Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Transfusion Medicine and Blood Bank 11 Rational Use of Blood And Blood Administration PPT-Powerpoint Presentations and lecture notes
RATIONAL USE OF BLOOD
&
BLOOD ADMINISTRATION
Blood Components
The Appropriate Use Of Blood And Blood
Products
? Essential part of modern health care
? Transfusion can save life and improve health.
? However, it always carries potential risks for the recipient
? Should be prescribed only for conditions with significant potential for morbidity or
mortality that cannot be prevented or managed effectively by other means.
Indication Vs Clinical Benefit
Why Rational use of blood?
? Economy -Scarcity of resource
1 in 4 get blood component
? Safety - Inherent risks involved
in transfusion therapy
1 in 2 mil ion gets HIV
? Scientifical y appropriate
Haematinic in nutritional anemia
1. Give only what is needed
Red cells
O2 carrying
capacity (Anemia)
Platelets
Thrombocytopenia
FFP
Multiple clotting
factor deficiency
CRYO
Hemophilia A
2. DIFFERENT STORAGE CONDITIONS
Component
Temperature
Shelf Life
Red Cells
2 -60 C
42 days
Platelets
20-240 C
5 days
Fresh Frozen Plasma
-300 C
1 year
Cryoprecipitates
-400 C
1 year
3. CONSERVATION OF SCARCE RESOURCE
? Separation of whole blood in 3-4 components
? Benefits more than one patient at a time.
One Unit Can Save Three To Four Lives
Why `Whole Blood' is Not Rational
vBetter patient management
? concentrated dose of required component
? avoid circulatory overload
? minimize reactions
eg. Requirement of platelets to raise count from 30 to 50,000/ul
? Fresh whole blood
5 units
1750 ml
? Random platelets
5 units
350-450 ml
? Apheresis platelets
1 unit
200-300 ml
v Decreased cost of management
? except for the cost of bag, other expenses remain same
Whole Blood Vs Packed Red Cel s
Parameter
Whole blood
Packed red cells
Volume
350 ? 450 ml
200 ? 240 ml
Increment in Hb
1 -1.5 gm/dl
1 -1.5 gm/dl
Red cell mass /ml
Same as PRBC
Same as WB
Viable platelets
No
No
Labile factors
No
No
Plasma citrate
++++
+
Allergic reactions
++++
+
FNHTR
++++
+
Risk of TTI
++++
+
Waste of components
Yes
No
Fresh Blood" ? A Misconception
4What is "fresh blood"?
v unit kept at 4oC for 4 hours is no longer "fresh"
v storage lesions in different constituents due to storage temp
4Increased risk of disease transmission
v intracellular pathogens (CMV, HTLV) survive in leukocyte in fresh blood
v syphilis transmission (Treponema can not survive > 96 hours in stored blood)
v malaria transmission (malarial parasite can not survive > 72 hrs in stored blood)
Prescribing Blood: A Checklist For Clinicians
Always ask yourself the following questions before prescribing blood or blood products for a
patient
v What improvement in the patient's clinical condition am I aiming to achieve?
v Can I minimize blood loss to reduce this patient's need for transfusion?
v Are there any other treatments I should give before making the decision to transfuse, such as
intravenous replacement fluids or oxygen?
v What are the specific clinical or laboratory indications for transfusion for this patient?
v What are the risks of transmitting HIV, hepatitis, syphilis or other infectious agents through the blood
products that are available for this patient?
v Do the benefits of transfusion outweigh the risks for this particular patient?
v What other options are there if no blood is available in time?
v Wil a trained person monitor this patient and respond immediately if any acute
transfusion reactions occur?
v Have I recorded my decision and reasons for transfusion on the patient's chart and the
blood request form?
Final y, if in doubt, ask yourself the fol owing question.
v If this blood was for myself or my child, would I accept the transfusion in these
circumstances?
RATIONAL USE OF BLOOD
? Right product
? Right dose
? Right time
? Right reasons
CHOICE FOR ABO BLOOD GROUPS
Patient type Donor PRBC
Donor FFP
Donor PC
O Positive
O
O,B,A,AB
O,B,A,AB
A Positive
A,O
A,AB
A,AB,O,B
B Positive
B,O
B,AB
B,AB,O,A
AB Positive
AB,B,A,O
AB
AB,B,A,O
RhD Positive
RhD Positive
-
-
RhD Negative
RhD Negative
RhD Negative
-
-
Cross matching: Special Circumstances
Clinical urgency
Immediate
Minutes
Within an hour
Group O RhD neg
ABO & RhD type
ABO & RhD type
Packed RBCs
Complete crossmatch
Group specific blood
Immediate spin
(5-10 min)
crossmatch
( 15-20) min)
If units are issued without X match ? written consent of physician to be taken,
-complete X match protocols fol owed after issue
BLOOD ADMINISTRATION
BLOOD REQUEST FORM
When blood is required for transfusion, the prescribing clinician should complete and
sign a blood request form that is designed to provide all necessary information. Al
details requested on the blood request form must be completed accurately and legibly.
vThe blood request form should always be accompanied by the patient's blood sample.
