Makindo Medical Notes.com

If suspected transfusion reaction stop blood, assess patient, check bloods and patient match, take advice if unsure

About

• Talk to Laboratory if urgent
• Get a cross match sample to the lab

Introduction

• Blood is scarce, potentially dangerous and expensive
• Transfusion where risks are exceeded by benefits
• Blood is usually supplied as red cell concentrates (280-350mls).
• In general fully cross-matched blood should be used. In an emergency, this can be provided within 40 minutes of receipt of the sample.

Safe Group and Save and Transfusion

• Failure to check patient identity can be fatal. Patients must wear an ID band (or equivalent) with name, date of birth and unique ID number.
• Confirm identity at every stage of the transfusion process. Patient identifiers on the ID band and blood pack must be identical. Any discrepancy, DO NOT TRANSFUSE.
• The patient must be monitored during the transfusion. Education and training underpin safe transfusion practice.

Clinical Urgency

• Very urgent: life-threatening haemorrhage and blood needed now: The laboratory will issue group 0 Rh(D)-negative blood. These may be stored close to you in ITU/Resus.
• Urgent: blood required in 5-10 min. Get cross-match to lab urgently. The blood matched for ABO and Rh(D) group only.
• Non-urgent: blood required in 30–60 min. Full pre-transfusion compatibility test. The laboratory will issue fully compatible blood

Further transfusion

• If an additional transfusion is required more than three days later, then a new sample must be sent for cross match
• This is not necessary if more blood is requested within 72 hours of initial cross-match).

Non Emergency /Elective Transfusion

• When transfusing anaemic patients with no acute bleed then it is given more slowly, in general 2-4 hourly.
• In those patients with poor cardiac reserve give blood 4 hourly and "cover" with oral Furosemide e.g. 40 mg with alternate bags.
• Acute Blood loss: Any loss of more than 20% of blood volume (1000ml) will need a transfusion. Do not delay when blood loss acute and rapid. Follow local guidelines and consider massive transfusion protocol.
• Surgical patients: Transfuse if Hb < 80 g/L or if Pre-op Hb < 90 g /L and significant perioperative blood loss anticipated. Investigated any known anaemia. Maintain Hb > 80g/L at all times and even > 100g/L in those with significant comorbidities e.g. IHD, valvular heart disease
• Acute MI: Transfuse to Hb > 100 g/L but no higher
• General Case Hb < 80 g/L - investigate and treat cause. Transfuse particularly if symptomatic - severe fatigue, breathlessness and reduced exercise tolerance from pre anaemia baseline.
• General case Hb 80-100g/L: investigate and treat the cause. Transfuse particularly if symptomatic - severe fatigue, breathlessness and reduced exercise tolerance from pre anaemia baseline.