CHIN ANNRIE EIDWINA B1

Management Of Blood Transfusion

1. Pretransfusion test:

Consideration for the therapy:

i.
Does the patient need blood products.
ii.
What are the alternative options for treatment.
iii.
Using the product that will be most effective in providing the desired outcome.
iv.
Cost.
v.
Minimum donor exposure.
vi.
What is the patients view of treatment.

Reference material in decision making for patient therapy.

i.
Patient clinical details and presentation.
ii.
Up to date blood results.
iii.
Transfusion history and any adverse events.
iv.
Drug history and dosage.
v.
Colleagues, patient, nursing staff, family members are a viable source of information.
vi.
Transfusion policy and practitioners, lab staff.

Specimen collection
i.
Sample should be collect no more than 3 days before transfusion unless it is known that
the patient has not been pregnant or transfused within the preceding 3 months.
ii.
Pretransfusion may be collected during the preceding outpatient visit.
iii.
One option is required that is the patient have to wear a identification wristband
iv.
Other alternative: assign unique number to pretransfusion specimen

ABO, Rhesus (D) typing and screening for unexpected red cell antibodies.
i.
If antibody screen is positive, antibody identification tests should be performed.
ii.
Result of current testing should be compared to records of previous testing.
iii.
Clinically significant red cell antibodies may become undetectable over time but will
cause delayed haemolytic owing to an anamnestic reponse
iv.
Therefore, a history of a clinically significant red cell antibody should be honoured by
providing only antigen negative red cell for transfusion.
v.
For new born, they do not have or lack of isohemagglutinons.Expected ABO antibodies
not present until 6 months of age.Recently transfused patients may show a mixture of
circulating red cell if they have not receive ABO identical unit.
vi.
In urgent cases, selection of O rded cell and group AB plasma usually is safe.

Crossmatch
i.
Purpose of crossmatch: final check of ABO compatibility and to a lesser extent, detection
of unidentified antibodies.
ii.
Major crossmatch is performed between recipients serum or plasma and donor red cell
iii.
Minor crossmatch is between recipients red cell and donor or plasma.
iv.
Crossmatch can be performed by direct agglutination for detection of ABO compatibility.
v.
If unexpected red cell antibodies are present, crossmatch shoulf be performed by
antiglobulin technique.
vi.
For antibodies that judge to be clinically significant, antigen negative cell are selected for
crossmatch.

2.Transfusion Administration
Accurate identification of component and intended recipient
i.
2 unique identifier name and registration number and comparison with permanent
identifier which is wrist band

CHIN ANNRIE EIDWINA B1

ii.
iii.
iv.
v.

Unit identifier on the blood container should be checked

Verify compatibility of blood, expire time and date of blood component.
Required 2 qualified individuals to perform identify check before transfusion
Patients consent and doctors order should also be verified

Blood component should be administered through a filter

i.
Administration sets should contain a drip chamber, attached compatible intravenous
solution and a mean to control the flow rate.
ii.
During surgery it is routine practice to add a microaggregate filter through which the
blood component flow first.
iii.
Care should be taken to avoid admixture of blood with incompatible. Eg: solution
iv.
It is desirable to adminster refrigerated blood components through a blood warming
device. This is due to if transfusion of cold components is faster than 100mL per minutes
may increase risk of cardiac arrest.
Desirable of administration depend on the patients blood volume,cardiac status and
hemodynamic state
i.
Transfusion should be started slowly( approximately 2mL /min for the first 15 min)
ii.
Patient should be carefully onserved the first 15 min of incusion. Subsequently, the rate of
administration will increased.
iii.
During the transfusion the patients vital sign should be checked at regular interval, and
any suspected reaction should prompt interruption of transfusion and immediate
investigation.
3.Transfusion reaction

Febrile nonhemolytic reaction

Allergic reaction
Acute hemolytic reaction
Delayed hemolytic reaction
Transfusion related acute lung injury( TRALI)
Graft-versus-host disease
Hypotensive reactions
Nonimmune hemolysis
Transfusion associated circulatory overload
Transfusion transmitted disease
Hepatitis
Human immunodeficiency virus
Human T cell lymphotrophic viruses(HTLV)
Cytomegalovirus
Parvovirus B-19
West nile virus
Malaria
Babesiosis
Trypanosoma cruzi
Transmissible spongiform encephalopathies