Title: Blood Transfusion Essentials
1Blood Transfusion Essentials
2Topics
- Rules for patient identification
- Collecting pretransfusion samples
- Picking up blood from the lab
- Blood administration
- Transfusion reactions
3Pretransfusion Collection
- Refer to the sample requisition in handout
- Instructions are on the requisition!
- Identification labeling must be done at
patients side - Two person identification check
- Blood Bank Identification number system
-
4Transfusion medicine collection instructions are
on the requisition!
5Tube 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!
6Ready To Transfuse?Checks
- Patient consent obtained (by the ordering
physician) - Physicians 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.
7Blood 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 patients 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.
8Remember
- Take the blood component directly to the
patients (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.
9Blood administration Transfusion Instructions
see tag
- Record patients 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. -
10Blood Component Label
11Monitoring 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
12Blood 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.
13Blood 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.
14Blood Administration
- Units of cryoprecipitate are usually infused
rapidly and flushed with saline. - Due to their small volume, flushing is required
to maximize product usage.
15How 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
16No 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.
17Transfusion Reactions
- Any new symptom or sign during or following
transfusion of a blood component or fractionation
product
18Transfusion Reactions
19TRANSFUSION 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.
20Can 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.
21Blood Product RequestBBIN Pretransfusion
Testing See requisition
Packed RBC BBIN and crossmatch required. Autologous RBC BBIN and crossmatch required. Directed RBC or Platelets BBIN and crossmatch required.
Plasma (AFFP, FP) BBIN required. Platelets plasma product BBIN required. Cryoprecipitate plasma product BBIN required.
IVIG RhIg Albumin
Other immunoglobulin fractions Coagulation factor concentrates Pentaspan pentastarch available through lab but it is not a blood product
22Blood product request guide is on the lower half
of the requisition.
23Why 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.
24Resources
- Call the blood bank!
- Blood bank staff
- Hematopathologist on call
- Clinical Guide to transfusion
- www.cha.ab.ca Search 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
25The End