BLOOD ADMINISTRATION
Blood Components
--- Content provided by FirstRanker.com ---
The Appropriate Use Of Blood And Blood
Products
--- Content provided by FirstRanker.com ---
? 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
--- Content provided by FirstRanker.com ---
mortality that cannot be prevented or managed effectively by other means.
Indication Vs Clinical Benefit
--- Content provided by FirstRanker.com ---
Why Rational use of blood?
? Economy -Scarcity of resource
--- Content provided by FirstRanker.com ---
1 in 4 get blood component? Safety - Inherent risks involved
in transfusion therapy
--- Content provided by FirstRanker.com ---
1 in 2 mil ion gets HIV
? Scientifical y appropriate
--- Content provided by FirstRanker.com ---
Haematinic in nutritional anemia1. Give only what is needed
Red cells
--- Content provided by FirstRanker.com ---
O2 carrying
capacity (Anemia)
--- Content provided by FirstRanker.com ---
PlateletsThrombocytopenia
FFP
--- Content provided by FirstRanker.com ---
Multiple clotting
factor deficiency
--- Content provided by FirstRanker.com ---
CRYOHemophilia A
--- Content provided by FirstRanker.com ---
2. DIFFERENT STORAGE CONDITIONSComponent
Temperature
--- Content provided by FirstRanker.com ---
Shelf Life
Red Cells
--- Content provided by FirstRanker.com ---
2 -60 C42 days
Platelets
--- Content provided by FirstRanker.com ---
20-240 C
5 days
--- Content provided by FirstRanker.com ---
Fresh Frozen Plasma-300 C
1 year
--- Content provided by FirstRanker.com ---
Cryoprecipitates
-400 C
--- Content provided by FirstRanker.com ---
1 year3. CONSERVATION OF SCARCE RESOURCE
? Separation of whole blood in 3-4 components
--- Content provided by FirstRanker.com ---
? Benefits more than one patient at a time.One Unit Can Save Three To Four Lives
--- Content provided by FirstRanker.com ---
Why `Whole Blood' is Not RationalvBetter patient management
? concentrated dose of required component
--- Content provided by FirstRanker.com ---
? avoid circulatory overload? minimize reactions
eg. Requirement of platelets to raise count from 30 to 50,000/ul
--- Content provided by FirstRanker.com ---
? Fresh whole blood5 units
1750 ml
--- Content provided by FirstRanker.com ---
? Random platelets
5 units
--- Content provided by FirstRanker.com ---
350-450 ml? Apheresis platelets
1 unit
--- Content provided by FirstRanker.com ---
200-300 ml
v Decreased cost of management
--- Content provided by FirstRanker.com ---
? except for the cost of bag, other expenses remain sameWhole Blood Vs Packed Red Cel s
--- Content provided by FirstRanker.com ---
ParameterWhole blood
Packed red cells
--- Content provided by FirstRanker.com ---
Volume
350 ? 450 ml
--- Content provided by FirstRanker.com ---
200 ? 240 mlIncrement in Hb
1 -1.5 gm/dl
--- Content provided by FirstRanker.com ---
1 -1.5 gm/dl
Red cell mass /ml
--- Content provided by FirstRanker.com ---
Same as PRBCSame as WB
Viable platelets
--- Content provided by FirstRanker.com ---
No
No
--- Content provided by FirstRanker.com ---
Labile factorsNo
No
--- Content provided by FirstRanker.com ---
Plasma citrate
++++
--- Content provided by FirstRanker.com ---
+Allergic reactions
++++
--- Content provided by FirstRanker.com ---
+
FNHTR
--- Content provided by FirstRanker.com ---
+++++
Risk of TTI
--- Content provided by FirstRanker.com ---
++++
+
--- Content provided by FirstRanker.com ---
Waste of componentsYes
No
--- Content provided by FirstRanker.com ---
Fresh Blood" ? A Misconception
4What is "fresh blood"?
