Archived Volumes of Past Issues

Blood /Blood Product Transfusion


Patient selection

Indication for transfusion

Hemoglobin of less than 9 g/dl in labor.

Acute blood loss(abruptio placenta , placenta previa , PPH ,ectopic)

Disseminated intravascular coagulation

Check Blood send for cross Match in patients like:

High risk obstetric patient

Patient for induction of labour

Thrombocytopenia

Bleeding or clotting disorders

Gynecological major cases

Details entered on forms and sample

Blood requisition form is filled by same resident who collected the blood.

Sample collection in EDTA bulb

Full name written in ( block letters) and clearly on sample .

IPD number (No OPD OR CASUALTY NUMBER)

Ward number

Unit name

Old Blood Group and Cross Match report attached to the form.

Diagnosis

Reason for transfusion

Hemoglobin percentage written

Signature and designation of the person

Presence of errors (fill a new form instead of correcting the old one).

When Blood bag comes from blood bank

Different Types of labels For different Blood group


Check
    Different Types of labels For different Blood group
    Blood group
    Label color
    Blood group A
    Yellow
    Blood group B
    Pink
    Blood group AB
    White
    Blood group O
    Blue
    • Do Not rely on color codes
    • Check: written matter on label on bags…..
    • Label is of Blood Bank KEM HOSPITAL
    • Unit No
    • Date of collection
    • Date of expiry
    • Blood group and Rh typing
    • HIV Tested on

    Getting blood from other blood bank

    BGCM forms have 'NO STOCK' written on it.

    Blood availability in other blood bank (recognized by KEM blood bank): contact operator (No. 9) ask to connect to various blood banks (nos available with operator).

    Send relative to KEM blood bank for a requisition slip to get blood from other blood bank. For standalone blood banks, send patient's blood sample along with the request.

    Patient's relative is informed by doctors on how the blood or blood products should be brought. Ensure Cryoprecipitates are    transported with ice packs.
    .
    Relative takes the blood to KEM blood bank after getting it from outside. Blood from standalone blood banks is cross matched by the concerned blood banks and is used after checking the reports. (KEM blood banks does not cross match the sample again.)

    Blood and blood product are cross matched and issued from KEM blood bank. They have now KEM label.

    Platelets are agitated and not allowed to stand still during transport.

    Rapid cross match

    Valid indication.

    Assistant Professor on duty is consulted.

    Consent of patient after complete information regarding the high risk.

    Assistant Professor’s signature on written call along with blood sample and form.

    Look for reactions.

    Routine cross match

    Blood for cross match is sent one day prior to surgery

    Blood sample is sent before 12 noon.

    In case of holiday, blood sample is sent one day prior to holiday.

    The word 'Routine' written on form sent

    The date and time when blood is required is mentioned.

    Procedure prior to blood transfusion

    Ensure Informed valid written consent is taken for blood /blood product transfusion.

    Base line vital parameters– pulse rate, blood pressure, temperature, respiratory rate are recorded.

    The patient's identification is verified.

    Blood bag is not issued in advance and is issued only when required.

    The label of blood and blood product bag and transfusion slip are checked.

    The patient full name, IPD number, bag unit number, blood group and Rh are same on label, form, and paper.

    The bag is checked for date of collection, date of issue, date of expiry, testing is done for HIV.

    The blood bag is checked for any clotting, leak, frothing, discoloration, and/or fungus.

    All previous reports of blood group are checked and confirmed to be the same.

    Procedure during starting the transfusion

    A vein on forearm is selected.

    All aseptic and antiseptic precautions are taken.

    Hands are washed.

    Sterile gloves are worn.

    A 170-260 micron blood filter set is used for transfusion.

    Blood filter blood set is inserted aseptically with no touch technique.

    All air is removed from the IV tubings.

    Methylated spirit is applied at the site of cannulation.

    An 18 gauge i.v. cannula is used. And fix it

    The cannula is fixed to the skin.

    Blood transfusion started within half hour of issue.

    Warming of blood bag is not done in case of a slow transfusion.

    Special precautions

    Air not introduced into the administration set or the blood components or blood products.

    Ensure transfused blood component/blood product is mixed gently by inversion to resuspend the product.

    No drug is added to the blood or blood product.

    Notes to be written on Indoor paper

    Name, designation of the person starting the transfusion and date are written in case paper.

    The information written on bag slip/label is recorded on transfusion notes.

    Fresh instructions (orders) are written for the nurse.

    Blood is started at rate of 1ml/min .

    Vital parameters are checked after 15 minutes.

    If no blood transfusion reaction seen, the transfusion rate id increased to 4ml/minute.

    Total blood/blood product transfused within 4 hour of issuing it.

