Safe Transfusion Practice Workbook
Safe Transfusion PracticeWorkbookDiana Agacy CowellSpecialist Practitioner of TransfusionPathologyCreated by dagacy1
Administration of Blood Components and ProductsSafe Transfusion PracticeTable of contentsLearning outcomesIntroductionSafe Transfusion PracticeAnatomy and physiology of bloodRed blood cells:Normal Haematology values:Platelets and Fresh Frozen Plasma (FFP):Normal Coagulation Screen values:ABO Blood GroupRh D Blood GroupHaemolytic disease of the new born:Sample TakingPre-collection checklistCollection and Transport of Blood ComponentsReceipt of blood components in the clinical areaAdministration of Blood components 6‘Final bedside check’Transfusion rate:Care of patient being transfused 9Observations required for a Blood TransfusionEnd of transfusion: Disposal of empty packsPROCEDURES6Preparing for a transfusionChecking the blood componentTransfusion of plateletsTransfusion of FFPTransfusion of red cellsPATIENT MONITORINGIf there has been a reaction do not discard the pack (see page 29‘Procedure following reactions’)Procedure for reporting adverse reactionsTypes of reactionsProcedure following reactionsAppendix 1: Equipment Required for Transfusion 5Cannulae / Venous Access DevicesBlood Giving Sets / Blood Administration SetsInfusion PumpsPressure devicesBlood WarmersAppendix 2: Adverse Reactions to a Blood Transfusion 5Recognition of an acute adverse reactionsTypes of Acute ReactionsAppendix 3:MCQGlossaryReferencesCreated by 2728292930313134353535363636373737404244462
Learning outcomesUpon completion of this chapter, the reader should be able to accomplish thefollowing:1. Define the purpose of a red cell transfusion, platelet transfusion and aFresh Frozen Plasma (FFP) transfusion.2. Demonstrate a basic knowledge of the ABO and the Rh D bloodgroups.3. Identify the various stages of the Blood Transfusion Process.4. Identify the difference between a Group & Screen sample and a CrossMatch sample, and the correct process of labelling these samples.5. Identify the correct procedure of collection and transportation of bloodcomponents.6. Identify the equipment required for a blood transfusion.7. Explain the safe process for the administration of different bloodcomponents.8. Discuss potential adverse reactions to a blood transfusion.9. Discuss the risks of blood transfusion and identify the biggest risk oftransfusion. Explain how this risk can be completely eliminated.Created by dagacy3
IntroductionIn an acute hospital setting the transfusion of blood components and bloodproducts is an integral part of everyday life however it is a finite commodity aswe rely on voluntary donors for its supply.The National HaemovigilanceOffice states that blood components and products are life saving and whenused appropriately they will improve the quality of life in a large range ofclinical conditions. However, it is also widely recognised, that as in any otherclinical intervention, there are a number of risks associated with this therapy,transfusion transmitted infections (TTI) and human error. The quality of bloodhas been given precedence over that of human error due to the impact ofhepatitis, human immunodeficiency virus (HIV) and more recently variantCreutzfeldt-Jakob (vCJD) disease. However in the last decade the SeriousHazards of Transfusion (SHOT) scheme1 has attributed most major incidentsto human error.Safe Transfusion Practice relies on collaborative teamwork, as bloodtransfusion is a complex, high risk and multi-step procedure. The TransfusionProcess crosses several professional boundaries and involves manyindividuals. There are at least 23 stages between taking a pre-transfusioncompatibility blood sample, the recipient receiving their transfusion and thecompletion of the transfusion.2 Six different professional groups intervene atdifferent stages of the process and with each stage there is the potential oferror.In 2005 when the European directive for blood was transcribed into Britishcriminal law as the Blood Safety and Quality Regulations (2005)3 it became alegal requirement that every unit issued for transfusion had to be fullytraceable from donor to recipient, vein to vein traceability.The healthprofessional responsible for communicating the final fate of every unit in theclinical area is the responsibility of the nurse as they are invariably the onesthat administer the transfusions on the wards.To make this process easiermost hospitals, if they have not already, are in the process of implementing anelectronic tracking system to meet the above requirements. The laboriousCreated by dagacy4
