Administration of Blood and Blood

Components

Dr. Rakesh Kumar

Assistant Professor
Department of Transfusion Medicine
& Blood Bank
AIIMS Patna
 TOPICS TO BE
DISCUSSED

• How to fill Blood request form and

Significance

• How to label sample tube

• What type of blood component and

group to choose

• Monitoring of patient during blood

transfusion
42 days in the
5 days at room 1 year in the freezer < -
refrigerator or 10 1 year in the freezer < -
temperature 22° C ± 2° C 20° C
years in the 20° C
BLOOD SAMPLE COLLECTION

• Must be drawn by doctor on duty and a trained nursing staff/

phlebotomist.

• Place only one plain/EDTA vial labeled with patient’s name,

CR no. at the patient’s bedside.

• Patient’s identification

- If the patient is conscious, he/ she can identify him/herself.

- If the patient is unconscious, ask the relative/ other member

of the staff to verify patient’s identity.
Information required on the sample

• Name of the patient- First and Second Name

• CR number of the patient

• Signature of the phlebotomist

• Date and time of collection of sample

• Samples from new born should be labeled as “Baby of

mother’s name” and should be labeled with mother’s
identification.
Choice for ABO Blood Groups

Patient type Donor PRBC Donor FFP Donor PC

O Positive O O,B,A,AB O,B,A,AB

A Positive A,O A,AB A,AB,O,B

B Positive B,O B,AB B,AB,O,A

AB Positive AB,B,A,O AB AB,B,A,O

Choice for Rh Blood group

• Rh (D) negative patient transfused with Rh (D) positive components

PRBC Only as a life saving measure

and with consent from treating physician &
patient’s relative
FFP No anti-D immunoprophylaxis
required
PC Anti D immunoprophylaxis required
(300 µg anti-D gives protection for 7
plateletpheresis units or 30 Rh (D) positive
platelet concentrates for 6 weeks)
Rational Use of Blood
• Right product
• Right dose
• Right time
• Right reasons
• Best Transfusion is
“No Transfusion”
Answer 4 Qs before transfusion

• Why to transfuse ?
 benefit > risk
 patients symptoms Vs lab levels
 prophylactic Vs therapeutic
• What to transfuse ?
 whole blood NO
 components / fractions
• How much to transfuse ?
 Single unit NO
• How to transfuse ?
 use of filter
 rate of transfusion
 warming
 Cross matching: Special Circumstances

Clinical urgency

Urgent(45-60 min) Routine

Immediate (10-15 min)

ABO & Rh D type

ABO & Rh D type ABO & Rh D type

Group O Rh neg Group specific

Crossmatch on gel Crossmatch on gel or
Packed RBCs blood or tube tube

If units are issued without X match – written consent of physician to be taken,

-complete X match protocols followed after issue
 IN THE WARDS/ OT
• PRBC

Get the component issued only when the need for transfusion
arises.

Transfusion should be started within 30 min of issue.

Transfusion should be completed in 4 hours.

If any delay in transfusion is there, unit should be sent to blood

bank for storage.
 Contd..
• Platelets
Should never be placed in refrigerator

Should be transfused as soon as possible after issue

Transfusion should be completed in 20-30 min

• Fresh frozen plasma

Should be transfused as soon as possible after issue.

Transfusion should be completed in 20-30 min

 RECORDING OF TRANSFUSION

Consent from patient and/or relatives- Valid informed consent

for blood transfusion should be obtained and documented in the
patient's clinical record.

• Pre-administration checks :
STEP 1- Patient’s Identification
 Badges, Wrist bands with Bar code labels
 Cross check the patient’s identification against the
compatibility report and the blood bag label.

STEP-2- : Check the patient’s notes for

 The component prescribed
 Any special requirements- leucodepletion, irradiation

14
Contd…
STEP-3 Check the details on compatibility report
and the blood bag labels-
Blood Group
Unit registration number
Expiry date
Type of component
Any instructions for transfusion from blood bank
Colour coded labels
• Blue – O blood group
• Yellow – A blood group
• Pink – B blood group
• White – AB blood group
 ADMINISTRATION
• Blood should be administered only through blood
transfusion sets with filter size of 170- 200 µm.

• Must be sterile and must never be reused.

