BLOOD TRANSFUSION

LEARNING OBJECTIVES:
• How to transfuse blood and monitoring during transfusion
• Recognition and differentiation of life threatening transfusion
reactions from mild reactions
• Management of transfusion reactions
BLOOD TRANSFUSION GUIDELINES:
BLOOD TRANSFUSION GUIDELINES:
• Consent.
• Blood grouping & cross matching
• Sample should be taken & LABELLED on bedside
• Verification of identity should be cross checked.
BLOOD TRANSFUSION GUIDELINES:
• Check blood bag
• Ensure identification of
blood bag matches with
patient identification
• Check blood bag ABO
and Rh compatibility
matches with patient
BLOOD TRANSFUSION GUIDELINES:
• Check vitals before start of transfusion and document those.
• Start slowly and check vital after 10-15 minutes.
• If no reaction, then increase flow rate to standard.
• Check vitals on hrly basis and document.
• Check vitals 4 hrs after completion of transfusion.
TRANSFUSION REACTIONS:
WHAT SHOULD BE DONE:
• Stop blood transfusion.
• Record following information
• Type of reaction
• Length of time after the start of transfusion that the reaction occurred
• Volume, type and pack number of blood product
• Take following samples and send them for lab investigations to blood ban
• Repeat ABO and RhD group
• Repeat cross match
• Full blood count
• Coagulation screen
• Direct antiglobulin test
• Urea & creatinine
• Electrolytes
WHAT SHOULD BE DONE:
• Blood cultures
• Blood unit and infusion set
• First specimen of urine
• Complete transfusion reaction form
• Send samples:
• Blood sample from opposite vein 12 and 24 hrs after start of reaction
• Patient 24 hrs urine sample
 SHOCK AND/OR
RESPIRATORY DISTRESS +VE

WHEEZING, Angioedema
urticaria ACUTE
HEMOLYTIC
REACTION

+VE -VE

LUMBER PAIN
ANAPHYLACTIC FEVER
SHOCK RED COLOR URINE
 SEVERE DYSPNEA WITHOUT
SHOCK

SIGNS OF FLUID OVERLOAD

PRESENT ABSENT

TRANSFUSION ASSOCIATED
TRANSFUSION ASSOCIATED
CIRCULATORY OVERLOAD
LUNG INJURY (TRALI)
(TACO)
 DYSPNEA AND SHOCK ABSENT

• isolated temperature>
Rash , hives
38°C, or rise of 1–2°C,

• FEBRILE NON-HEMOLYTIC • MILD ALLERGIC

REACTIONS REACTIONS
ACUTE HEMOLYTIC REACTION:
• 1 Stop the transfusion. Replace the infusion set and keep IV line
open with normal saline.
• START A B C
• Infuse normal saline (initially 20–30 ml/kg) to maintain systolic BP. If
hypotensive, give over 5 minutes and elevate patient’s legs.
• Urine output goal is >100 mL/hour, to prevent oliguric renal failure.
• Should fluid resuscitation fail to meet urine output goal, forced
diuresis should be considered. Mannitol is the diuretic of choice in
this setting because it acts as a free radical scavenger
• Prior to initiating a forced diuresis, intravascular volume depletion
should be excluded by evidence of central venous pressure
• Assess for bleeding from puncture sites or wounds. If there is clinical
or laboratory evidence of DIC give platelets (adult: 5–6 units) and
either cryoprecipitate (adult: 12 units) or fresh frozen plasma (adult:
3 units).
ANAPHYLACTIC REACTION:
BLOOD TRANSFUSION REACTION:
• TRALI:
• There is no specific therapy
• Symptomatic therapy
• May need ventilatory and circulartory support in ICU
• Transfusion-related fluid overload:
• Stop the transfusion
• Give supplemental oxygen
• Give loop diuretics
• May need inotropic support
BLOOD TRANSFUSION REACTION:
• Mild allergic reactions:
• Give CHLORPHENIRAMINE 10 mg IM or IV slowly
• Steroid controversial
• Continue blood transfusion slowly
• Febrile Non-hemolytic reactions:
• Transfuse at slow rate
• Observe more frequently
• Give paracetamol 500 mg to 1 gm
COMMON QUERIES REGARDING BT:
• Concept of universal donor and recipient should be followed??
• Can be used but in emergency situations only

• If a patient is transfused 4-5 pints of O negative blood, will his blood

group changed now??
• No

• When should we repeat LABS after transfusion?

• If wants to check Hb only then immediate. If want to check oxygen
carrying capacity of blood then after 24 hrs.
COMMON QUERIES REGARDING BT:
• How much transfusions per day can be done safely?
• One, if not actively bleeding

• Can we transfuse cold blood ?

• Yes, can be done at standard rate
• No evidence that cold blood causes hypothermia at rate <
100ml/min.

• Are warming methods right which are being used in our setup??
• Armpit and clothes are fine. Boiling water should be avoided.
COMMON QUERIES REGARDING BT:
• What is fresh whole blood?
• Whole blood less than 7 d old is called fresh blood

• After how many transfusions should we replace calcium?

• Calcium replacement is only indicated if biochemical, clinical or
electrocardiographical evidence is present.
SUMMARY:
• Transfusion guidelines
• Blood reactions