BLOOD TRANSFUSION

A blood transfusion is a procedure that restores blood to the body. A healthcare professional will
pass blood through a rubber tube into a vein using a needle or thin tube. The sections below will
cover the different types of blood transfusion procedures available, as well as the different types
of blood.

Types of blood transfusions

According to the American Red Cross, there are four common types of blood transfusions:

 Red blood cell transfusions: A person may receive a red blood cell transfusion if they
have experienced blood loss, if they have anemia (such as iron deficiency anemia), or if
they have a blood disorder.

 Platelet transfusions: A platelet transfusion can help those who have lower platelet
counts, such as from chemotherapy or a platelet disorder.

 Plasma transfusions: Plasma contains proteins important for health. A person may
receive a plasma transfusion if they have experienced severe burns, infections, or liver
failure.

 Whole blood transfusion: A person may receive a whole blood transfusion if they have
experienced a severe traumatic hemorrhage and require red blood cells, white blood cells,
and platelets.

Before a blood transfusion, a healthcare professional will remove the white blood cells from the
blood. This is because they can carry viruses.

BLOOD COLLECTION AND BLOOD PRODUCT REQUEST    

ESSENTIAL EQUIPMENT

• Blood request form Procedure  

1. The following information must be completed on the request form.

(a) First name

(b) Surname
(c) Date of birth

(d) Gender

(5) Hospital identification number

(6) Ward or department

Full demographics are required to minimize the risk of patients with the same or similar names
being given the incorrect blood component .

Details on the request form must match the enclosed blood sample. Discrepant samples should
not be processed

2. Complete the following clinical information.

(a) Diagnosis

(b) Reason for request; this should include details of any surgical procedure

(c) Number and type of components requested.

(d) Any special requirements such as irradiated, cytomegalovirus (CMV) negative

(e) If group and screen only

(f) Date and time required

Enables laboratory staff to assess need against the surgical blood ordering schedule.

Some vulnerable patient groups may have a fatal reaction to wrongly transfused non-irradiated
or CMV-positive products Negative and positive status should always be written in full and not
as + or – as they may get defaced and be incorrectly processed . This allows laboratory staff to
plan ahead for complex cross-matches to ensure the required products are available at the correct
time .

Each request should also include:

(a) The name of the doctor/nurse requesting the components

(b) The name and signature of the person who has taken the blood sample.

Every step of the transfusion must be fully traceable and the record held for 30 years. (Should be
according to the hospital policy.)

The following information can also be included if it is available in the patient’s clinical record.

(a) Patient’s blood group

(b) Presence of known antibodies

(c) Date of last transfusion

This information is useful to laboratory staff.

PROCEDURE GUIDELINE

Blood sampling: pre-transfusion    

Essential equipment

• Antimicrobial skin cleanser – the recommended solution is 0.5% chlorhexidine in 70% alcohol

• Safety needle/winged infusion device

• Appropriate tubes for blood sample collection

• Gauze

• Hypoallergenic tape

• Non-sterile, well-fi tting gloves

• Sharps container

Pre-procedure  

1 Explain and discuss the procedure with the patient. To ensure that the patient understands the
procedure and gives their valid consent.

2 Take pre-transfusion blood from one patient at a time. To ensure that samples from different
patients are not confused which can have fatal consequences and to minimize this risk

3 Check all packaging before opening and preparing the equipment. To ensure there has been no
contamination and all equipment is in date.

Procedure  

4 Before taking the sample, ask the patient to state their first name, surname and date of birth.
Cross-check these details against the blood request form. For patients unable to identify
themselves, verification can be obtained from a care giver or relative if present. This information
must match the wristband and request form. To ensure that the sample obtained corresponds with
the request.

5 Check these details against the patient’s identity wristband. To ensure that the patient is
positively identified before obtaining a blood sample.
6 Check the patient’s hospital number on the wristband against that on the blood request form.
To ensure that the sample obtained corresponds with the request.

7 Obtain the blood sample by direct venipuncture or via central venous access device, in the
appropriate tube. To ensure the correct procedure is followed and an adequate sample is
obtained.

