Blood Transfusion

1. Blood Transfusion Safe Practice

2. Definition • Introduction of new matching blood into the bloodstream or/andof any specific blood components.

3. Blood Components Available at KAUH • PackedRBC • Platelet • Fresh frozen plasma • Cryoprecipitate

5. Blood Component Preparation

6. Red Blood Cells (Erythrocytes)

7. Component of choice to maintain adequate supply of oxygen

8. Indication • Symptomatic anemia (Hb<8g/dl) • Acute blood loss • Preoperative (Hb<7-8g/dl) • Chronic transfusion patient (Hb<9g/dl)

9. Red Cell Storage & Administration Store for 35 or 42 days Administration 3-4 hours • Volume 250 – 350 ml • Do not mix with other drug / blood component • Change blood filter every 4 hours or after 2 units have been transfused • Never store it in ward refrigerator

10. Platelets

11. Platelets Essential for Homeostasis Prevent or Stop Bleeding

12. Indication • Bone marrow failure • Abnormalities of platelet function • Acute dissemination intravascular coagulopathy–DIC • Massive blood transfusion

13. PlateletsStorage & Administration within 15-30 minutes Yellow in colour Give immediately Stored for 5 days • Do not store in ward fridge • Do not mix with other drug / blood component • Bacterial contamination greater than with red cells • Volume 45 - 65 ml

14. Fresh Frozen Plasma (FFP)

15. FFP Replaces Clotting Factors Initial Treatment of Massive Bleeding

16. Stored for 1 year Give each unit over 30 minutes Needs thawing Volume 150 – 250 ml

17. Cryoprecipitate

18. Stored for 1 year Needs thawing Volume 15 – 25 ml Indication • fibrinogen deficiency • Hemophilia • Von will brands disease (bleeding disorder caused by a deficiency of von Willebrand factor • factor XIII deficiency • Disseminated intravascular coagulation (DIC)

19. Blood Warmers

20. The routine warming of blood and blood component is NOTrecommended limited benefit potentiallydangerous Keeping the patient warm is probably more important than warming the infusion blood

21. Blood warmer indicated • Exchange transfusion in infant • When transfusion patient with clinically significant cold agglutination • Adult receiving blood at rate greater than 50ml/kg/hr • Children receiving blood at rate greater than 15ml/kg/hr • Massive transfusion ( 50% or above of body blood volume • Trauma situation • Cardiopulmonary bypass surgical procedure • Blood and blood component should not be warmed using improvisation such as putting the pack into hot water, in microwave

22. Transfusion Process • Prescription of blood component (Doctor’s order) • Pre-transfusion sample collection

23. Prescription of Blood Component • Prescription form Should include: • patient name & ID • date and time • patient diagnosis • Reason of transfusion • number of unit to be administered • rate of infusion • special procedure

24. Prescription of Blood Component

25. Informed Consent Signed

26. vital signs monitoring • Prior Transfusion • 15 to 20 Minutes After Starting • Post Transfusion.

28. Blood Transfusion Reaction

30. What to do? • Stop the Blood transfusion • Inform the senior Physician • Start .9% Normal Saline KVO • Return entire transfusion set up including tubing ( without IV needle) to the blood bank after the physician orders the discontinuation of the transfusion • 5 cc of blood from the patient in EDTA (2 purple topped) tube, • Obtain first voided urine for analysis, mark “post transfusion” • Fill transfusion reaction form • Write an OVR send to TQM

32. Transfusion Of Incompatible Blood • Transfusion of incompatible blood component is regarded as an error that should be avoided • Some situation it is the only option available that can save patient life • The patients physician will always be informed of decision by director of the blood bank

33. Summary • Doctors & Nurses have a major role in blood transfusion practice. • They should follow all safety and general precautions throughout all of the steps for administering transfusions. • They should adhere to KAUH transfusion policy & procedure

34. Thank you CSSC