hazards of blood transfusion Flashcards
(43 cards)
what is needed to ensure a safe blood transfusion?
- protection of donor
- protection of recipient
what is done to protect the donor?
- 17 – 70 years old
- > 8 stone. (51 Kg)
- Normal health
- Volunteer
- Medical history check
- Anaemia check
- Sign declaration
what are all donations tested for to ensure the protection of the recipient?
- ABO and Rhesus group
- Clinically important red cell antibodies
- HIV I and II
- HTLV
- Syphilis
- Hepatitis B and C
- Cytomegalovirus (CMV)-in some cases
what is done to ensure positive patient identification?
- Identification wristband with full name, date of birth and hospital number
- Unconscious patients should have Typenex wristband
- If ID band is removed it must be replaced
what precautions should be taken when obtaining the sample?
- One patient at a time
- ID by wristband and interrogation
- Mix sample and label by hand at the bedside
- Label with full identification details and sign
- DO NOT pre label tubes
- DO NOT use addressograph labels
what must be included on the request card?
- Full patient ID: minimum 3 points of ID
- Obstetric and transfusion history
- Blood group and antibodies (if known)
- Number of units and type of blood component
- Location at which blood is required
- When blood component is required
- Reason for request
- Special requirements
- Prescribing and requesting: MSBOS
what precautions must be taken when collecting blood from the blood bank?
- Bring evidence of patient details: not a lab report
- Check card details match
- Check blood bag label matches
- Check blood unit number (bar code number of unit)
- Check blood still in date
- Check blood looks OK
what must be done when administering blood?
- Prescribed by doctor
- Can be a registered nurse
- Final bedside check by at least one person
- Start transfusion within 30 minutes of removing unit from blood bank. If not return unit to blood bank
- Only warm in a blood warmer
- Do not add drugs
- Change giving set every 12 hours
- Flush cannula before using it for anything else
when must patient observations be done?
- Base line 30 minutes before transfusion starts
- During first 15 minutes
- After about one hour then every hour
- One hour after transfusion has finished
what are the features of acute haemolytic transfusion reactions?
- Usually due to ABO incompatibility
- Usually happens within first 15 minutes
- Agitation
- Pain at infusion site
- Pain in abdomen, flank or chest
- Flushing
- Feeling of apprehension or doom
- Intravascular haemolysis
what are the signs of a reaction?
- Fever
- Hypotension
- Oozing from wounds of puncture sites
- Haemoglobinaemia
- Haemoglobinuria
- Raised temperature
- Nausea
- Sweating
- Rashes
- Bruising
what are the properties of delayed transfusion reactions?
- Non-detectable blood group antibodies
- 5-10 days post transfusion
- Rare
- Usually not life threatening
- Extravascular haemolyisis
what are the features of extravascular red cell destruction?
- Normal red cell breakdown occurs in liver/spleen
- Cells aged/damaged
- Haemoglobin is broken down into haem and globin
- Molecules of haem are converted to bilirubin
- Degraded in liver
- Free haemoglobin in circulating blood is avoided
what are the features of intravascular red cell destruction?
- Red cells broken down within blood vessels
- Free haem is removed by binding to haptoglobin
- Haptoglobin levels in circulation are reduced
- Haem-haptoglobin complex removed by reticuloendothelial system
what are the mechanisms of acute intravascular haemolysis?
• Antibodies in patient plasma
• Antibody binds to antigen on donor red cell membrane
• If antibodies are complement fixing complement proteins bind to red cell membrane
• Activation of complement leads to membrane damage
• Rapid haemolysis of donor red cell
• Causes:
- Disseminated intravascular coagulation (DIC)
- Acute renal failure
- Shock
- Death
what are serious hazards of transfusion (SHOT)?
• Incorrect component being requested and issued to patient
• Failure of bedside check to pick up errors
• Wrong pack from blood bank
• Wrong blood in tube.
- Blood in sample tube not from patient whose details appear on request card
• Transmission of disease
what can cause the adverse effects of blood transfusion?
- Infectious agents
- Transfused red cells
- Transfused white cells
- Transfused platelets
- Transfused plasma
- Transfused coagulation concentrates
- Other causes
what are the infectious agents?
• Viral infections - Hep B, C - HIV - CMV • Bacterial infections - Yersinia - Treponema • Protozoal infections - Malaria - Toxoplasma
why may red blood cells need to be transfused?
for the correction of anaemia
or if active bleeding is occurring
when may anaemia need to be corrected by red blood cell transfusion?
- Hb 70-80g/l post-op (NR 115-165g/l)
- Patient symptomatic
- Patient history
- Hb 80-90g/l with cardiovascular disease
- Not correctable by any other method
what adverse effects might be caused by red blood cells?
• Acute haemolytic transfusion reactions - Intra vascular haemolysis - Destruction of red cells • Allo-immunization - Antibody production • Febrile reactions - Reactions to donor white cells-uncommon blood is now filtered to remove white blood cells • Urticaria - Reactions to donor plasma proteins • Bacterial infections • Iron overload • Volume overload
what are some reasons that white blood cells are transfused?
White blood cell transfusions are only used for desperately ill patients
• Bone marrow failure
• Severe neutropaenia <0.5x109/l
• Abnormal neutrophil function with persistent infection
• Genetic- Chronic granulomatous disease
what are some adverse effects of white blood cells?
• Donor blood is filtered to remove white blood cells
• Variant CJD
• Transfusion Related Acquired Lung Injury (TRALI)
• Pulmonary infiltration
- Sequestration of WBC in the lungs
• Adult respiratory distress syndrome
- Most severe form-can cause death
• TAGvHD- Transfusion Associated Graft versus Host Disease
what are some reasons for why a platelet transfusion may be needed?
• To prevent bleeding in patients with thrombocytopaenia - Stop haemorrhage - Prevent haemorrhage • Abnormalities of platelet function - Bernard Soulier - Glanzmann’s thrombasthenia • Dilutional thromocytopaenia • Vascular surgery • Autoimmune thrombocytopaenia purpura