paper systems, which might be still in use in some hospitals, are unreliableand few have achieved 100% traceability as they rely heavily on the healthprofessional remembering to sign, date and return the traceability slip.Despite this change from paper to electronic systems the transfusion processwill remain the same and the same safety steps will need to be followed.With the transcription of the EU Directive on Blood Safety and QualityRegulations in to British criminal law also came a new Haemo-vigilancescheme which is monitored by the MHRA (Medicines and HealthcareProducts Regulatory Agency) known as S.A.B.R.E. (Serious Adverse BloodReactions & Events). This new scheme works alongside SHOT.Created by dagacy5
Safe Transfusion PracticePatients should not be exposed unnecessarily to blood components andproducts as there is always the potential risk of transfusion transmittedinfections, those that we are aware of and those yet to be discovered.Therefore it is important to check the most recent haemoglobin result andassess the patient for signs of anaemia. If the patient is not actively bleeding,infection free and haemodynamically stable, query the transfusion, protectyour patient. Remember the use of blood requires a conservative approachas the safest transfusion is the one not given. It is important to follow procedure even though at times it can be quiteprescriptive but the evidence demonstrates that when we disregardprocedure errors occur.Created by dagacy6
Anatomy and physiology of bloodBlood is a highly specialised circulating tissue consisting of several differenttypes of cells suspended in a straw coloured fluid called plasma5.Cellular ConstituentsRed cells or erythrocytesWhite cells or leucocytesPlatelets or thrombocytesFunctionCarry respiratory gases and give it its red colourbecause they contain haemoglobin, an ironcontaining protein that binds to oxygen in thelungs and transports it to the tissues in the body.Fight infectionCell which play an important part in the clotting ofbloodThe main components transfused are red blood cells (Rbc), platelets, plasma(non-cellular) and cryoprecipitate (non-cellular). In this chapter we will focuson the first three as they are the most commonly used components.All components and products are derived from whole blood.Red blood cellsWBC and plateletsPlasma45% 1%55%Whole bloodPicture 1PlasmaPicture 2Created by dagacyRed cellsPicture 3PlateletsPicture 47
The National Blood Service (NBS), part of the National Health Service Bloodand Transplant (NHSBT) take whole blood from voluntary donors. Thesevoluntary donations are then processed, to provide us with the componentswe see in hospital 5.Fresh Frozen Plasma(plasma)Packed red cells(red blood cells)PlateletsBlood components Picture 5Red blood cells:Red cells are prescribed to treat anaemia and haemorrhage.Causes of anaemia: Iron deficiency Vitamin B 12 deficiency Folate deficiency Bone marrow failure Secondary to chemotherapy. Slow bleeding, especially from gastro-intestinal tract.The diagnostic test used to detect anaemia is the ‘Full Blood Count’ (FBC).One of the indices measured by this diagnostic test is the level ofhaemoglobin (Hb) and it is this Hb level that is used to quantitate the degreeof anaemia.The FBC is a valuable test for the diagnosis of anaemia as it provides othervaluable data which Haematologist use to differentiate between types ofanaemia.Normal Haematology values:Table 1Haemaglobin (Hb)MaleFemaleg/dl13-1812-16AdultCritical valuesx109 /litre150-450 30 or 7100Platelet/thrombocyte countCreated by dagacy8
Red cells are stored in refrigerators in the Blood Transfusion Laboratory (BTL)or in designated refrigerators, often referred to as satellite blood banks orsatellite refrigerators. The temperatures of these refrigerators are strictlymonitored in order to preserve the quality of red cells. It is important tomaintain red cells at 2 o to 6o C. Therefore under no circumstances should redcells ever be stored, even for a short period, in the ward refrigeratorPlatelets and Fresh Frozen Plasma (FFP):Platelets and FFP are prescribed to treat a coagulopathy. That is to stopexcessive internally or externally bleeding or in some circumstances toprevent bleeding.The FBC provides us with the number of circulating platelets (Table 1). Whilethe diagnostic test ‘Coagulation screen’ (CS) will indicate if FFP is requireddepending on the International Normalised Ratio (INR).Normal Coagulation Screen values:Table 2International NormalisedRatio (INR)MaleFemaleCritical values0.9 – 1.20.9 – 1.2 5FFP is stored frozen, hence the name, in the BTL and is defrosted before it issent to the clinical area.Platelets are stored in an incubator at approximately 22o C on a ‘rocker’. Thegentle motion of the rocker prevents the platelets from aggregating.Platelets should never be stored in a refrigerator.Platelets and FFP are ordered on a named patient basis.Patients borne after January 19967In order to minimise the risk of transmitting new variant CJD these patientsshould receive pathogen reduced FFP sourced from outside the UK. Thiswould either be methylene blue or solvent detergent treated FFP (Octaplas).Created by dagacy9
