protocols for blood transfusion phpl
TRANSCRIPT
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PROTOCOLS FOR BLOOD
TRANSFUSION
FOLLOWED AT PAREKHS
HOSPITAL
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CHECK-LIST
1.Ask the patient to identify herself/himself
by
Family name give name, date of birthand any appropriate
If the patient is unconscious ask a
relative or a second member of staff to
state patients identity.
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2. Check that patients identity and gender
against.
Patient's identity wristband or label.
Patients medical notes.
3.Check that the following details ofcompatibility label attached to the blood
pack exactly match the details of the
patients documentation and identify
wristband.
Patients name.
Hospital reference number
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4. Check that there are no discrepancies between
ABO group and Rh D group on Blood pack
Compatibility level.
5. Check that there are no discrepancies betweenthe unique donation number on
Blood pack
Compatibility level6.Check that expiry date on the blood pack has
not passed.
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7.Examine the pack before
transfusion. Do not administer
the transfusion if the pack is
damaged or there is any
evidence of signs ofdeterioration.
Leakage Unusual Colour.
Signs of heamolysis.
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Monitoring the Transfused Patient
1. For each unit of blood transfusion,monitoring the
following stages.
Before starting the transfusion.
As soon as the transfusion is started.
15minutes after starting transfusion.
On completion of the transfusion.
4 hrs after completing the transfusion.
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2. At each of these stages the following
information on the patients chart.
Patient's general appearance
Temperature.
Pulse. Blood Pressure
Respiratory rate.
Fluid balanceOral and IV fluid intake.
Urinary Output.
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3. Record
Time the transfusion is started.
Time the transfusion is completed.
Volume and type of all products
transfused.
4Monitor the patients particularly
carefully during the first 15 minutes ofthe transfusion to detect early sign
and symptoms of adverse ill effects.
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TIME LIMIT FOR INFUSION OF BLOOD COMPONENTS
Start infusion Complete infusion.
Whole Blood/Red
cells
Start infusion
Within 30 minutes
of removing pack
from refrigerator
immediately.
Complete infusion
Within 4 hours
(or less in high
ambient temperature)
Platelet concentrates Immediately Within 20minutes
Fresh frozen plasma Within 30minutes Within 20 minutes.
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TRANSFUSION REACTION
Category Signs Symptoms Possible cause
l-MildLocalized cutaneous
reactions
Pruritus Hypersensitivity
(mild)
ll-Moderately Severe
Flushing
Urticatria
Rigors
Fever
Restlessness
Tachycardia
Anxiety
Pruritus
Palpitation
Mild Dyspnoe
Headache
Hypersensitivity moderately
severe)
Febrile non-hemolytic
transfusion reaction.
Ab to protein, including Ig
Possible contamination with
pyrogens and/or bacteria
Ill-Life threatening
Rigors
Fever
Restlessness
Hypotension
(fall of 20% of
systolic BP)
Tachycardia
(rise of 20% of
heart rate)
Hemoglobinuria(red
urine)
Unexplained
bleeding
(DIC)
Anxiety
Chest pain
Pain near infusion site
Respiratory Distress
Loin/Back pain
Headache
Dyspnea
Acute intravascular hemolyisis
Bacterial contamination and
septic shock
Fluid overload
Anaphylaxis
Transfusion associated lung
injury
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NOTE
If acute transfusion reaction occurs, first check theblood pack labels and the patients identity. If there isany discrepancy, stop the transfusion immediately andconsult the blood bank.
In an unconscious or anesthetized patient,hypotension and uncontrolled bleeding may be theonly signs of an incompatible transfusion.
In a conscious patient undergoing a severe hemolytic
transfusion reaction, signs and symptoms may appearvery quickly within minutes of infusing only 5-10 ml ofblood. Close observation at the start of infusion ofeach unit is essential.
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IMMEDIATE MANAGEMENT
Category1:-Mild
1. Slow the transfusion
2. Administer antihistamineIM(eg.Chlorpheniramine 0.1mg/kg or
equivalent).
3. If no clinical improvement within 30min or ifsigns and symptoms worsen,treat as
Category2.
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Category 2: Moderately Severe.
1. Stop the transfusion. Replace the giving set andkeep IV line open with normal saline.
2. Notify the doctor responsible for the patient andblood bank.
3. Send blood unit with giving set, freshly collectedurine and new blood samples (clotted andanticoagulanted) from vein opposite infusion sitewith appropriate request form to blood bank andlaboratory for investigation.
4. Administer antihistamine IM(eg.Chlorpheniramine
0.1mg/kg or equivalent) and oral or rectal anti-puretic (eg. Paracetamol 10mg/kg 500mg-1 G inadults). Avoid aspirin in thrombocytopenicpatients.or equivalent).
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5. Give IV corticosteroid and
bronchodilators if there are anaphylactic
features(eg. Bronchospasm,stridor)6. Collect urine for next 24hrs for evidence
of haemolysis and send to laboratory.
7. If clinical improvement restart transfusion
slowly with new blood unit and observe
carefully.
8. If no clinical improvement within 15min
of it signs and symptoms worsen,treat ascategory 3.
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Category 3:-Life Threatening.
1. Stop the transfusion.Repalce the giving set
and keep IV line open with normal saline.2. Infuse normal saline (initially 20-30ml/kg) to
maintain systolic BP; if hypotensiv,give over
5mins and elevated patients legs.3. Maintain airway and give high flow oxygen by
mask.
4. Give adrenaline(as1:1000 solution) 0.01mg/kgbody-weight by slow intramuscular injection.
5. Give IV corticosteroids and bronchodilators if
there are anaphylactoid features
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6. Give diuretic eg. Frusemide 1mg/kg IV or
equivalent.
7. Notify the doctor resposible for the patient andblood bank immediately.
8. Send blood unit with giving-set fresh urine
sample and new blood samples( 1clotted and1 anticoagulatted) from vein opposite infusion
site with appropriate request form to blood
bank and laboratory for investigation.
9. Check a fresh urine specimen visually for signs
of heamoglobinuria(red or pink urine).
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10. Start a 24hrs urine collection and fluid
balance chart and record all intake and output.
Maintain fluid balance.
11. 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 3 units). Use
virally inactivate plasma coagulation products
whenever possible.
12. Reassess if hypotensive
* Give further saline 20-30ml/kg over 5mins
* Give inotropes if available
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13. If urine output falling or laboratory evidence of
acute renal failure(rising K+,Urea,Creatinine)
Maintain fluid balance accurately. Give further frusemide
Consider dopamine infusion, if available.
Seek expert help, the patient may need renaldialysis.
14.If bacteremia
suspected(rigors,fever,collapse,no evidence ofhaemolytic reaction), start broad spectrum anti-
biotics,to cover pseudomonas and gram
positives.