Blood Transfusion – BloodSafe Module

8/9/2019 Blood Transfusion – BloodSafe Module

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• E&planation of procedure

• E&planation of riss

• E&planation of alternatives

Dosage

• >enerally – for an average si(ed adult$ one unit of blood willincrease Hb by appro&. 95g#,

• But in the end depends on pac volu"e %?0@5",'$ ptsweight and hydration status

Causes of anaemia

• Hae"atinic deciency – Fe$ B90$ folate %B='

• Bleeding

•

0o "edication• ruptured vessels

• surgery

Blood loss minimisationPreoperative

• pti"ise pre-op Hb eg correction of iron deciency

• 2i"ely cessation of anti-hae"ostatic agents

Intraoperative

• Mini"ise tissue trau"a

• *areful vessel ligation and use of electro-cautery

• ro"pt attention to surgical bleeding

• 2opical thro"bogenic "easures eg brin sealant

• Ase of brinolytic drugs

• Ase of regional anaesthesia

• 6ntraoperative cell salvage

• /cute nor"ovole"ic hae"o-dilution %/H'

Pre and postop

• Mini"ise pt blood sa"pling

Iron replacement - Clinical tip

• Following therapeutic doses of oral iron$ reticulocytosis should occurwithin 40 hours$ and hae"oglobin should rise by 9 g#, per day%about 05 g#, every C wees'$ but this varies fro" patient to patient.

https://www.bloodsafelearning.org.au/secure/mini-elmo/course/run/ctp/01-risks-and-benefits/10-other-treatmentshttps://www.bloodsafelearning.org.au/secure/mini-elmo/course/run/ctp/01-risks-and-benefits/10-other-treatments


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• 6t is reasonable to replenish iron stores by continuing treat"ent forC-D "onths %0-C "onths in children' beyond nor"alisation ofhae"oglobin.

Risks and frequenc

• High ;9955 "inor allergic reaction %urticarial'$ fever• Moderate 9955 – 99$555 Guid overload$ cardiac failure

• ,ow 99555 – 995$555 delayed hae"olytic reaction$ 2!/,6

• )ery low 995$555 – 9955$555 non-fatal acute hae"olytic reaction%wrong blood'

• Mini"al 9955$555 – 99$555$555 fatal acute hae"olytic reaction

%wrong blood'

• egligible 399$555$555 H6)$ H*)$ H2,)$ "alaria$ syphilis

Implementing the decisionhen the decision to transfuse has been "ade there are a nu"ber ofsteps that need to be followed. 2hese include

• Ensuring the patient:s infor"ed consent has been obtained and

docu"ented in the patient:s "edical record

•


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• !educes ris of specic types of transfusion reactions andtrans"ission of *M)

• 6n /us and J$ /,, red cells and platelets are

leucodepleted during donor collection process

• ashed red cells

• !e"oves unwanted plas"a proteins which "ay be thecause of allergic reactions

• /lso re"oves any white cells and platelets

• 6ndicated in pts with reactions to transfused plas"a

protein$ severe allergic reactions of unnown cause$ severereactions despite leucocyte depletion

"iming

• Argent – give as rapidly as pts circulatory syste" will tolerate

• on-urgent – 0 hours for adults$ but always within K hours of being

re"oved fro" the fridgeLconsider slow rate in pts at ris of circulatory overload %"a& K hours'L"ay have another rule of within K hours of co""ence"ent$ say in

neonates who re7uire a slower rate of transfusion#dministration

• /ll the checs – right patient$ right product$ right pac

• Special intravenous blood line$ which can be pri"ed with the blood

or #S %2 hart"ans$ ringer lactate or de&trose'

• Monitor closely for 9@ "inutes – pay special attention to the

develop"ent of any rash$ SB$ whee(ing$ tachycardia$ hypotensionincrease in te"perature %?9 degree is signicant' and co"pare to

baseline "easure"ents$ or generalised oo(ing %"ay reGect ongoing


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Transfusion reactions – Signs and symptoms

Adverse transfusion events can be life threatening. It is important to quickly recognise,

respond to and report any possible events. Signs and symptoms of immediate adverse

reactions include:1,2

• fever (e.g. ≥ 1 °C above baseline, if baseline ≥ 37 °C)

• chills

• urticarial rashUrticarial rash – a sign of an allergic reaction involving raised and itchy

areas of skin. Also known as hives.

• tachycardia, hypotension (shock)

• dyspnoea, wheezing

• rigors, chills

• nausea, vomiting

• back or chest pain

• haemoglobinuria, oliguria

• pain along the IV site

• uncontrolled bleeding or generalised oozing from IV sites or wounds (DIC)

anxiety, feeling generally unwell or a sense of impending doom.

What to do if transfusion reaction is suspected

• S2 transfusion i""eadiately

• /ct

• *hec vital signs

• E"ergency treat"ent if necessary

• Maintain 6) access %dont Gush e&isting line – use a new 6)

line if re7uired'

• *hec the right pac has been given to the right patient

• otify "edical oNcer and transfusion service provider

Documents

Blood Transfusion – BloodSafe Module