Blood groupsThere are many blood group systems along with their sub-groups but at thisstage we will limit our attention to the two most clinically significant bloodgroups, the ABO and the Rh D blood systems. All blood groups are inheritedand there are two ways of reporting the ABO blood group, the genotype or thephenotype. The latter is the most common of the two.ABO Blood GroupGenotypePhenotypeDadMumA OBODanielOLisaOMaryABRecipient/PatientABOBlood GroupDonor red cellsCompatible with:Donor FFPCompatible with:Donor plateletsCompatible with:AA or OA or ABA or B or OBB or OB or ABB or A or OABAB, A, B, OABA or B or OOOO, A, B, ABO or A or BTable 3The table 3 shows which blood group each recipient is compatible or suitablewith depending on the component they need.Created by dagacy10
This choice is dictated by a substance that is present or absent on the redcells of the recipient.People who are blood group A have an ‘A’ substance (antigen)on their red cell membrane. This ‘A’ substance stimulates theproduction of Anti B Antibodies that will circulate in plasma.The function of these antibodies is to defend the body from Bantigens which are present on the surface of B red cells and ABred cellsAPeople who are blood group B have a ‘B’ substance (antigen)on their red cell membrane. This ‘B’ substance stimulates theproduction of Anti A Antibodies that will circulate in plasma.The function of these antibodies is to defend the body from Aantigens which are present on the surface of A red cells and ABred cellsBPeople who are blood group AB have both the ‘A’ and ‘B’substances (antigens) on their red cells. The presence of boththe substances prevents the stimulation and therefore theproduction of Antibodies in plasma.ABPeople who are blood group O do not have ‘A’ or ‘B’ substance(antigens). Hence they produce A,B Antibodies in plasma.OThe rationale for producing the specific antibodies is to defend the body fromwhat is foreign to it.Example: Elizabeth is blood group A and needs a red cell transfusion.John is blood group B and wants to donate blood to give to Elizabeth.However if John’s red cells are transfused to Elizabeth the anti Bantibodies in Elizabeth’s plasma will destroy John’s donated B red cellscausing haemolysis.This will make Elizabeth very ill and it can be fatal.Elizabeth can only receive type A or O red cellsThe absence of AB antigens on O red cells make them safe totransfuse to A, B or AB recipients.Created by dagacy11
Rh D Blood GroupIn the past, though you will still hear the term used, this blood group wasreferred to as the Rhesus blood group. However, the term Rhesus refers tothe species of monkey in which a similar antibody to that of the human versionwas discovered. Using the previous example both blood groups would bereported as:Elizabeth is ‘A negative’ or ‘A Rh D negative’John is ‘B positive’ or ‘B Rh D positive’Negative means the absence of the Rh D factor on the surface of the red cellmembrane. Those that have this factor on their red cells are said to be Rh Dpositive.However, unlike the ABO antigens, the antibodies against the Rh factor aredeveloped either through placental sensitisation or transfusion. That is aperson who has never been exposed to the Rh D antigen will not posses theRh D antibody e.g.Haemolytic disease of the new born:MotherRh D negBiological fatherRh D positiveFoetusRh D Pos or neg ?Rh status of the baby is unknown until it is bornIf the foetus is Rh D negative like the mother there is no problem but if thefoetus is Rh D positive there could be a problem. Usually if it is the firstpregnancy the child is born without any problems however the risk increaseswith future pregnancies. The problem occurs when the baby’s blood (RH Dpositive) crosses the placenta into the mother’s circulation. When this occursthe mother can become sensitised and her immune system will produce Rh DCreated by dagacy12
