Administration of blood and blood components can be indicated to restore blood volume where there is inadequate tissue perfusion, to replace platelets, coagulation factors and other plasma proteins, as well as to increase the haemoglobin concentration and the blood oxygen carrying capacity.
Red Cell Concentrates – indicated for anaemia and acute blood loss: help increase oxygen carrying capacity through raising haemoglobin concentration in the patient. Can be stored in a temperature of 4 +/-2°C for 42 days (or for 28 days if irradiated). If unused or left for more than 30 minutes in the transport box, Red Cell Concentrates should be returned to the Blood Bank to minimise the risk of bacterial growth.
Fresh Frozen Plasma – indicated for warfarin reversal in a bleeding patient, in DIC (Disseminated Intravascular Coagulation) in a bleeding patient, or in Thrombotic Thrombocytopenia Purpura during plasma exchange. Can be stored in a temperature of less than -25°C for 3 years; must be used by 6 hours following thawing if stored in the blood transport box.
Platelets – indicated for massive haemorrhage / DIC, acute leukaemia, lumbar puncture, gastroscopy, biopsy, liver biopsy, laparatomy and eye operations: help prevent and/or treat haemorrhage in patients with Thrombocytopenia or Platelet Function Defect. Can be stored in a temperature of 22 +/-2°C for 5 days in an agitator. Platelets should be transfused immediately…they should NOT be stored outside the Blood Bank.
Special Requirements:
CMV (CytoMegaloVirus) Negative Blood: indicated for intrauterine transfusions, neonate transfusion (28 days post EDD) and pregnant women transfusion.
Irradiated Blood: indicated for intrauterine transfusion, BM/ stem cell transplantation, Hodgkin’s disease, etc.
Collection of Blood Units from HBB
Prior to blood units being collected from the Hospital Blood Bank, patient must be ready to be transfused: WEARING ID band; HAVING patent IV access; RECORDING of patient baseline observations.
Blood should be collected in the appropriate transport boxes with the necessary ice pack and separator. Platelets should NOT be packed with ice packs.
Collection should be done only when providing a legibly filled out Blood Issue Form.
Once collected, blood component should be delivered without delay to the responsible healthcare professional.
Procedure for Administration of Blood Products & Blood Components
- Decision – potential risks and benefits as well as alternatives to blood transfusion should be considered during discussion between the doctor and patient. Information should be given so the patient can make an informed decision (leaflet should also be given to the patient or relatives prior to transfusion).
- Prescription – blood components can only be prescribed by a medical practitioner.
- Collection – prescribed blood components should be picked up from the HBB (Hospital Blood Bank) ONLY when the patient is ready to be transfused (See Collection of Blood Units from HBB)
- Inspection – check expiry date, integrity of pack, discolouration or haemolysis, and that platelet pack does not show clumps or looks cloudy. Transfusion should be started immediately after being collected from HBB. DO NOT STORE in medicine fridges!
- Transfusion – only qualified healthcare professionals with transfusion training can transfuse blood components. Procedure must be performed by 2 healthcare professionals, both of who need to sign the Nurses Record – Blood Product Transfusion Form. Overnight transfusions should be avoided unless absolutely necessary. Blood components should be gently mixed prior to administration. The blood administration set used for transfusion should contain an integral clot filter for all blood components (170-200 µm -micrometer). Blood administration set should be primed with the blood component or 0.9% normal saline. Platelets should NOT be transfused through an administration set which has already been used for blood transfusion. DO NOT flush out the blood in the administration line once transfusion is finished.
- Administration Rate – RCC should be transfused over 90-120 minutes (less tolerant patients should be transfused at a slower rate with extra monitoring, not exceeding 4 hours of transfusion); Platelets should be administered over 30-60 minutes immediately following availability; Plasma should be infused at a rate of 10-20ml/kg/hr, not exceeding 4 hours of transfusion.
- Note – administration set should be changed at least every 12 hours in RCC and FFP transfusion. Transfusion completion should happen within 4 hours following removal from temperature controlled storage. RCC and FFP exposed to temperatures of over 40° may cause a severe transfusion reaction.
- End of Transfusion – wear gloves and remove empty blood bag and administration set (change set if infusion is to be continued); flush the cannula, document observations; fill in Traceability Form and send to HBB; dispose of blood administration set and bag in a yellow bag (clinical waste).
Patient Observation During Transfusion
- Patient should be monitored by regular visual observations which should also be documented, throughout the transfusion phase of each transfused unit.
- Record baseline observations of temperature, pulse, respiration and blood pressure prior to transfusion, 15 minutes into the transfusion and at the end of the transfusion plus more if needed.
- Transfusion reaction signs include: fever, nausea, respiratory distress, back/flank or IV site pain, skin changes, uticaria, diarrhoea, shaking, headache, hypo/hypertension, chest pain, urine colour changes, tachycardia, oliguria, jaundice, unusual feelings.
- Acute transfusion reactions include Acute Haemolytic Transfusion Reactions, Febrile Non-Haemolytic Transfusion Reactions FNHTR (mild or moderate fever, chills or rigors without any other known cause – if patient is otherwise stable administer paracetamol and restart transfusion at a slower rate), Acute Allergic & Anaphylactic Transfusion Reaction, Transfusion Associated Circulatory Overload (TACO), Transfusion Related Acute Lune Injury (TRALI) and Hypotensive Transfusion Reaction.
- Delayed transfusion reactions include Delayed Haemolytic Transfusion Reaction, Transfusion-Associated Graft-Versus-Host Disease, Post Transfusion Purpura and Transfusion Transmitted Infection.
- If transfusion reaction is suspected STOP/PAUSE immediately; report reaction to nursing officer, medical officer and the Blood Bank; assess airway, breathing and circulation and if need be call for resuscitation team; maintain venous access through slow normal saline administration; record observations (temperature, pulse, RR, BP, SPO2 and Urinary Output); if patient experiences temperature rise of <1.5°C, transfusion can be paused so patient can be administered necessary medication, and later on if symptoms subside can be restarted on transfusion.
- Document reaction time, signs and symptoms, name of consulted physician, treatment and patient response, and plan.
The law stipulates that “Member States shall ensure that blood establishments, hospital blood banks, or facilities retain the data for at least 30 years in an appropriate and readable storage medium in order to ensure traceability” – Directive 2005/61/EC
Below you can find a collection of videos that can help provide a more visual approach to Administration of Blood and Blood Components.
Blood Types, Blood Group Systems and Transfusion Rule – Animation
Blood Types Explained
Administration of blood and blood components
Administration of blood and blood components – Method
Special thanks to the creators of the featured videos on this post, specifically Youtube Channels Alila Medical Media, RegisteredNurseRN and The Rotherham NHS Foundation Trust.
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Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading awareness on the negative effects that domestic abuse leaves on its victims’ mental, emotional, social and physical wellbeing.
Claire aspires to continue studying following completion of her Nursing Degree, because she truly believes in lifelong education.
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