    Monitoring of blood transfusion

    Symptoms of transfusion reaction like breathlessness, itching, loin tenderness, etc are watched for.

    The following parameters are checked after 15 minutes, and if normal, every 30 minutes till 1 hour after completion of blood transfusion.

    General condition

    Temperature

    Pulse rate

    Blood pressure

    Respiration rate

    Skin Rashes

    Bleeding from any site

    Completion of blood transfusion

    Following completion of the transfusion, post transfusion information is documented on the patient’s chart.

    Blood bag label is removed and stuck to the blood transfusion notes after transfusion completion and not initially.

    Discarding empty bags

    Bag discarded In Red bag.

    IV cannula discarded after cutting in sharps (non puncture containers).

    Concurrent fluids and medications

    Ensure concurrent fluids administered as far as possible from the transfusion site (different arm.)

    Ensure medication given from another IV access if required.

    Ensure drugs, etc. not injected in the blood bag or blood products

    Ensure blood bags not punctured with needles, except for insertion of the blood set.

    Change of IV transfusion set

    Transfusion set is changed after four consecutive units of red cells have been transfused.

    Set is confirmed to be not occluded .

    Set is changed at least once every 24 hours

    Manufacturer’s requirements for use are met.

    Indications for blood warmers

    Routine warming of blood is not indicated

    A blood warmer is indicated for:

    Large volume rapid transfusions of >50 ml/kg/hour

    Exchange transfusions.

    Plasma exchange for therapeutic apheresis in adults.

    Patients with clinically significant cold agglutination antibody.

    Blood products transfusion: Special precautions

    Platelets: continuously agitated till transfused.

    Cryoprecipitates: storage at 5 degree C till actual use

    in ice pack in transport stage.

    Fresh Frozen Plasma: no sample ia sent as blood grouping is not necessary.

    Blood is not used

    Blood bags are issued only when required immediately for transfusion.

    Unused blood bags are not left in department's refrigerators.

    Blood and blood products are not wasted.

    Blood bag out of temperature controlled storage for greater than 30 minutes is not used.

    Discard unused blood and blood product bag(s) in yellow bag. (Blood bank never takes bags back.)

    Blood transfusion reaction

    Diagnostic symptom(s) and sign(s) are recorded.

    Transfusion is stopped immediately.

    Action is taken with speed because of the possible life- threatening nature of acute transfusion reactions.

    Assistant Professor on duty is informed when a reaction occurs.

    Any adverse reaction to the transfusion of blood or blood components is reported to blood bank personnel immediately by the Unit concerned.

    Remove Unit and administration set are removed.

    The intravenous cannula is left in place and a new administration set is put up.

    Intravenous saline infusion is started.

    Injection chlorpheniramine 10 to 20 mg by is given intravenously.

    Injection hydrocortisone 100 mg is given.

    Injection adrenalin 0.5 ml 1:1000 dilution is given intramuscularly in case of anaphylatic shock. It is repeated after 15 minutes if there is no significant response. (Intramuscular adrenaline is the first line treatment for anaphylaxis, with intravenous adrenaline reserved for unresponsive anaphylaxis or circulatory collapse)

    Blood transfusion reaction information

    Transfusion reaction form is obtained from the blood bank.

    All columns in the transfusion reaction form are filled.

    Blood unit and administration set are removed and sent to the blood bank.

    Blood samples are taken from the other arm and sent to blood bank and other respective laboratories for the following tests:

    Repeat group / cross match / DCT (goes to blood bank)

    Coagulation studies, biochemistry – renal and liver function tests and uirnalysis.

    Checklist after transfusion reaction

    Transfusion is stopped immediately.

    Remove Unit and administration set are removed.

    The intravenous cannula is left in place and a new administration set is put up.

    Intravenous saline infusion is started.

    Injection chlorpheniramine 10 to 20 mg by is given intravenously.

    Injection hydrocortisone 100 mg is given.

    Injection adrenalin 0.5 ml 1:1000 dilution is given intramuscularly in case of anaphylatic shock. It is repeated after 15 minutes if there is no significant response. (Intramuscular adrenaline is the first line treatment for anaphylaxis, with intravenous adrenaline reserved for unresponsive anaphylaxis or circulatory collapse)

    In the case of simple, urticarial-type reactions with no other symptoms or signs, the patient is given antihistaminics and the transfusion may be continued at a slower rate.

    Monitoring Parameters: Dangerous if values raised as below:

    The following parameters are checked.

    Temperature ≥1.5°C above baseline.

    Hypotension/shock or hypertension.

    Tachycardia.

    Tachypnea, wheeze, stridor.

    Rigors or chills.

    Nausea, vomiting or pain (local, chest, back).

    Bleeding

    Skin rash