antibodies. These Rh D antibodies will attack an Rh D positive foetus causinghaemolytic disease of the foetus and of the newborn.1.MumRh D negDadRh D positiveFoetusRh DPos or neg ?2.MumRh D negFoetusRh D Pos3.MumRh D neg *Y*Foetus *Rh D Pos YYYHaemolysis**Y antibodies* red cell breakdownSome cases may warrant an intrauterine transfusion. If the baby is born witha high billirubin count caused by haemolysis the baby will require anexchange transfusion. In order to avoid this Rh D negative pregnant womenCreated by dagacy13
are offered preventive treatment with Anti D immunoglobulin however as it is ablood product some women refuse this treatment.Therefore it is important to always transfuse the right Rh D blood group. If achild or adolescent is Rh D negative they must always receive Rh D negativered cells and platelets. There can be exceptions to this rule during a majorincident or severe donor blood shortage however this is beyond the scope ofthis chapter.The Rh D status does not affect the transfusion of FFP or cryoprecipitate.The Transfusion ProcessSample TakingThe transfusion process begins the moment a pre-transfusion sample istaken. For this purpose a request form indicating the nature of the testrequired must completed:JH NH AEM07 89 12 3S hep h ardJo hn25/ 07/ 078. 45Pr e - op , t o ns il le ct o m yDAC12 /0 3/1 96 0S pr ing fo rd clo s eS W1 6P TG ro u p & Scr e e nD r. H G reen2457A group and screen/save is required for the transfusion of all components.Created by dagacy14
For a cross-match the time, date and number of units required must bespecified on the request form. This test is requested when a patient requires ared cell transfusion.Before taking a blood sample the person taking the sample must first obtainthe patient’s or carer’s consent to take the sample and inform them of thepurpose of the test.Use an open-ended question to identify the patient? Are you Tommy Smith? XIs this Tommy Smith? X Can you tell me your full name and date of birth? Can you tell me this person’s full name and date of birth? All blood samples for the BTL must have the following information:Patient’s: Forename Surname Date of birth (DoB) Hospital number or NHS number Gender The person taking the sample must sign, date and time the sample tube aswell.The sample label must be completed by the person taking the sample beforeleaving the patient’s side or in outpatient clinics before the patient leaves theroom.Created by dagacy15
The labelling of blood transfusion samples in the event of a major incident orfor unknown/unconscious patients vary at different hospitals. The reader isadvised to find out what the local policy is for these situations.Once all of the above has been completed send the sample to the BloodTransfusion Laboratory (BTL).No Identification wristband no transfusionPre-collection checklist1. Patient is ready for the transfusion2. Prescription on Transfusion Record, must include rate, date andprescriber’s signature3. Concomitant drugs are prescribed on the Drug Chart4. IDENTIFICATION WRISTBAND in situ5. Test patency of cannula6. Do your baseline observation7. Equipment required for the transfusion (Appendix 1): Transfusion giving set Pump (see hospital policy) Protective equipment, usually just gloves and apron, as per hospitalpolicy. 0.9% saline flush for intravenous access.Collection and Transport of Blood ComponentsAll blood components must be transferred from the site of collection e.g. BTL,satellite blood bank etc to the clinical area in a box or non-transparent bag.Blood components must be transferred directly from the collection point to theclinical area and the person who receives the unit on the ward should take itdirectly to the patient’s side in order to begin the transfusion immediately.Blood components should only be collected or requested for delivery when thepatient is ready for the transfusion in order to avoid wastage.Created by dagacy16
To collect any blood component the person doing the collection must take fourpoints of patient identification (PID) to the blood bank and check these to theLaboratory register, compatibility tag and National blood service label:a)b)c)d)ForenameSurnameDoBHospital number/NHS numberCollecting Red Cells from a blood bankfridge213Best PracticeIs when theclinical area takesthe responsibilityto collect bloodfrom thedesignated bloodbankor return it1. Check patient details on TR to Lab register2. Check 14 digit unit number to Lab register3. Check 14 digit unit number on compatibility tag to unit number on bagand confirm patient details are exactly the same on the TR, Lab.Register and compatibility tag.Created by dagacy17
