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Precautions to be
taken before Transfusion
Proper
identification of the patient for transfusion.
Collection of a blood sample with proper labeling for grouping and cross matching.
Request form for blood or its component must be properly filled with details such as:
Collection of a blood sample with proper labeling for grouping and cross matching.
Request form for blood or its component must be properly filled with details such as:
- Name of the patient,
- Hospital identification number,
- Blood group if known,
- Component required,
- Number of units required,
- History of transfusion if any,
- Diagnosis
- Reason for request.
- Name and signature of the doctor.
- Special request if any like irradiation, coombs test etc.
When the blood bag is collected from the blood bank, make sure to check the bag for
- Name of the patient to be transfused
- His/her hospital identification number
- His/her blood group
- The date of collection
- The date of issue
- The date of expiry of the unit.
The
transfusion of blood and blood components should begin as soon as
possible after its delivery at the bed side. If this is not possible,
it should be returned to a blood transfusion refrigerator with the time
of return documented. The transfusion of platelet concentrates and
fresh frozen plasma should commence as soon as possible to preserve the
maximum activity of the platelets or coagulation factor.
THE ADMINISTRATION OF BLOOD AND ITS COMPONENTS
Blood should be transfused through a sterile giving set designed for the procedure. A standard blood or platelet administration set should be used for the transfusion of platelet concentrates
The size of cannula chosen should depend on the size of the vein and the speed at which the blood is to be transfused.
Blood and blood components mustnot be warmed using improvisations such as putting the pack into hot water, in a microwave or on a radiator.
Drugs must not be added to blood under any circumstance.
Patients receiving transfusions should be monitored for signs of the potential complications of transfusion.
Vital signs such as temperature, pulse and blood pressure should be measured and recorded before the start of each unit of blood or blood component, and at the end of each transfusion episode.
Temperature and pulse should be measured 15 min after the start of each unit of blood or blood component.
In case severe reaction is suspected during blood transfusion:
Stop transfusion immediately.
Blood bag and a blood sample from the patient has to sent to the blood bank for checking for an mismatch.
Volume and colour of urine has to be reported.
Management of the reaction depends on the the type and severity of the reaction.
Adverse reaction during or after transfusion may be of the following type :
Acute reactions:
Acute intravascular hemolysis of red blood cells.
Febrile non hemolytic reaction
Urticaria
Anaphylaxis
Infective shock
Transfusion related leg injury
Non cardiogenic pulmonary edema
Delayed reactions:
Delayed hemolysis of transfused red cells
Transfusion associated graft versus host reaction.
Post transfuion purpura
Iron overload.
Reference:
British Committee for Standards in Haematology, Blood Transfusion Task Force in collaboration with the Royal College of Nursing and the Royal College of Surgeons of England. The administration of blood and blood components and the management of transfused patient. Guidelines. Transfusion Medicine, 1999, 9, 227-238.
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PAGE IS BEST VIEWED WITH MOZILLA FIREFOX Blood Transfusions
Blood transfusions form an important part in the treatment of patients of aplastic anemia. As these patients have bone marrow which are incapable of producing blood cells, they need to be provided with these by means of transfusions. This is essential before , during and after treatment in patients of aplastic anemia. This is called as supportive treatment. The need for blood and its components decreases with the bone marrow starting to respond to the treatment given.
Transfusion
of blood and its component has its own merits and demerits. The
positive effect is the fact that, due to a decrease in red cell counts,
the patient can become tired, very easily, he may have palpitations,
where as the decrease in platelet count can lead to internal or
external bleeding, a decrease in WBC can result in increased chances of
getting infected. This is very common in patients of aplastic anemia.
For all these reasons they are depended on transfusions till the body
starts producing adequate cells.
Blood components which are commonly transfused in aplastic anemia patients are
- Red cells
- Platelets
Red cell transfusion: Red cell transfusion is indicated to increase the oxygen delivering capacity of the blood when acute or chronic anemia which contributes to inadequate oxygen delivery to tissues.
No specific parameters exists as a guide for the transfusion of red cells. It maily depends on factors such as the cause of anemia, severity and chronicity, patients ability to compensate for the anemia, the likely hood of further blood loss and finally the need to provide some reserve before tissue hypoxia sets in. Here again the risks associated with transfusion has to be compared with the benefits of transfusion in these patients.
