Why do patients get transfused?
Red blood cells (RBC)
•To treat symptomatic anaemia
Fresh Frozen Plasma (FFP)
•To increase oxygen carrying capacity
•To replace certain clotting factors
during bleeds
•To treat blood loss
Platelets (Plts)
Cryoprecipitate (Cryo)
•To correct a low platelet count
•To treat massive bleeds
•To boost poorly functioning platelets
•To treat DIC
•To combat bleeding/coagulation
When to transfuse
When to transfuse
• Always take samples from limbs that are not receiving any other type of
infusion.
Blood samples taken from limbs receiving clear fluids will be diluted, rendering inaccurate .
results, this often leads to unnecessary/over transfusions (externally reportable to SHOT).
• Always suspect and re-check spurious blood test results that don’t appear
to match clinical symptoms prior to prescribing a blood transfusion.
• Normal Hb = 140g/l – 180g/l
120g/l – 160g/l
(Men)
(Women)
• Hb between ‘normal’ and 70g/dl should be investigated and
treated but not necessarily with a blood transfusion.
Samples
Never pre-label sample bottles
Always have the request form available pre-bleed
Always identify your patient
Always label the sample before leaving the patient
Second samples
About 1 sample a month is sent through to Blood Bank which
shows a different blood group to a sample previously tested for
that patient!
(We know that wrong patients are being bled regularly – a potentially fatal mistake!)
2 samples must be taken on 2 different occasions ideally by 2 different people
(to guarantee the right patient has been bled = safety measure)
Do not take 2 samples at same time and use 2 different pens (we can tell!)
Do not take 2 samples at same time but put different times on bottles (defeats the object!)
How to prescribe blood
Considerations:
• Could I use an alternative?
• Can I justify this transfusion?
• What should it be written up on?
• What time is it?
• Consent
• Patient information
How to prescribe blood
Dosage:
Over how long:
• Red blood cells = 1 bag
• Red blood cells = <3 hours
• Platelets
• Platelets
= 1 bag
= <30 mins
• Cryoprecipitate = 2 bags
• Cryoprecipitate = <30 mins
• FFP
• FFP
= 3 bags
= <30 mins
Safe storage
Red blood cells (RBC):
Fresh Frozen Plasms (FFP):
Must only ever be kept in a blood fridge
Can be kept in a blood fridge or at room temperature
An adult dose of RBC is one bag
An adult dose of FFP is usually 3 bags
Max out of fridge time = 4 hours
Max out of fridge time = 4 hours
Must be returned within 30 minutes
Must be returned within 30 minutes
Every bag of RBC thrown away costs you £150
Every bag of FFP thrown away costs you £40
Platelets (Plts):
Cryoprecipitate (Cryo):
AB FROZEN PLASMA
ADULT CMV NEGATIVE IRRADIATED PLATELETS
Must be stored agitated at room temperature
Must only be kept at room temperature once defrosted
An adult dose of Plts is one bag
An adult dose of Cryo is usually 2 bags
Max out off the agitator = 2 hours
Max time from thawing = 4 hours
Must be returned within 30 minutes
Must be returned within 30 minutes
Every bag of Plts thrown away costs you £250
Every bag of Cryo thrown away costs you £250
Pre-transfusion checks
Is the blood ready – how do I know?
Is the patient ready – is it prescribed?
are the obs ok?
route of administration?
is the patient going to be able to have it now?
what time is it?
Who is allowed to collect the blood?
DOUBLE CHECK!
A MISTAKE COULD KILL!!!!
Blood Bank label:
NHSBT label:
(Must check against info brought with you)
(All this info found by comparing these 2 labels)
•Full name
•Check donor numbers
•Date of birth
•Blood groups
•Hospital number
•Expiry date
Donor number
Must be exactly the
same
Donor number
Blood group compatibility
Red Blood Cells
Blood Group:
A
B
AB
O
Can have:
A or O
B or O
A, B, AB or O
O
Must not have:
B or AB
A or AB
-
A, B or AB
Blood Group:
Can have:
D-positive
D-negative
D-positive or D-negative
D-negative
-
D-positive
Must not have:
Platelets
Blood Group:
A
B
AB
O
First choice:
A
B
AB
O
Second choice:
B
A
A
A
O (HT neg)
O (HT neg)
B
B
-
O (HT neg)
-
Third choice:
Fourth choice:
-
O (HT neg) = High Titre Anti-A and Anti-B negative
FFP
Blood Group:
Can have:
Must not have:
A
B
AB
O
A, B, AB
A, B, AB
A, B, AB
O, A, B, AB
O
O
O
-
Cryoprecipitate - does not need to be ABO or Rh D matched.