Receipt of blood components in the clinical areaBest practice is for the nurse who is going to administer the blood transfusionto go and collect the blood component. However, sometimes the collection isdelegated to a porter, health care assistant or another nurse.The nurserequesting the collection is responsible that the right unit is collected andtherefore must provide the person delegated to collect the component withfour points of patient identification. We recommend that the TR is used ascollection slip though an electronic picking slip will be used when electronicblood track is implemented.If it is a porter who is delivering the blood it is best practice for the nurse whorequested the collection to sign the receipt of delivery. The receipt slip shouldinclude PID and the time of collection and delivery to the clinical area.It isimportant to patient safety and therefore the responsibility of the nurse tocheck that the blood component being delivered is the right one for the rightpatient.‘Right Blood, Right Patient, Right Time’Avoid night transfusions (SUHT Blood Transfusion Policy), this meansany transfusion that commences on the night shift, in any clinical area.Night transfusions must be limited to emergency situations only e.g.massive trauma or massive haemorrhage.The blood component must never be left unattended.On delivery to theclinical area the unit should be checked at the patient’s bedside. NOT AT THENURSE’S DESK OR TREATMENT ROOM, this is bad practice and has beenCreated by dagacy18
the cause of severe morbidity and even mortality. As soon as the checkingprocedure has been completed the transfusion must be commenced.In some hospitals a single registered nurse may check and administer thecomponent. While in other hospitals two registered nurses are required forthe checking process however each nurse must check the details individuallyin silence and then sign the relevant paperwork.Created by dagacy19
Administration of Blood components 6‘Final bedside check’Step 1:Check 14 digit donation number on the NBS unit label to the Unit IdentificationLabel, if they matchStep 2:Check patient information on Unit to Identification Labelto patient’s ID wristband, if the information matchesStep 3:Prime the line with the blood component at the patient’s bedside/side andcommence the transfusion.Step 4Return compatibility tag to BTL as per policyN.B See Appendix 3Created by dagacy20
Transfusion rate:Red cells: For non-emergency transfusions the transfusion of red cells mustfinish within 4 hours from the time the unit was taken out of the fridge. Mostred cell transfusions can be prescribed over 2 – 3 hours.Platelets: Over 30 minutesFFP: Over 30 minutesCare of patient being transfused 9Observations required for a Blood TransfusionOne UnitTwo Units and moreBaseline ObservationsBaseline observations (taken at the end oftransfusion of previous unit)At 15 minutes following startAt 15 minutes following start of each unitAt end of transfusion (this will form the baselineobservations for 2nd unit etc.)At the end of each unit. Further observations will depend on the clinical condition of the patientor if the patient becomes unwell or shows signs of an adverse reactionto the transfusion. Unconscious patients can be difficult to assess for signs of adversereaction to the transfusion and must be closely monitored during thefirst 15 minutes of each unit for any visual or vital sign changes. It is good practice to remain with the patient for the first 15 minutes ofevery unit transfused as this is when the majority of reactions occur.This is why some text books recommend that the rate of transfusionduring the first 15 minutes should be slower than the prescribed rate.Once the 15 minute vital signs have been checked and no change hasbeen observed from the baseline than the rate can be increased to theprescribed rate.Created by dagacy21
It is important to physically observe the patient at regular intervalsduring the blood transfusion and to warn the patient or carers to informa member of staff immediately should the patient become agitated ordevelops a rash etc. (Appendix 2)End of transfusion: Disposal of empty packs Empty packs should be kept on the ward until the current transfusionepisode (one or more units in one session) is complete.If thepatient’s observations have remained stable and no there have beenno signs of an adverse reaction the empty packs maybe disposed ofin ward clinical waste.Created by dagacy22