Post-procedure  

8 Hand-write the sample tube clearly and accurately, ensuring all names are spelled correctly.
This should only be done once the sample has been successfully obtained and should be done at
the patient’s (bed) side.

(a) First name (b) Surname (c) Date of birth (d) Gender (e) Hospital identification number (f)
Ward or department (g) Date - To ensure the sample is labeled with the correct patient details.
Blood tubes should never be completed in advance as this has been identified as a major cause of
patient identification errors .

Removal of blood components from their storage location continues to be identified as a major
source of error in the transfusion process . Only those staff who are authorized, trained and
competent may remove blood components from storage.

Essential equipment

• Documentation containing the patient’s three core identifiers – full name, date of birth and
hospital number/unique identifying number – must be held by the person removing the
component from storage

Pre-procedure  

1 Check that the reason for the transfusion has been documented in the patient’s notes. To ensure
the transfusion is appropriate and necessary.

2 Check that there is a valid written order for the administration of the component including
special requirements – CMV negative or irradiated components. To ensure the selected
component meets the patient’s individual requirements.

3 Check the patient is aware of and has ‘consented’ to the procedure. To ensure the patient is
fully informed.

4 Check the patient is available. To avoid delays once the component has been removed from
storage.
5 Take baseline observations to include blood pressure, temperature, pulse and respiratory rate.
To ensure that any transfusion reaction can be immediately identified, due to changes in baseline
and managed appropriately.

6 Check the patient has patent venous access. If not then ensure appropriate device is inserted.
To avoid any delay in commencement of the transfusion and adhere to ‘cold chain’ requirements
7. Check the patient is wearing an identification wristband. To avoid delays in confirming patient
identity

Procedure

8 Where possible, the same person who will administer the component should collect it from
storage. To minimize the number of people involved in the process

9. Remove one component at a time, unless rapid transportation of large quantities is needed or
if blood is being transported to remote areas in specifically designed validated blood transport
containers. If large quantities are required this must be discussed with the transfusion laboratory
and local procedures followed. To ensure components are stored in the appropriate conditions.

10. Check the component at the point of removal for correct patient-identifying details. A visual
inspection of the component should also be performed to check the expiry date and any signs of
leakage, clumping or discoloration.

11. In order to minimize the risk of incorrectly administering the component to the wrong
patient. Expired or damaged products must not be used .

12 Deliver the component to the clinical area where an appropriately trained and competent
member of staff should check that the correct blood has been delivered. To ensure the correct
component has been received for the patient, to comply with traceability and cold chain
requirements

The compatibility label is generated in the hospital transfusion laboratory. It is attached to the
blood bag and contains the following patient information:

Surname, First Name(s), Date of Birth, Gender, Hospital Number/Patient Identification Number,
Hospital and Ward.

The blood group, component type and date requested are also included on the label. The unique
donation number is printed on the compatibility label; this number must match exactly with the
number on the blood bag label. Compatibility label or tie-on tag. This is the unique number
assigned to each blood donation by the transfusion service and allows follow-up from donor to
patient. The unique donation number on the blood bag must match exactly the number on the
compatibility label. This section of the label gives instructions on storage conditions and the
checking procedures you are required to undertake when administering a blood component. It
also includes information on the component type and volume This shows the special features of
the donation, e.g. CMV negative Rh O POSITIVE The expiry date must be checked – do not use
any component that is beyond the expiry date. Shows the blood group of the component. This
does not have to be identical with the patient's blood group but must be compatible Group O
patients must receive group O red cells. Unique donation number Cautionary notes Special
requirements., Red Cells Signature

Once transfusion has been started, send the completed section below to the Hospital Transfusion
Laboratory. This is a legal requirement Donation Number: Component: Component: Date Given:
Time Given: I confirm that the above patient received this blood component Sign and Print
Name Peel off label above and place in patient's Medical Records

Always check patient/component compatibility/identity Inspect pack for signs of deterioration or

damage Risk of adverse reaction/infection

Essential equipment

• Written order for blood component transfusion

• Blood administration set with 170–200 μm macroaggregate filter

Pre-procedure  

1 Check that the component has been correctly ‘prescribed’, including any special requirements
such as irradiated or CMV-negative blood, and if the patient requires any other medications, for
example diuretic, premedication. To prevent incorrect blood component transfused (IBCT)
error: ABO incompatibility or non-irradiated CMV-positive products may cause a fatal reaction
if transfused. Negative and positive status should always be written in full and not as + or – as
they may get defaced and be incorrectly processed.

