blood trans
Blood Transfusion Overview
Presenters:
Niobe Amoros (Transfusion Specialist Nurses)
Alison Rudd
Greg Pankhurst (Transfusion Practitioner)
Contact Information:
niobe.amorosrodriguez@nnuh.nhs.uk
transfusionpractitionerteam@nnuh.nhs.uk
Legal and Safety Framework for Blood Transfusion
Relevant Regulations:
Blood Safety and Quality Regulations 2005
Standards of quality and safety for blood
Collection and testing of human blood
Processing, storage, and distribution intended for blood transfusion
Serious Hazards of Transfusion (SHOT)
Establishment:
National haemovigilance scheme introduced in 1996
Key Features:
Reports incidents related to blood transfusions from all areas
Annual report highlights issues with practice and policies
Allows identification of common themes and trends through national participation
Reports are anonymized, ensuring that no patient or staff details are disclosed
Regulatory Oversight
Medicines and Healthcare Products Regulatory Agency (MHRA)
Responsibilities:
Report transfusion incidents to the MHRA
Inspects hospitals for compliance with Blood Safety and Quality Regulations 2005
Blood safety incidents reported via the Serious Adverse Blood Reactions and Events (SABRE) website
Blood Components
Types of components derived from blood donations:
Red blood cells (RBC)
Fresh frozen plasma (FFP) / Cryoprecipitate
Platelets
Red Blood Cells (RBC)
Characteristics:
Most commonly administered blood component
Storage conditions:
2-6 °C
Stored only in a designated blood bank with constant monitoring
Usage Guidelines:
Must start transfusion within 30 minutes of removal from fridge
Complete transfusion within 4 hours
Always use a filtered giving set
Fresh Frozen Plasma (FFP)
Storage:
Kept frozen below -30°C, thawed upon request
Guidelines post-thaw:
Can be stored in blood fridge for 24 hours
Must be used within 4 hours after removal from fridge
In specific cases (e.g., actively bleeding), FFP can be used within 5 days after thawing if kept in a blood fridge
Platelets
Storage conditions:
Kept in an agitator incubator at 22°C (never refrigerated)
Administration Guidelines:
Must follow established guidelines for prescription
Any deviations must be discussed with a Haematology consultant
Cryoprecipitate
Characteristics:
Kept frozen below -30°C and thawed upon request
Usage Guidelines:
Must be used within 4 hours of defrost
Must not be stored in a fridge
Blood Products and Additional Considerations
ANTI-D
Indications for Use:
Prevent sensitization to Rh-positive fetal cells
Prevent Hemolytic Disease of the Fetus and Newborn (HDFN)
Guideline Recommendations:
Routine antenatal prophylaxis with single dose at 28 weeks, or two doses at 28 and 34 weeks
Following potentially sensitizing events (e.g., bleeding, procedures), administration should occur within 72 hours
Some protection can still be offered up to 10 days if it was missed
Postnatal Use:
Administered within 72 hours if the baby is Rh-positive
cffDNA Testing
Description:
Tests for cell-free fetal DNA in maternal blood
Indications and Results:
Screens for fetal RhD status in RhD-negative mothers
Non-invasive testing for chromosomal abnormalities
Results interpretation:
Baby is D Positive: Continue with anti-D as normal
Result is inconclusive: Continue with anti-D as normal
Baby is D Negative: No further anti-D required this pregnancy
Fibrinogen Concentrate
Usage:
For major obstetric hemorrhage (MOH) when fibrinogen levels are low (<2 g/L)
Benefits:
Restores fibrinogen quickly without thawing cryoprecipitate
Virus-inactivated and available in powder form
Prescribed under the Massive Obstetric Haemorrhage protocol
Availability:
Not all hospitals stock it
Patient Identification and Safety Protocols
Patient ID and Blood Transfusion
Importance of Identification:
Printed wristband required for inpatients
Must include full name, date of birth (DOB), and hospital number
Must not proceed if discrepancies arise
Sample Labelling
Requirements for sample tags:
Full patient ID
Date and time of sample collection
Signature of the person taking the sample
Adhering to the two-sample rule
Pre-Transfusion Checks
Requirements Before Collecting Blood:
Patient informed about transfusion and has given consent
Patient has a wristband attached
Blood is prescribed
Observations within normal limits
Appropriate IV access available
Compatibility Checks
Details to Confirm Pre-Administration:
Patient ID must be verified verbally and via wristbands
Cross-check details against prescription and unit compatibility label
ABO and RhD groups must be identical on compatibility label and blood unit label
Pre-Administration Checks to Conduct
Confirm:
Expiry date
Condition and appearance of blood component
Any special requirements for the component
Equipment Needed for Blood Transfusion
Necessary Equipment:
Infusion pump
Blood giving set (170-200 micron filter to remove clots/cell clumps)
Blood tracking equipment (e.g., PDA and printer) if utilized
Monitoring During Transfusion
Observations
Key Parameters to Monitor:
Temperature
Heart Rate
Respiration Rate
Blood Pressure
Documentation:
Baseline and ongoing vital signs recorded (increased frequency if changes occur)
Transfusion Reactions to Monitor
Types of Reactions:
Non-haemolytic reactions
Allergic reactions
Haemolytic reactions
Anaphylaxis
Transfusion-associated circulatory overload (TACO)
TACO Checklist
Risk Assessment for TACO:
Is the patient at risk?
Consider factors:
Pulmonary oedema?
Impaired renal function?
Reduced cardiac function?
Body weight dosing for red cells
Historical factors:
Chronic anemia not actively bleeding?
Emergency Protocols
O Rh Negative Units
Usage:
O negative units administered when patient ABO group is unknown
Criteria for Major Obstetric Haemorrhage (MOH):
Actual or anticipated blood loss >1500 ml or >20% circulating blood volume
Blood loss rate >150 ml/min
Clinical signs of shock present
Maintain plasma fibrinogen levels >2 g/L during ongoing postpartum hemorrhage (PPH)
Major Obstetric Haemorrhage (MOH) - The 4 T's of PPH
Causes of PPH:
Tone
Tissue
Trauma
Thrombin
Massive Transfusion Pack Composition
Components:
4 units of O-negative red blood cells (RBC)
4 units of fresh frozen plasma (FFP) in a 1:1 ratio
Apheresis pack of platelets
Ideally include fibrinogen concentrate and prothrombin complex concentrate
Documentation Procedures
Legal and Professional Requirements
Importance of Documentation:
Must document all stages of transfusion legally and professionally
Complete electronic/paper prescription chart including start and end time of transfusion
Note any actions taken in patient notes
Reporting incidents and near misses is essential for risk management
Transfusion practitioners should report significant incidents to SHOT if necessary
Disposal Procedures
Guidelines for Disposal of Units and Equipment
If no untoward effect:
Save all empty bags until transfusion completion; dispose of in clinical waste and sharps container
If suspected reaction occurs:
Spigot current giving set and return with all unit bags to the blood bank for investigation
NICE Quality Standards (QS 138)
Issuance Date: December 2015
Key Statements:
Statement 1: Offer iron supplementation before and after surgery for iron-deficiency anemia
Statement 2: Offer tranexamic acid for surgery with expected moderate blood loss
Statement 3: Clinically reassess and check hemoglobin levels after each RBC unit transfusion unless patient is bleeding or on chronic transfusion
Statement 4: Provide verbal and written information about blood transfusions for those who may need or have had a transfusion
Conclusion
Our Vision
Commitment to providing the best care for every patient.
A reminder:
"Whatever you do, always give 100%, unless you’re donating blood."
Questions and Discussion
Open floor for any questions related to the material presented during the session.