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 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