2 Check that the patient’s baseline vital signs, temperature, pulse, blood pressure and respirations
have been recorded. To ensure that any transfusion reaction can be immediately identifi ed, due
to changes in baseline , and managed appropriately .

3 Conduct a visual inspection of the component to be used for signs of clumping, discoloration,
damage or leaks. Expired or damaged products must not be used.

4 If there are any discrepancies at this point do not proceed until they have been resolved. To
ensure an IBCT (incorrect blood component transfused) event does not occur.

5 Positively identify the patient by asking them to state the following information. (a) First name
(b) Surname (c) Date of birth

If the patient is unable to positively identify themselves then verification can be given by a carer
or relative. This information must match the wristband exactly. This is the final check of identity
which must be performed next to the patient prior to transfusion and is absolutely vital in
minimizing the risk.

6 Check the details given against the patient’s name band and the patient details on the blood
component. To minimize the risk of error.

7 Check that the information on the compatibility label matches the details on the blood
component, checking expiry date, unique component donation number, blood group on the
component label against the laboratory-produced label. Check special requirements have been
met. If there are any interruptions during this checking procedure, the entire process should be
restarted from the beginning. To minimize the risk of error

Procedure  

9 Prime the set with blood/blood components unless there are concerns about patency of the
device, then prime with 0.9% sodium chloride. Other agents may damage the product
components and precipitate transfusion complications ; for example, dextrose should never be
used to prime a set or flush the blood administration set following a transfusion as this can cause
haemolysis .

10 Set up infusion via a volumetric infusion pump if appropriate. Check the infusion pump and
settings prior to use. To ensure the pump is in working order. Some older infusion pumps can
damage the red cells. Blood administration sets for specific infusion pumps must always be used.
If none are available, the standard blood administration set should be used via gravity and the
rate monitored as necessary.

11 Set the desired infusion rate as indicated by the blood component being used and the patient’s
condition. The rate of administration is indicated by the patient’s clinical condition and/or
dictated by current guidelines. Either: Red cell administration can range from 5–10 minutes in
acute blood loss to the maximum time of 4 hours (from the time the component is removed from
storage) in elderly patients .Platelets, fresh frozen plasma and cryoprecipitate should be
transfused over 30–60 minutes and must be completed within 4 hours of puncturing the blood
component.

12 Sign the written order ‘prescription’ as the person administering the component. The unique
component donation number, the date and start time should be recorded in the patient’s clinical
notes. To ensure that documentation and traceability requirements are met

13 Fifteen minutes after the commencement of each component, take and record patient
observations – blood pressure, temperature, pulse and respiratory rate. Follow local hospital
policy regarding how observations are documented but they should be easily identifiable as
being related to the transfusion. Adverse reactions will often occur during the first 15 minutes of
transfusion . Complaints of serious anxiety, transfusion site pain, loin pain, backache, fever, skin
flushing or urticaria could be indicative of a serious transfusion reaction . In such cases the
transfusion should be stopped immediately and urgent medical advice sought .

14 Observe and monitor the patient throughout the transfusion episode. If there are any concerns,
undertake additional observations as appropriate. To monitor for any adverse reactions .

15 Record the finish time of each unit. All units must be completed within 4 hours of removal
from storage. Continuation of a transfusion beyond 4 hours increases the risk of transfusion
reaction and complications

16 Take and record the patient’s observations on completion of each unit, ensuring that post-
transfusion observations are performed within 60 minutes of completion of the unit. To ensure
the patient’s progress is recorded and acts as a baseline for subsequent units

Post-procedure  

17. Record the time the transfusion finished and the volume of the component transfused on the
patient’s fluid balance chart. To ensure an accurate record of fluid is maintained as fluid balance
monitoring can identify fluid overload in at-risk patients.