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
v intracellular pathogens (CMV, HTLV) survive in leukocyte in fresh bloodv syphilis transmission (Treponema can not survive > 96 hours in stored blood)
v malaria transmission (malarial parasite can not survive > 72 hrs in stored blood)
--- Content provided by FirstRanker.com ---
Prescribing Blood: A Checklist For CliniciansAlways ask yourself the following questions before prescribing blood or blood products for a
patient
--- Content provided by FirstRanker.com ---
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?
--- Content provided by FirstRanker.com ---
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?
--- Content provided by FirstRanker.com ---
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?
--- Content provided by FirstRanker.com ---
v Wil a trained person monitor this patient and respond immediately if any acutetransfusion reactions occur?
v Have I recorded my decision and reasons for transfusion on the patient's chart and the
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
circumstances?
RATIONAL USE OF BLOOD
--- Content provided by FirstRanker.com ---
? Right product
? Right dose
? Right time
? Right reasons
--- Content provided by FirstRanker.com ---
CHOICE FOR ABO BLOOD GROUPS
Patient type Donor PRBC
--- Content provided by FirstRanker.com ---
Donor FFPDonor PC
O Positive
--- Content provided by FirstRanker.com ---
O
O,B,A,AB
--- Content provided by FirstRanker.com ---
O,B,A,ABA Positive
A,O
--- Content provided by FirstRanker.com ---
A,AB
A,AB,O,B
--- Content provided by FirstRanker.com ---
B PositiveB,O
B,AB
--- Content provided by FirstRanker.com ---
B,AB,O,A
AB Positive
--- Content provided by FirstRanker.com ---
AB,B,A,OAB
AB,B,A,O
--- Content provided by FirstRanker.com ---
RhD Positive
RhD Positive
--- Content provided by FirstRanker.com ---
--
RhD Negative
--- Content provided by FirstRanker.com ---
RhD Negative
RhD Negative
--- Content provided by FirstRanker.com ---
--
--- Content provided by FirstRanker.com ---
Cross matching: Special Circumstances
Clinical urgency
--- Content provided by FirstRanker.com ---
Immediate
Minutes
--- Content provided by FirstRanker.com ---
Within an hourGroup O RhD neg
ABO & RhD type
--- Content provided by FirstRanker.com ---
ABO & RhD type
Packed RBCs
--- Content provided by FirstRanker.com ---
Complete crossmatchGroup specific blood
Immediate spin
--- Content provided by FirstRanker.com ---
(5-10 min)
crossmatch
--- Content provided by FirstRanker.com ---
( 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
--- Content provided by FirstRanker.com ---
BLOOD ADMINISTRATION
BLOOD REQUEST FORM
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
cause haemolysis.
v For a routine case, the sample and request form should be submitted to the
--- Content provided by FirstRanker.com ---
transfusion department at least 24 hours before required, to make sure of theavailability of blood.
v Physicians may request those, who accompany the patient, to consider
--- Content provided by FirstRanker.com ---
becoming blood donors if they are healthy and lead a healthy lifestyleBLOOD SAMPLES
--- Content provided by FirstRanker.com ---
? The taking of a blood sample from the patient needs supervision. If the patient is conscious at the time of taking thesample, 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
--- Content provided by FirstRanker.com ---
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.
--- Content provided by FirstRanker.com ---
v Registration number.v Ward/bed number.
v Date and time specimen taken.
--- Content provided by FirstRanker.com ---
v Phlebotomist's signature/initials
? Use positive patient identification to identify the patient.
? NEVER prelabel the sample tube before phlebotomy.
--- Content provided by FirstRanker.com ---
? 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.
--- Content provided by FirstRanker.com ---
? The signature of the individual who took the sample must appear on the specimenlabel.
--- Content provided by FirstRanker.com ---
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.
--- Content provided by FirstRanker.com ---
? 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
--- Content provided by FirstRanker.com ---
be retained in case of investigation of transfusion reaction.RED CELL COMPATIBILITY TESTING
? The laboratory performs:
--- Content provided by FirstRanker.com ---
ABO and RhD grouping on patient and donors.Antibody screening on patient.
