of single coagulation factor
deficiencies where a specific or combined
factor concentrate is unavailable
Immediate reversal of warfarin effect in the
presence of life threatening bleeding
Acute DIC in the presence of bleeding and
abnormal coagulation results
TTP in conjunction with plasma exchange
Massive transfusion and surgical bleeding


Indications for Transfusion

Cryoprecipitate (BCSH, 2004)

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Acute DIC where there is bleeding and
fibrinogen level <1g/l

Bleeding associated with thrombolytic
therapy causing hypofibrinogenaemia
Hypofibrinogenaemia 2o to massive
transfusion


SPECIAL REQUIREMENTS
Irradiated
 CMV negative
 Antigen negative
 Washed
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Massive blood loss
Aim of treatment:
- restore adequate blood volume
- maintain blood composition within safe limits
Stem bleeding surgically
Use RBC’s, crystalloids / colloids to maintain
BP / BV / HB >7g/dl


Massive Transfusion Guidelines
Acute blood loss – Guidelines for clinical use of red
cell transfusions (BCSH, 2001)
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Maintain circulating blood volume and Hb conc. >7g/dl in
otherwise fit patients & >9g/dl in older patients and those with
known cardiovascular disease

15-30% loss of blood volume (800-1500ml in an
adult): transfuse crystalloids or synthetic colloids. Red cell
transfusion is unlikely to be necessary.

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30-40% loss of blood volume (1500-2000ml in an
adult): rapid volume replacement is required with crystalloids or

synthetic colloids. Red cell transfusion will probably be required to
maintain recommended Hb levels.
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>40% loss of blood volume (>2000ml in an adult):
rapid volume replacement including red cell transfusion is
required.


Massive bleed procedure

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Administer crystalloids / colloids until 1500ml loss of
blood

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Inform blood bank – degree of urgency

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Samples collected for crossmatching, FBC, clotting,
biochemistry.


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2 x O Rh (D) negative units available - always
inform blood bank

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ABO Rh (D) group specific blood available 10
mins. after sample arrives in blood bank
Medical staff must accept full
responsibility for administration of uncrossmatched blood
X-matched blood available after 40 mins.

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Monitor FBC & clotting (inc. fibrinogen) to
guide blood component therapy


Taking Blood Samples
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Only 1 patient at a time.
Identify the correct patient.
Confirm identification.
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First name.
Surname.
Address.
Date of birth.

Check the wristband with the request
form.


Taking Blood Samples
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Take the blood.
At the bedside label the sample bottle,using ink
– First name
– Surname

– DOB
– Hospital Registration Number (or casualty no.)
– Date
– Signature of person taking blood


DO NOT!
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Do not ask someone else to label the sample.
Do not label the sample prior to phlebotomy.
Do not leave the bedside until you have
labelled the sample tube.
Do not use pre-printed labels to label the
sample tube.
Do not use the form details to label the
sample tube.


PRESCRIBING
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Prescription chart must contain:
- Full patient identification details i.e
full name, date of birth, hospital
number

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Must specify:
- Blood product to be administered,
quantity, duration and special
instructions


Serious Adverse
Reactions
ACTION
 Stop transfusion immediately
 Take down blood product / giving set
 Maintain IV access with infusion of 0.9%
sodium chloride
 Treat patient
 Inform Blood Bank


Adverse reaction cont…
Investigation
Send to Blood Bank:
 The unit of blood
 Samples stated on transfusion reaction
form
 Complete adverse reaction report (from
blood bank)