- Red cell concentrate
- Red cell suspension
Red cell concentrate: It is also called as packed red cell or plasma reduced red cell. Consists of 150-200 ml red cells from which most of the plasma has been removed. The hemoglobin concentration is usually 20grams/ 100 ml. The hematocrit is 55%- 75%. Suggested as a replacement of red cells in patients with aplastic anemia.
Red cell suspension:
Consists
of 150–200 ml red cells with minimal residual plasma to which
±100 ml normal saline, adenine, glucose, mannitol solution or an
equivalent red cell nutrient solution has been added. Hemoglobin
concentration is approximately 15g/100 ml and the
Hematocrit is
50%–70%. Suggested as a replacement of
red cells in patients with aplastic anemia.
The shelf life of
packed red cell at a storage temperature of 1-6°C is 21-35
days.
Red cell transfusion can be made after removing WBC s' present in the collected blood. This reduces the white cell immunization in patients receiving repeated transfusions. This also reduces risk of cytomegalovirus transmission. At the bed side WBC s' can be removed by using leucodepletion filter at the time of transfusion.
The number of units to be transfused is to be determined by the attending hematologist depending on the condition of the patient. Usually for a patient with aplastic anemia with a Hb < 6gm/dl two units of packed red cells are given, and for those with Hb between 6 gm/dl and & 7 gm/dl one unit is given at the maximum. One unit of packed red cell transfusion usually raises the Hb in the donor by 1 gm/dl.
One of the main problem with transfusing more packed cells in patients with aplastic anemia is that the patient may have volume over load, second these transfusions may inhibit the bone marrow from producing cells of its own possibly by a mechanism known as feedback inhibition. To avoid volume over load, the packed cells are given over larger period of time by slow infusion and diuretic injections are given to remove extra fluid volume from the body in between two successive pints.
Red cell transfusion can be made after removing WBC s' present in the collected blood. This reduces the white cell immunization in patients receiving repeated transfusions. This also reduces risk of cytomegalovirus transmission. At the bed side WBC s' can be removed by using leucodepletion filter at the time of transfusion.
The number of units to be transfused is to be determined by the attending hematologist depending on the condition of the patient. Usually for a patient with aplastic anemia with a Hb < 6gm/dl two units of packed red cells are given, and for those with Hb between 6 gm/dl and & 7 gm/dl one unit is given at the maximum. One unit of packed red cell transfusion usually raises the Hb in the donor by 1 gm/dl.
One of the main problem with transfusing more packed cells in patients with aplastic anemia is that the patient may have volume over load, second these transfusions may inhibit the bone marrow from producing cells of its own possibly by a mechanism known as feedback inhibition. To avoid volume over load, the packed cells are given over larger period of time by slow infusion and diuretic injections are given to remove extra fluid volume from the body in between two successive pints.
Platelet transfusion : Platelet
transfusions are indicated for the prevention and treatment of bleeding
in patients with thrombocytopenia(decreased platelet count) or platelet
function defects.
- Platelet concentrate prepared from whole blood donation
- Platelet concentrate prepared by apherisis
Platelet concentrate prepared
from whole blood donation: 50–60
ml of plasma will contain at least 55 x 109
platelets, <1.2 x 109 red
cells and <0.12
x 109
leukocytes. It is either prepared from blood collected from a
single donor or from prepared from 4 to 6 donor units
‘pooled’ into one pack to contain an adult dose of at least 240 x 10 9
platelets .
Process of collection: The unit of blood is subjected to two centrifugational steps. The first step is called a soft spin, which makes platelet rich plasma and a concentrated (packed) red cell. The platelet rich plasma is expressed from the bag and then subjected to a second centrifugation called a hard spin, after which the platelets are concentrated into a small amount of plasma.
The platelets collected by this method can be stored for up to 72 hours at 20°C to 24°C. Longer storage of this product may lead to the risk of bacterial proliferation and septicemia in the recipient.
Process of collection: The unit of blood is subjected to two centrifugational steps. The first step is called a soft spin, which makes platelet rich plasma and a concentrated (packed) red cell. The platelet rich plasma is expressed from the bag and then subjected to a second centrifugation called a hard spin, after which the platelets are concentrated into a small amount of plasma.