The sample is placed in a sample tube that is correctly labelled and is uniquely
identifiable with the patient.
vThe blood sample shall not be submitted in a syringe, as this could lead to errors
when transferring to a test tube for grouping and compatibility testing. It may also
cause haemolysis.
v For a routine case, the sample and request form should be submitted to the
transfusion department at least 24 hours before required, to make sure of the
availability of blood.
v Physicians may request those, who accompany the patient, to consider
becoming blood donors if they are healthy and lead a healthy lifestyle
BLOOD SAMPLES
? The taking of a blood sample from the patient needs supervision. If the patient is conscious at the time of taking the
sample, ask him/her to identify himself/herself by given name and al other appropriate information.
? A 5 mL blood sample should be col ected into a dry test tube and then correctly and clearly label ed with the patient's
details, and submitted to the blood centre for testing. The specimen label must include the fol owing information:
v Patient's ful name, age and sex.
v Registration number.
v Ward/bed number.
v Date and time specimen taken.
v Phlebotomist's signature/initials
? Use positive patient identification to identify the patient.
? NEVER prelabel the sample tube before phlebotomy.
? Use the blood product request form, write legibly and fil in all appropriate details.
? When taking a blood sample for cross match, complete the whole procedure before
any other task is undertaken
? It is important that there are no interruptions during the process.
? The signature of the individual who took the sample must appear on the specimen
label.
RETENTION OF BLOOD SAMPLES:
? Blood samples from recipient and donor(s) must be retained for 7 days at +2?C to
+8?C after each transfusion.
? Should another transfusion be necessary 72 hours after the earlier transfusion, a
fresh sample shal be requested for cross match. Col ection of a second 5 mL
blood sample is required for re checking and further cross matching and must
be retained in case of investigation of transfusion reaction.
RED CELL COMPATIBILITY TESTING
? The laboratory performs:
ABO and RhD grouping on patient and donors.
Antibody screening on patient.
Cross matching between serum of patient and red cells of donor
These procedures normal y take about an hour or more to complete. Shortened
procedures are possible in case of emergency, but may fail to detect some incompatibilities.
COLLECTION AND RECEIPT OF BLOOD
v ALWAYS take a completed patient documentation label to the issue room of the blood
trans fusion department when col ecting the first unit of blood.
v MATCH the details on the blood request form against the blood compatibility label (tag), the
bag unit number and the patient documentation label.
v If everything matches, sign out the unit with the date and time
v If there is any discrepancy, DO NOT sign out the unit; contact the staff member of the blood
transfusion department immediately.
vWhen receiving the unit of blood in the clinical area, check that it is the right unit for the
right patient.
? Always check patient/component compatibility/identity. Inspect pack and contents for
signs of deterioration or damage.
Blood Bag Should Be Checked For:
v Any sign of haemolysis in the plasma indicating that the blood has been
contaminated, allowed to freeze or to warm.
v Any sign of haemolysis on the line between the red cells and plasma during storage.
v Any sign of contamination, such as a change of colour in the red cells, which often
look darker/ purple/ black when contaminated.
vAny clot, which may mean that the blood was not mixed properly with the
anticoagulant when it was collected or might also indicate bacterial contamination due
to the utilization of citrate by proliferating bacteria.
vAny sign that there is a leak in the bag or that it has already been opened
Checking For Signs Of Deterioration
Normal / Haemolyzed
Clots
Discarding Blood
The blood unit must be discarded if:
v It has been out of the refrigerator for longer than 30 minutes, or
v The seal is broken, or
v There is any sign of haemolysis, clotting or contamination.
Blood Transfusion Set
? Blood should be administered only through blood transfusion sets with
filter size of 170- 200 ?m.
? Must be sterile and must never be reused.
? Never add medication to a unit of blood. Should not be administered
with any i.v. solution containing calcium, dextrose or ringer' solution.