Cross matching between serum of patient and red cells of donor
--- Content provided by FirstRanker.com ---
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.
--- Content provided by FirstRanker.com ---
COLLECTION AND RECEIPT OF BLOODv 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.
--- Content provided by FirstRanker.com ---
v MATCH the details on the blood request form against the blood compatibility label (tag), the
bag unit number and the patient documentation label.
--- Content provided by FirstRanker.com ---
v If everything matches, sign out the unit with the date and timev If there is any discrepancy, DO NOT sign out the unit; contact the staff member of the blood
transfusion department immediately.
--- Content provided by FirstRanker.com ---
vWhen receiving the unit of blood in the clinical area, check that it is the right unit for theright patient.
? Always check patient/component compatibility/identity. Inspect pack and contents for
--- Content provided by FirstRanker.com ---
signs of deterioration or damage.
Blood Bag Should Be Checked For:
--- Content provided by FirstRanker.com ---
v Any sign of haemolysis in the plasma indicating that the blood has been
contaminated, allowed to freeze or to warm.
--- Content provided by FirstRanker.com ---
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.
--- Content provided by FirstRanker.com ---
vAny clot, which may mean that the blood was not mixed properly with theanticoagulant when it was collected or might also indicate bacterial contamination due
to the utilization of citrate by proliferating bacteria.
--- Content provided by FirstRanker.com ---
vAny sign that there is a leak in the bag or that it has already been opened
Checking For Signs Of Deterioration
--- Content provided by FirstRanker.com ---
Normal / Haemolyzed
Clots
--- Content provided by FirstRanker.com ---
Discarding BloodThe 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
--- Content provided by FirstRanker.com ---
v There is any sign of haemolysis, clotting or contamination.Blood Transfusion Set
--- Content provided by FirstRanker.com ---
? Blood should be administered only through blood transfusion sets withfilter size of 170- 200 ?m.
? Must be sterile and must never be reused.
--- Content provided by FirstRanker.com ---
? Never add medication to a unit of blood. Should not be administered
with any i.v. solution containing calcium, dextrose or ringer' solution.
--- Content provided by FirstRanker.com ---
Compatible Solutions With Bloodv Only Isotonic saline is recommended to be used with blood
components
--- Content provided by FirstRanker.com ---
v Do Not prime the administration set with 5% Dextrose or Ringer
Lactate solutions
--- Content provided by FirstRanker.com ---
v Dextrose will cause hemolysis of the red cells and calcium inRinger Lactate will cause clot formation
v Before administering blood completely flush all the incompatible IV
--- Content provided by FirstRanker.com ---
fluids and drugs or preferably Change the set
Recording of Transfusion
--- Content provided by FirstRanker.com ---
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 :
--- Content provided by FirstRanker.com ---
STEP 1- Patient's Identification? Badges, Wrist bands with Bar code labels
? Cross check the patient's identification against the compatibility report and
--- Content provided by FirstRanker.com ---
the blood bag label.STEP-2- : Check the patient's notes for
? The component prescribed
? Any special requirements- leucodepletion, irradiation
--- Content provided by FirstRanker.com ---
STEP-3 Check the details on compatibility report and the blood
bag labels-
? Blood Group
--- Content provided by FirstRanker.com ---
? Unit registration number
? Expiry date
--- Content provided by FirstRanker.com ---
? Type of component? Any instructions for transfusion from blood bank
--- Content provided by FirstRanker.com ---
COLOUR CODED LABELS? Blue ? O blood group
? Yellow ? A blood group
? Pink ? B blood group
--- Content provided by FirstRanker.com ---
? White ? AB blood groupYELLOW ? `A' BLOOD GROUP
--- Content provided by FirstRanker.com ---