The platelets collected by this method can be stored for up to 72 hours at 20°C to 24°C. Longer storage of this product may lead to the risk of bacterial proliferation and septicemia in the recipient.
Platelet concentrate prepared by
apherisis: The volume collected
is 150–300 ml,which contains 150–500 x 109
platelets,
which is equivalent to 3–10 single donations
Platelet content, volume of plasma and leukocyte contamination of the
concentrate will depend on the collection procedure .
Process of collection: Donors are connected to the apherisis machine by means of sterile closed tubes for blood collection. This tubes pass through the apherisis machines centrifuge. The anticoagulants are added to the blood as it is drawn into the machine. In this procedure, platelets are separated by centrifugation, and the red cells returned to the blood donor together with most of the plasma. This procedure takes 50-90 minutes. The correct name for this product is platelet pheresis, but is more commonly known as single donor platelets or apherisis platelets.
Slight muscle twitching around
the lips and other muscles of the body are
usually seen in donors undergoing this procedure. This is because of
the presence of small amount of anticoagulant in the plasma that
re-enters the donors body after removal of platelets. This
anticoagulant binds to calcium and removes calcium and results in
muscle twitching. This is a very small side effect and can be easily
over come by taking calcium tablets during the procedure it self.
Complications associated with
platelet transfusions:
Febrile, non-hemolytic urticarial reactions are seen during platelet
transfusions. These are more common in patients who are on repeated
transfusions.
General Principles of blood Transfusions
General Principles of blood Transfusions
- All transfusions are to be completed with in 4 hours
- Platelet transfusions are to be completed with in 30-60 minutes
- Cross matching is must for the transfusion of packed red cells.
- The receipient/patient should be monitored carefully during the initial 15 minutes, as most adverse events are reported during this period.
- Only 0.9% saline should be added to blood. Drugs should not be added.
Disease transmission
Due to stringent screening of blood, transmission of infectious diseases by the transfusion of blood and blood componenets are relatively uncommon. The disease which can be transmitted include
Due to stringent screening of blood, transmission of infectious diseases by the transfusion of blood and blood componenets are relatively uncommon. The disease which can be transmitted include
- Hepatitis B and C
- Human immunodeficiency virus(HIV)
- Human T-cell Lymphotropic Virus (HTLV 1).
- Cytomegalovirus (CMV)
- Syphilis.
Every single
unit of blood and its components are usually tested for these blood
born diseases before they are released for transfusion.
Blood Groups
The common blood groups are
- A
- B
- O
- AB
- A group have antibody to B group
- B group have antibody A group
- O group have antibody for A and B group
- AB group doesnot have any antibodies to A or B.
- The presence or absence of RhD antigen gives the blood group +ve or -ve sign respectively.
In red cell transfusion, there must be ABO and RhD compatibility between the donor’s red cells and the recipient’s plasma.
- Group O individuals can receive blood from group O donors only
- Group A individuals can receive blood from group A and O donors
- Group B individuals can receive blood from group B and O donors
- Group AB individuals can receive blood from AB donors, and also from
- group A, B and O donors
Pre-transfusion testing.
Each unit of blood is tested for compatibility before transfusion.
- The patient’s ABO and RhD type are determined
- The patient’s serum is tested for clinically significant red cell
- antibodies.
- A direct test of compatibility
is usually performed before
blood is infused. This is a test of reaction between the patient’s serum and donor red cells.
- The clinical use of blood. Hand book. World Health Organization Blood Transfusion Safety, GENEVA.
- McClelland DBL. Hand book of Transfusion Medicine. United Kingdom Blood Services, 4th edition. TSO@Blackwell and other Accredited Agents. ISBN-10 0 11 322677 2.
- Sweeney JD and Rizk Y. Clinical transfusion medicine. Landes Bioscience, Texas, USA.ISBN: 1-57059-494-5.
- Blood Substitutes. Winslow R (Eds).Elsevier Academic Press.
- Guidelines for the clinical use of red cell transfusion. British journal of Hematology 2001; 113:24-31.
Last
updated on 9 August 2008