Blood Transfusion

BLOOD TRANSFUSION MAXINE BOYD HOSPITAL TRANSFUSION PRACTITIONER HOSPITAL TRANSFUSION TEAM      CONSULTANT HAEMATOLOGIST – LEAD FOR TRANSFUSION MEDICINE BLOOD BANK MANAGER HOSPITAL TRANSFUSION PRACTITIONER CHAIR HOSPITAL TRANSFUSION COMMITTEE PATHOLOGY QUALITY MANAGER COST OF BLOOD PRODUCTS Packed Red Cells = £136.05  Fresh Frozen Plasma = £35.37  Platelets = £226.18  Cryoprecipitate = £221.38  Albumin = £20 Special requirements – additional cost  Emergency Blood Management Plan     July 2004 DoH issued summary version of the ‘National Contingency Plan for Blood Shortages’ Each Trust expected to have their own EBMP based on this guidance Based on traffic light system –Trust running on green under normal circumstances In cases of shortage – some elective ops will be cancelled – patients with greatest clinical need are prioritised Blood Conservation      Adhere to guidelines and policy including MSBOS Autologous transfusion - intra-operative cell salvage - post operative cell salvage Pre-operative assessment Education and Training Pharmaceutical alternatives e.g erythropoietin RED CELL TRANSFUSION TRIGGERS Guidelines for the clinical use of red cell transfusions (BCSH 2001)    Hb > 10g/dl – Transfusion not indicated Hb > 7-10g/dl – Transfuse only if clinically indicated Hb < 7g/dl – Transfusion generally indicated Red Cell Transfusion Triggers cont…     Critical Care: transfuse to maintain Hb >7 g/dl Post-chemotherapy: transfusion threshold of or g/dl Radiotherapy: transfuse to maintain Hb above 10 g/dl Chronic anaemia: Transfuse to maintain Hb just above lowest conc not associated with symptoms of anaemia (usually patients asymptomatic with Hb >8 g/dl) Indications for Transfusion Cryoprecipitate (BCSH, 2004)    Acute DIC where there is bleeding and fibrinogen level 7g/dl Massive Transfusion Guidelines Acute blood loss – Guidelines for clinical use of red cell transfusions (BCSH, 2001)   Maintain circulating blood volume and Hb conc >7g/dl in otherwise fit patients & >9g/dl in older patients and those with known cardiovascular disease 15-30% loss of blood volume (800-1500ml in an adult): transfuse crystalloids or synthetic colloids Red cell transfusion is unlikely to be necessary  30-40% loss of blood volume (1500-2000ml in an adult): rapid volume replacement is required with crystalloids or synthetic colloids Red cell transfusion will probably be required to maintain recommended Hb levels  >40% loss of blood volume (>2000ml in an adult): rapid volume replacement including red cell transfusion is required Massive bleed procedure  Administer crystalloids / colloids until 1500ml loss of blood  Inform blood bank – degree of urgency  Samples collected for crossmatching, FBC, clotting, biochemistry  x O Rh (D) negative units available - always inform blood bank  ABO Rh (D) group specific blood available 10 mins after sample arrives in blood bank Medical staff must accept full responsibility for administration of uncrossmatched blood X-matched blood available after 40 mins  Monitor FBC & clotting (inc fibrinogen) to guide blood component therapy Taking Blood Samples    Only patient at a time Identify the correct patient Confirm identification – – – –  First name Surname Address Date of birth Check the wristband with the request form Taking Blood Samples   Take the blood At the bedside label the sample bottle,using ink – First name – Surname – DOB – Hospital Registration Number (or casualty no.) – Date – Signature of person taking blood DO NOT!      Do not ask someone else to label the sample Do not label the sample prior to phlebotomy Do not leave the bedside until you have labelled the sample tube Do not use pre-printed labels to label the sample tube Do not use the form details to label the sample tube PRESCRIBING  Prescription chart must contain: - Full patient identification details i.e full name, date of birth, hospital number  Must specify: - Blood product to be administered, quantity, duration and special instructions Serious Adverse Reactions ACTION  Stop transfusion immediately  Take down blood product / giving set  Maintain IV access with infusion of 0.9% sodium chloride  Treat patient  Inform Blood Bank Adverse reaction cont… Investigation Send to Blood Bank:  The unit of blood  Samples stated on transfusion reaction form  Complete adverse reaction report (from blood bank) Incident Reporting – An incident form will be completed for all adverse reactions and for any events which delay the patients treatment – An incident form will be completed for any practice that contravenes this policy – All incidents will be graded and investigated in line with the Trust Incident Reporting Policy – All incidents occurring during the blood transfusion process, regardless of where it happens, must be reported to the blood bank manager BLOOD TRANSFUSION CAN KILL SHOT (Serious Hazards of Transfusion) A confidential, anonymised, UK wide scheme that aims to collect data on adverse events of transfusion of blood and blood products SHOT Serious Hazards of Transfusion