PINK ? `B' BLOOD GROUPBLUE ? `O' BLOOD GROUP
--- Content provided by FirstRanker.com ---
WHITE ? `AB' BLOOD GROUPIN THE WARDS/ OT
PRBC
--- Content provided by FirstRanker.com ---
?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
--- Content provided by FirstRanker.com ---
for storagePlatelets
?Should never be placed in refrigerator
--- Content provided by FirstRanker.com ---
?Should be transfused as soon as possible after issue
?Transfusion should be completed in 20-30 min
Fresh frozen plasma
--- Content provided by FirstRanker.com ---
?Should be transfused as soon as possible after issue.?Transfusion should be completed in 20-30 min
Monitoring Of The Patient
--- Content provided by FirstRanker.com ---
Before starting transfusion:
? Record baseline vital signs and assessment before starting each unit
? Temperature
? Blood pressure
--- Content provided by FirstRanker.com ---
? Pulse? Respiratory rate
? Oxygen saturation if available
? Auscultation for patients at risk for overload (elderly, paediatric, cardiovascular
--- Content provided by FirstRanker.com ---
disease)After Starting Blood:
--- Content provided by FirstRanker.com ---
For the first 15 minutes:? Start initially with a slow rate (1-2ml/min or 60-120 ml/hr)
unless transfusion is extremely urgent.
--- Content provided by FirstRanker.com ---
? 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
--- Content provided by FirstRanker.com ---
ml/hr) if no reaction observed.
Monitor the patient
--- Content provided by FirstRanker.com ---
? At least every hour during transfusion
? On completion of the transfusion
? 4 hours after completing the transfusion
--- Content provided by FirstRanker.com ---
Patient's Blood Transfusion NotesWhen blood is transfused, it is important to keep detailed records including the fol owing
in the patient's notes:
--- Content provided by FirstRanker.com ---
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.
--- Content provided by FirstRanker.com ---
Patient's Blood Transfusion Notes
v Monitor the patient before, during and on completion of the transfusion.
--- Content provided by FirstRanker.com ---
v Record the time of completion of the transfusion.v Identify and respond immediately to any adverse effect, by stopping the
transfusion.
--- Content provided by FirstRanker.com ---
v Record the details of any transfusion reaction.? Any transfusion reaction should be documented
? Return the transfusion form to the blood bank
--- Content provided by FirstRanker.com ---
Compatibility/ Reaction FormWARMING BLOOD
--- Content provided by FirstRanker.com ---
? There is no evidence that warming blood is beneficial to the patientwhen transfusion is slow.
? At transfusion rates of greater than 100 mL/minute, cold blood may
--- Content provided by FirstRanker.com ---
be a contributing factor in cardiac arrest.
? However, keeping the patient warm is probably more important
--- Content provided by FirstRanker.com ---
than warming the blood.Indications
Warmed blood is most commonly required in:
--- Content provided by FirstRanker.com ---
1. Large volume rapid transfusions:? Adults: more than 50 mL/kg/hour.
? Children: more than 15 mL/kg/hour.
2. Exchange transfusion in infants.
--- Content provided by FirstRanker.com ---
3. Patients with clinically significant cold agglutinins.
? Blood should only be warmed in a blood warmer. Blood warmers
--- Content provided by FirstRanker.com ---
should have a visible thermometer and an audible warning alarmand should be properly maintained.
? Blood should never be warmed in a bowl of hot water as this could
--- Content provided by FirstRanker.com ---
lead to haemolysis of the red cells which could be lifethreateningwhen transfused.
References
--- Content provided by FirstRanker.com ---
1. THE APPROPRIATE CLINICAL USE OF BLOOD AND BLOOD PRODUCTS. Information Sheet forClinicians. Blood Transfusion Safety Department of Essential Health Technologies World Health
Organization, 2006.
--- Content provided by FirstRanker.com ---
2. Technical Manual, AABB. 18th edition"DONATE BLOOD SAVE LIVES"
--- Content provided by FirstRanker.com ---
Thank you