Transfusion procedure

Although fussy, strictly laid down hospital protocols must be followed for administration of blood and blood products. Errors carry the potential for major morbidity or fatality.

1. Identity of label on each matched unit must match EXACTLY with the patient's identity.

2. The ABO and Rh groups on the blood pack and the compatibility report must correspond as must the donor number on the pack and compatibility form.

3. Units must show no sign of leakage or damage and be used within their expiry period.

4. The prescription of blood must be made by a registered medical practitioner and details of the product's administration must be recorded in the case record.

5. An IV line should be established and flushed with 0.9% saline solution before the pack is opened.

6. No drug or other infusion solution should be added to any blood component.

7. Monitoring of the patient involves recording temperature, pulse and blood pressure before transfusion, every 15 min for the first hour and hourly until transfusion is finished.

8. Adverse events should be recorded meticulously.

9. Major reactions require immediate cessation of the transfusion and instigation of a full investigative protocol (see Emergencies: Transfusion reactions, p 502-504).

10. Minor febrile reactions are not uncommon, their occurrence should be recorded, simple measures such as slowing the rate of infusion or 649 administration of an antihistamine may deal with the problem; if not transfusion of the specific unit should be stopped.

11. An RBC pack should be given within 30 min of removal from the blood bank; the target infusion time for an individual unit should be <4h.

May be given as prophylaxis against bleeding e.g. in patients undergoing intensive chemotherapy or to arrest overt haemorrhage e.g. in DIC. Platelets may be required to cover surgery and dentistry.

Indications for platelet transfusion 5 production due to Acute and chronic leukaemias BM failure/infiltration Myelodysplasia

Myeloproliferative disorders and myelofibrosis Marrow infiltration with other malignant tumours Post-chemotherapy or TBI Aplastic anaemia

4 platelet destruction

Hypersplenism 2° splenic infiltration or portal

in peripheral circulation

hypertension

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