Blood Transfusion Essentials

1
Blood Transfusion Essentials
2
Topics

• Rules for patient identification
• Collecting pretransfusion samples
• Picking up blood from the lab
• Blood administration
• Transfusion reactions

3
Pretransfusion Collection

• Refer to the sample requisition in handout
• Instructions are on the requisition!
• Identification labeling must be done at
  patients side
• Two person identification check
• Blood Bank Identification number system

4
Transfusion medicine collection instructions are
on the requisition!
5
Tube Labeling

• Just a little note from Blood Bank to the
  labelers?
• Please try to place labels on the tubes
  vertically with the name reading from the lid
  down.
• There is room for the BBIN number to the right
  of, or below the patient healthcare number.
• Do not put the BBIN on the purple cap, the lids
  are removed during testing!

6
Ready To Transfuse?Checks

• Patient consent obtained (by the ordering
  physician)
• Physicians transfusion orders confirmed
• IV checked
• Blood product pick up slip prepared
• patient first name, last name
• ULI (PHN) or other Identification number
• product required
• dosage required for manufactured products
• A patient ID label with the product required
  written on it or a blood product pick up slip is
  acceptable.

7
Blood pick up - laboratory

• Present the pick up slip or label to the
  technologist.
• The technologist will select the appropriate
  unit.
• You will be asked
• to spell the patients name and ULI from the pick
  up slip, while checking these identifiers on the
  tag
• to confirm the blood product request / dosage
• for your initials.
• The date, time, tech code and your initials will
  be logged in the laboratory computer system.

8
Remember

• Take the blood component directly to the
  patients (recipient's) bedside. Once picked up
  the blood should be infusing within 30 minutes.
• Blood products should not be stored in any
  on-unit refrigerators.
• Blood products should be completely infused
  within 4 hours to avoid the possibility of
  bacterial growth in the unit.

9
Blood administration Transfusion Instructions
see tag

• Record patients pretransfusion vital signs.
• Two identifiers must certify that
• The, name, BBIN and ULI (PHN) on the patient ID
  wristband are the same as those on the tag.
• The ABO/RH blood group on the tag, agree with the
  ABO/RH group on the blood bag.
• The donor unit number on the tag, agrees with the
  number on the blood product.
• The transfusion is started within 30 minutes of
  issue from blood bank , and is administered
  through a blood filter.
• Record transfusion date and time on the tag.
  Then both identifiers sign the tag.

10
Blood Component Label
11
Monitoring the Transfusion

• Vital signs (VS) should be taken pretransfusion
  and recorded in the chart.
• Repeat vital signs at 15 minutes and then at
  least once during the remainder of the
  transfusion.
• Consider more frequent VS for unstable patients
  or those for whom some blood group
  incompatibility may be present.
• Blood tag will be labeled Transfuse with
  caution in these circumstances.
• Site specific policies may require more frequent
  monitoring

12
Blood Administration

• Standard blood IV set 18 gauge catheter if
  possible.
• Y connector to saline for blood components.
• Certain types of IVIG may be run with D5W.
• Review package inserts for specific instructions
• Standard blood filter required.
• Other filters optional and not recommended.

13
Blood Administration

• Rate must be specified by ordering physician (in
  ml/min or over ___h).
• No greater than 4 hours per unit of red cells.
• For patients in whom volume overload is of
  concern, the unit may be split in the blood bank
  upon request and each half unit transfused over 4
  hours.

14
Blood Administration

• Units of cryoprecipitate are usually infused
  rapidly and flushed with saline.
• Due to their small volume, flushing is required
  to maximize product usage.

15
How Long Does It Take The Lab To Prepare a RBC
Order?

• O negative unmatched stock always available.
• 5 10 minutes
• Crossmatched blood no antibodies detected.
• 1 hour
• Crossmatched blood simple antibodies.
• 2 hours
• Crossmatched blood complex antibodies.
• 2 hours to 2 days

16
No Time For a Crossmatch!

• O negative is given as the universal donor group
  for red cells.
• Type O-negative blood does not have any ABO
  antigens. It is called the "universal donor" type
  because it is compatible with any blood type.
• AB is given as the universal donor group for
  plasma.
• AB plasma contains no anti A or anti B
  antibodies.

17
Transfusion Reactions

• Any new symptom or sign during or following
  transfusion of a blood component or fractionation
  product

18
Transfusion Reactions
19
TRANSFUSION REACTION INSTRUCTIONS (see back of
tag)

• STOP the transfusion.
• Maintain the IV with NS keep the blood product
  and attached tubing.
• Do a clerical check (right blood to patient?).
• Determine vital signs and contact medical staff.
• Notify the treating physician and blood bank.
• Collect a post transfusion sample and document
  reaction symptoms and signs on the blood tag.
• Send remnants of component with the post
  transfusion sample, the tag, and a transfusion
  service requisition to the blood bank.

20
Can You Give More Blood?

• It depends
• Status of the patient
• interpretation of the reaction
• Let the blood bank know if more blood is required
  immediately.

21
Blood Product RequestBBIN Pretransfusion
Testing See requisition
Packed RBC BBIN and crossmatch required. Autologous RBC BBIN and crossmatch required. Directed RBC or Platelets BBIN and crossmatch required.
Plasma (AFFP, FP) BBIN required. Platelets plasma product BBIN required. Cryoprecipitate plasma product BBIN required.
IVIG RhIg Albumin
Other immunoglobulin fractions Coagulation factor concentrates Pentaspan pentastarch available through lab but it is not a blood product
22
Blood product request guide is on the lower half
of the requisition.
23
Why Do We Need To Collect Pretransfusion Samples
every 3 Days?

• Red cell exposure leads to possible antibody
  development.
• Antibodies may start to form or increase in
  amount within 3 days.
• After the 3 days, in a person who has been or may
  have been transfused, we need to recheck to make
  sure no antibodies are present before issuing
  more blood.
• Pregnancy is also a potential means of red cell
  exposure and antibody development.

24
Resources

• Call the blood bank!
• Blood bank staff
• Hematopathologist on call
• Clinical Guide to transfusion
• www.cha.ab.ca Search transfusion or
• Choose information for health professionals then
  lab medicine and pathology on side bar
• Scroll down and select more information
• Scroll down and select transfusion medicine
• Select guide to blood transfusion

25
The End