Blood group compatibility
The most compatible blood group to give to your patient is exactly the same
group that they are (this includes O-ve too!)
If Blood Bank issues blood
that is not the same group
as your patient it must
display this sticker
ATTENTION
THERE IS A DIFFERENCE BETWEEN THE DONOR
AND THE RECIPIENTS BLOOD GROUP. HOWEVER
THIS UNIT IS SUITABLE TO TRANSFUSE
If you do not see this sticker and you have been
given a different blood group do not transfuse it –
ring Blood Bank for clarification.
Tracing where the blood has gone
CMV NEGATIVE RED CELLS
Legally we must be able to track all units of blood and
prove which blood has been given to which patient and
which units were wasted
It is no longer acceptable to just write ‘blood’ in the
patients notes – the donation number must be recorded
(use the stickers off the bags)
In emergency situations this information can be
entered retrospectively
Even the emergency O-ve has to be traced!
The blood prescription chart
Blood must be written up on an
STH blood prescription chart
Time of collection should be filled
in by the person who collected it
Should lead you step by step
through the bedside checking
and administration process
Each chart has enough room for 6 bags of blood
The bedside check
Two people must check ALL blood components at the side of the patient prior to
putting it up for transfusion (not at the nurses desk!!!)
These two people must be assessed as competent:
Person 1:
Person 2:
A qualified nurse
A qualified nurse
A qualified midwife A qualified midwife
A qualified ODP
A qualified ODP
A qualified doctor
A qualified doctor
Giving set lines
Type of giving set: Blood must only ever be given through a blood giving set (integral
filter) and for every different type of blood – use a different blood giving set
Changing lines: Manufacturer’s instructions state a blood giving set should be changed
after every 2nd unit of blood transfused
.
.
...
Priming lines: It is not necessary to prime a giving set with anything other
than the blood (only 0.9% sodium Chloride is compatible with blood)
Volumetric pumps:
pumps: Where possible/when appropriate it is preferable
Volumetric
for blood to be given via a volumetric pump
Flushing lines: On completion of the transfusion, do not flush the
blood giving set (don’t transfuse the contents of the filter).
Minimum observations
Blood observations must be clearly identifiable, and must be retained with the
transfusion episode as part of the notes which must be kept for 30 years.
Observations must be recorded electronically or
on the observation chart & prescription chart
(Minimum obs)
.
Pre-transfusion: at least 15-30 minutes before the transfusion a
full set of SHEWS and temperature must be recorded
.
15 minutes after starting each unit of blood (not just red cells):
another full set of SHEWS and temperature must be recorded
.
Hourly: (If the patient is ok) a temperature and pulse must be . . .
recorded.
.
On completion: a full set of SHEWS and temperature must be . .
recorded
Reaction management
• If a transfusion reaction is suspected you must immediately stop the transfusion
• Contact doctor and nurses in charge
• Re-check that the right bag of blood was put up for the right patient
• Record observations every 15 minutes until episode subsides
• If the blood is to come down – send it back to Blood Bank for investigation along with .
. a suspected transfusion reaction form (download from the intranet) fresh samples will
. also be required
• Document what has happened and what has been done about it – it will need . . . .
. reporting as an incident as it will go to the Serious Hazards of Transfusion!
For more information
• SPOT - Jill Rowlands (0114 27)15246
(There will be a Transfusion Practitioner where you work – Jill can put you in touch)
• Lead Transfusion Consultant
• Hospital Transfusion Team
• Hospital Transfusion Committee
• Hospital Intranet Site
• Local Blood Transfusion Policy