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Blood Transfusion Essentials

Blood Transfusion Essentials. Topics. Rules for patient identification Collecting pretransfusion samples Picking up blood from the lab Blood administration Transfusion reactions. Pretransfusion Collection. Refer to the sample requisition in handout:

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Blood Transfusion Essentials

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  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 patient’s 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) • Physician’s 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 patient’s 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 patient’s (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 administrationTransfusion Instructions – see tag Record patient’s 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 Hyper / Hypotension Fever Chills Red or dark urine Itching Chest tightness Shortness of breath Tachypnea Tachycardia Rash Pain at infusion site

  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:

  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.caSearch “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

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