• Never add medication to a unit of blood. Should not be

administered with any i.v. solution containing calcium,
dextrose or ringer’ solution.
 Monitoring of the patient
Before starting transfusion:
• Record baseline vital signs and assessment before starting each
unit:

• Temperature

• Blood pressure

• Pulse

• Respiratory rate

• Oxygen saturation if available

• Auscultation for patients at risk for overload (elderly, paediatric,

cardiovascular disease)
After starting blood:

1. For the first 15 minutes:

• Start initially with a slow rate (1-2ml/min or 60-120 ml/hr) unless

transfusion is extremely urgent.

• Monitor your patient closely.

2. After the first 15 minutes:

• Reassess your patient and repeat vital signs.

• Increase flow to prescribed rate (4ml/min or 240 ml/hr) if no

reaction observed.
3.Monitor the patient

• At least every hour during transfusion

• On completion of the transfusion

• 4 hours after completing the transfusion

BLOOD TRANSFUSION NOTES
Transfusion

Type and Volume of component, unit number,

Blood Group,
Date and Time at which transfusion commenced,
Signature of person administering the transfusion
Pre and Post transfusion vital signs,
Volume transfused
• Any transfusion reaction should be documented
• Return the reaction form to the blood bank
What to Watch for During
Transfusion

Hyper- or
Chest, Urticaria
Nausea/
Fever Chills flank or flushing
hypotens vomiting
back pain pruritus
ion

Pain or
Jaundice
burning
or Oliguria
Dyspnea DIC at Shock
hemoglo or anuria
infusion
binuria
site.
 To be
Noted….
• The out of group transfusions require consent from treating
physician as well as the patient.
• Cross matched blood unit is kept reserved for 3 days for the
same patient.
• Blood once issued is not taken back for re cross match but
can be accepted if received within 30 minutes.
• Blood unit is issued with a blood compatibility report and a
reaction form.
• Reaction form duly filled, is to be returned back to the blood
bank after the completion of the transfusion.
• In case the blood unit issued is not transfused, refund of the
payment is done deducting the cross match charges
 Adverse Transfusion
Reaction

Any transfusion-related adverse event

that occurs during/ after the
transfusion
 Classification

Transfusion reaction

ACUTE/ IMMEDIATE DELAYED

within 24hrs of transfusion after 24hrs of transfusion

Immunologic Immunologic

Nonimmunolog Nonimmunologi
ic c
 Acute Transfusion Reactions

Immune Reactions

Non-Immune
Allergic Reactions
AHTR FNHTR transfusion TRALI
Reaction

Transfusion
Air
AHTR Associated TACO
Embolism
Sepsis
 Preliminary
steps:

a) Discontinue transfusion immediately

b) Maintain intravenous access for supportive
therapy
c) Maintain adequate blood pressure & urine
output
d) Perform clerical verification
1. Labels on the component
2. Patient records
3. Patient identification
 Preliminary steps:

d) Complete transfusion reaction documentation

e) Collect post transfusion reaction samples & a urine sample

f) Return discontinued bag of blood, the administration set

without the IV needle and all the related forms and labels.
 Basic testing
Post-Transfusion Reaction
Sample

Direct ABO Testing- to

Antiglobulin verify patient
Clerical check- Test- detects the ABO typing
postreaction Hemolysis - presence of
sample, visual check RBC’s
transfusion sensitized in
documentation, vivo
blood bag

No Discrepancy Discrepancy

Hemolysis Negative Positive

No hemolysis
present

No Discrepancy Discrepancy
Request redraw

Request redraw
Notify physician

Notify Physician
If another patient is If another patient is
involved in discrepancy, involved in discrepancy,
take necessary step to take necessary step to
prevent another adverse Hemolysis present on prevent another adverse
event second draw event
Notify physician Notify Physician
 Prevention of transfusion reaction

• Adherence to Standard Operating

Procedures (SOPs) for pre-transfusion
testing
• Appropriate storage and transfusion
instructions on labels
• Clerical
Educationchecks prior to of
and training issue ANDhealth care
nurses
assistants,
Transfusiondoctors at every level

• Proper and effective communication

• Educational sessions
Take Home Messages
• No place for Whole Blood in clinical medicine

• Component preparation and use is the demand of

time

• Best Transfusion is “No Transfusion”

• Promotion of judicious use of blood / components

• Audit of transfusion practices
• CME on use of components
• Discourage single unit / fresh blood
Thank you