18.Carefully fi le all transfusion documentation in the patient’s clinical record. In line with local
policy, return information on the final fate of each blood component to the hospital transfusion
laboratory. To ensure the transfusion episode has been recorded, maintaining the clinical record
for patient safety. Where the final fate of all blood components must be held for duration of 30
years.

19. Return any unused blood components to the laboratory promptly. To allow unused
components to be reallocated if returned in time. Refer to local guidelines.

20 If there is any suspicion of a transfusion reaction then the pack should be returned to the
transfusion laboratory with full clinical details. If the transfusion is completed uneventfully then
the empty pack and administration set should be disposed of according to local policy. To ensure
transfused bags are available in the event of incident investigation. Previously it was advocated
that empty packs be kept for a period of 48 hours to aid the investigation of severe post-
transfusion reactions. The benefits of this are unproven and it is associated with both practical
and health and safety concerns.

21. For patients receiving ongoing transfusion support, the blood administration set should be
changed at least every 12 hours, or after every second unit transfused. Dispose of used set in
clinical waste-To minimize risk from bacterial contamination.

Unknown unconscious patient.

 Do not transfuse unless clinically essential. In a major hemorrhage or emergency

situation, give O-negative red cells until the patient is allocated a unique hospital number.
  Assign unique hospital identification number to all requests and samples.

Major incident.

Do not transfuse unless clinically essential. As above if transfusion is essential. Use unique
major incident identification number for all requests and samples. The transfusion laboratory
also needs patient gender, minimum identification ‘unknown male/female’ and patient incident
or hospital number. Follow local policy for major incidents.

Problem Cause Prevention Resolution Patient unable to communicate verbally. Follow hospital
policy for identification of patients unable to confirm identity verbally. Consider the introduction
of photo identification card. Confirm identity with a relative or second member of staff

Ensure interpreting services are available if appropriate. Patient does not have a name band.
Name band has been removed or is no longer legible. Always follow local policy and never use
secondary identifiers such as bed numbers, notes or request forms that the patient may be
carrying. If a member of staff removes a patient’s identification band, they are then responsible
for ensuring that it is replaced. All inpatients are required to wear a name band; therefore, replace
name band and reconfirm identity.

PATIENT IS IN AN OUTPATIENT SETTING.

 Follow hospital policy for the identification of patients.

 Ensure patient has a correctly completed identification wristband prior to commencing a
transfusion. Unable to obtain verbal confirmation. Patient unconscious.
 Ensure hospital policy for the identification of unconscious patients is followed.
 Confirm identity with a relative or second member of staff or use unique patient
identifier. Patient unable to communicate verbally.
 Due to disease or language barrier.
 Follow hospital policy for the identification of patients unable to confirm their identity
verbally.
 Consider the introduction of photo identification cards.
 Ensure interpreting services are available if appropriate.
 Confirm identity with a relative or second member of staff.
 Always follow local policy and never use secondary identifiers such as bed numbers,
notes or request forms that the patient may be carrying.

Infusion slows or stops.

 Venous spasm due to cold infusion.

 Apply a heat pad prior to the transfusion to reduce venous spasm.
 Apply warm compress to dilate the vein and increase the blood flow.
 Occlusion.
  Check patency prior to administration.
 Always use a pulsatile flush ending with a positive pressure flush.
 Flush gently with 0.9% sodium chloride and resume infusion.
 If occlusion persists, consider reinserting cannula.
 Elevation in temperature of less than 2.0°C after commencing a unit of blood with no
other symptoms.
 Take history to identify whether patient has had a reaction previously.
 Observe the patient’s temperature, pulse and blood pressure during the transfusion as
indicated. If patient has no other signs and symptoms, give paracetamol and continue the
transfusion at a slower rate and observe more frequently.

SUMMARY

A blood transfusion is a safe procedure that replaces blood lost to injury or surgery. It can also
help treat certain medical conditions.Blood transfusions can be lifesaving, but they can cause
some mild side effects.Although infections are very rare, it is possible for the body to react to the
new blood. In most cases, however, these reactions are mild.