PROCEDURES6Preparing for a transfusionNo.12ActionConsenta) Formally identify the patient.Explain the procedure to thepatient/carers.b) Assess for any history ofreactions.c) Obtain verbal consent from thepatient/carer for the transfusionto take place.d) Document in TransfusionRecord (TR) or in patient’smedical notese) Give information to thepatient/carer and the need toreport problems, about thepotential side effects oftransfusion such as anaphylaxiswhich may present as shivering,flushing, shortness of breath,pain in loins or feelings ofagitation.RationaleTo establish positiveidentification.To prevent any reactions.Give patient/carer informationleaflet to read to enable themto have a full understanding ofthe procedure (Essence ofCare, DOH 2001)6.Patient/carer informed aboutpotential hazards oftransfusions and report earlyindications or reactionsMedication Preparationa) Under no circumstances are drugsTo comply with professionalto be added to any bloodstandards of practice.component / product.b) If Paracetamol, Chlorphenamine orHydrocortisone to be given as coverprior to transfusion or in the event ofa transfusion reaction occurring thismust be prescribed by the doctorprior to transfusion commencement.c) Check that the component/producthas been prescribed on theTransfusion Record to ensurecorrect transfusion of bloodproducts.d) Do not prime giving sets withnormal saline 0.9%. Do not flushgiving sets post transfusion withnormal saline 0.9%.Created by dagacyTo ensure correct transfusiongiven.23
NoAction2Medication Preparation (continued)e) Blood must be prescribed on aPrescription Chart or TransfusionRecord (TR) that contains thepatient’s ID number, surname, firstname and date of birth.f) The prescription must state thename of the blood component/product to be transfused, thevolume to be transfused, rate oftransfusion.g) A unit of red cells is usually givenover a minimum of 1 hour and amaximum of 4 hours.h) A unit of platelets or FFP is givenover 30 minutes.3Cannulation or Central Venousaccessa) Cannulate the patient accordingto Cannulation Policy. Ensurecannula is patent.b) The choice of cannula used forthe procedure should be dependon the individual and the desiredrate of infusion.c) Assess the need to flush thecannula (using a pulsating flush)according to policy, prior totransfusion and followingprocedure.d) Secure with non-allergic tape orIV dressing depending on choiceof cannula.e) Ensure cannula is well secured.RationaleAppropriate cannula is usedand individual patient needsaddressed.To keep cannula patent andtherefore stop blocking.Reduces the need for extratrauma to the patients.To avoid blood wastage ifaccess unobtainable.Baseline Observations4a) Take the patient’s temperature,pulse, respiratory rateTo have baseline vital signsand/oxygen saturation and blood recorded and ensure that thepressure prior to transfusionpatient is fit for transfusion.commencing.b) Document on Observation chartor specific Transfusion Record.If using ordinary observationchart highlight that the vital signscorrespond to those recordedduring a blood transfusionCreated by dagacy24
5Collection or receipt of bloodcomponenta) To collect any blood componentthe person doing the collectionmust take four points of patientidentification (PID): ForenameSurnameDoBHospital number/NHS numberb) The nurse requesting thecollection must provide the persondelegated to collect the componentwith the four points of patientidentification.Created by dagacy25
Checking the blood componentNo.Action1Formally identify the patient and ensurethat the information matches theTransfusion Record.Rationale2Check that the 14 digit number on thebar-coded National Blood Service (NBS)label matches the compatibility tag (CT)(luggage tag label attached to the bag).4Start time of unit must be recorded onpeel off section of CT, once the first fewmls have been transfused.5The third section of compatibility tag(CT) needs to be torn off and completedonce the transfusion has started ideallywhen doing the 15 minutes observationpost commencement.6The third section must be returned to theblood transfusion lab. This is a legalrequirement under the Blood Safety andQuality Regulations 2005.Vein to vein traceability7Fill in the time of arrival of bloodcomponent/product in clinical area.Tracking of blood from BloodBank to recipient.8Each blood component/product must beinspected for defects prior to theirinfusion. Particular attention should bepaid to the followinga) Integrity of packb) Discolourationc) Presence of clotsFaulty products will not beinfused.Created by dagacyThe correct unit of blood willbe given.26