Compatible Solutions With Blood
v Only Isotonic saline is recommended to be used with blood
components
v Do Not prime the administration set with 5% Dextrose or Ringer
Lactate solutions
v Dextrose will cause hemolysis of the red cells and calcium in
Ringer Lactate will cause clot formation
v Before administering blood completely flush all the incompatible IV
fluids and drugs or preferably Change the set
Recording of Transfusion
Consent from patient and/or relatives- Valid informed consent for blood transfusion
should be obtained and documented in the patient's clinical record.
Pre-administration checks :
STEP 1- Patient's Identification
? Badges, Wrist bands with Bar code labels
? Cross check the patient's identification against the compatibility report and
the blood bag label.
STEP-2- : Check the patient's notes for
? The component prescribed
? Any special requirements- leucodepletion, irradiation
STEP-3 Check the details on compatibility report and the blood
bag labels-
? Blood Group
? Unit registration number
? Expiry date
? Type of component
? Any instructions for transfusion from blood bank
COLOUR CODED LABELS
? Blue ? O blood group
? Yellow ? A blood group
? Pink ? B blood group
? White ? AB blood group
YELLOW ? `A' BLOOD GROUP
PINK ? `B' BLOOD GROUP
BLUE ? `O' BLOOD GROUP
WHITE ? `AB' BLOOD GROUP
IN THE WARDS/ OT
PRBC
?Get the component issued only when the need for transfusion arises.
?Transfusion should be started within 30 min of issue.
?Transfusion should be completed in 4 hours.
?If any delay in transfusion is there, unit should be sent to blood bank
for storage
Platelets
?Should never be placed in refrigerator
?Should be transfused as soon as possible after issue
?Transfusion should be completed in 20-30 min
Fresh frozen plasma
?Should be transfused as soon as possible after issue.
?Transfusion should be completed in 20-30 min
Monitoring Of The Patient
Before starting transfusion:
? Record baseline vital signs and assessment before starting each unit
? Temperature
? Blood pressure
? Pulse
? Respiratory rate
? Oxygen saturation if available
? Auscultation for patients at risk for overload (elderly, paediatric, cardiovascular
disease)
After Starting Blood:
For the first 15 minutes:
? Start initially with a slow rate (1-2ml/min or 60-120 ml/hr)
unless transfusion is extremely urgent.
? Monitor your patient closely.
After the first 15 minutes:
? Reassess your patient and repeat vital signs.
? Increase flow to prescribed rate (2-4ml/min or 120-240
ml/hr) if no reaction observed.
Monitor the patient
? At least every hour during transfusion
? On completion of the transfusion
? 4 hours after completing the transfusion
Patient's Blood Transfusion Notes
When blood is transfused, it is important to keep detailed records including the fol owing
in the patient's notes:
v Type and volume of each unit transfused.
v Unique donation number of each unit transfused.
v Blood group of each unit transfused.
v Time at which the transfusion of each unit commenced.
v Signature of the individual responsible for administration of the blood.
Patient's Blood Transfusion Notes
v Monitor the patient before, during and on completion of the transfusion.
v Record the time of completion of the transfusion.
v Identify and respond immediately to any adverse effect, by stopping the
transfusion.
v Record the details of any transfusion reaction.
? Any transfusion reaction should be documented
? Return the transfusion form to the blood bank
Compatibility/ Reaction Form
WARMING BLOOD
? There is no evidence that warming blood is beneficial to the patient
when transfusion is slow.
? At transfusion rates of greater than 100 mL/minute, cold blood may
be a contributing factor in cardiac arrest.
? However, keeping the patient warm is probably more important
than warming the blood.
Indications
Warmed blood is most commonly required in:
1. Large volume rapid transfusions:
? Adults: more than 50 mL/kg/hour.
? Children: more than 15 mL/kg/hour.
2. Exchange transfusion in infants.
3. Patients with clinically significant cold agglutinins.
? Blood should only be warmed in a blood warmer. Blood warmers
should have a visible thermometer and an audible warning alarm
and should be properly maintained.
? Blood should never be warmed in a bowl of hot water as this could
lead to haemolysis of the red cells which could be lifethreatening
when transfused.
References
1. THE APPROPRIATE CLINICAL USE OF BLOOD AND BLOOD PRODUCTS. Information Sheet for
Clinicians. Blood Transfusion Safety Department of Essential Health Technologies World Health
Organization, 2006.
2. Technical Manual, AABB. 18th edition
"DONATE BLOOD SAVE LIVES"
Thank you
This post was last modified on 08 April 2022