Transfusion of plateletsNo.Action1Transfusion of platelets should becommenced as soon as possiblefollowing collection/receipt in the clinicalarea.RationaleThis component is used tostop bleeding.2Always administer platelets before a redcell transfusionPlatelets are given first in theblood transfusion process asthey act to stop bleeding.3Platelets are stored at room temperature(Ideally 22 oC but can be between 2024). Platelets should never be storedin a refrigeratorPreserve the maximumactivity of platelets4If possible use a platelet giving set.5Agitate platelets before administering.These giving sets areshorter and it maximisesthe volume infused,therefore there will a betterincrement and it is morecost effective.To prevent clumping.6Platelets are administered rapidly over30 minutes. Carry out visualobservation for rashes, level ofconsciousness and change inrespiratory rate. Monitor temperature,pulse and blood pressure as for bloodtransfusion.As platelets are deliveredrapidly, a reaction ispossible.7Proceed as for blood transfusion.Platelets are more likely toreact than red cells becauseof the temperature at whichthey are stored.Created by dagacy27
Transfusion of FFPNo.Action1Transfusion of FFP should becommenced as soon as possiblefollowing collection/receipt in the clinicalarea.RationaleThis component is used tostop or avoid bleeding bycorrecting the INR.2Always administer FFP before a red celltransfusionFFP are given first in theblood transfusion process asthey act to stop bleeding.3FFP should be returned to the BTLwithin 30 minutes if it is not going to betransfused.Preserve FFP up to 24hours, reduces wastage4Use blood component giving set.6FFP is administered rapidly over 30minutes. Carry out visual observationfor rashes, level of consciousness andchange in respiratory rate. Monitortemperature, pulse and blood pressureas for blood transfusion.As FFP is delivered rapidly,a reaction is possible.7Proceed as for blood transfusion.FFP are more likely to givean allergic reaction owing toplasma proteins.Created by dagacyIt has the correct filter28
Transfusion of red cellsNo.Action1Transfusion must commence no longerthan 30 minutes after delivery to theward area.RationaleMaximum time of transfusion4 hours from time out offridge.Avoid wastage2The red cells can only be used for theperson who is named on thecompatibility tag.3If time out
compatibility blood sample, the recipient receiving their transfusion and the completion of the transfusion. 2 Six different professional groups intervene at different stages of the process and with each stage there is the potential of
7.1 Guidelines for recognition and management of acute transfusion reactions 28 7.2 Investigating acute transfusion reactions 29 7.3 Haemolytic transfusion reaction 30 7.4 Bacterial contamination and septic shock 31 7.5 Transfusion associated circulatory overload 31
College of American Pathologists 2019 Surveys & Anatomic Pathology Education Programs. Transfusion Medicine, Viral Markers, and Parentage Testing. Subsection Name Program Code Page(s) Transfusion Medicine Quality Cross Check—Transfusion Medicine JATQ 220 Viral Mar
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9.3. The compatibility label/tag shall remain attached to the blood component or blood product until the transfusion is complete. 10. A policy shall be established for patient monitoring pre, during and post transfusion. 10.1. The recipient shall be observed for changes in status pre, during and post
The American Academy of Blood Banks recommends single-unit red cell transfusion protocols across medicine to reduce transfusion complications and the use of a scarce resource. There are minimal data regarding single-unit pro-tocols within obstetrics. Key findings A single-unit transfusion protocol reduced the mean number of units transfused
laboratory practices (GLP), good manufacturing practices (GMP) and moving towards total quality management is vital for organization and management of Blood Transfusion Services. I would like to acknowledge the contribution made by the experts in Transfusion Medicine as membe
TRIGGER was a pragmatic, cluster randomised trial of a restrictive versus liberal RBC transfusion policy in adults with AUGIB in the UK, conducted to inform the feasibility and design of a phase 3 trial. Due to the need for immediate implementation of a RBC transfusion policy from first presentation until discharge, across several specialty
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