Safe and appropriate prescribing of blood components and products Flashcards
(29 cards)
What is the most common blood transfusion error?
Wrong blood product transfused
Most common cause of mortality is TACO.
How are RBCs stored and what is their shelf life?
Shelf life of 35 days (unless irradiated). Must be stored at 2-6 degrees in an authorised blood fridge with audible alarm system and functional temperature recorder. Should be completely transfused within 4 hours of removal from temperature controlled storage (TSSC)
How are platelets stored and what is their shelf life?
Platelets are stored in the HTL at 20-24 degrees in an agitator. They’re never stored in the fridge as this causes the platelets to aggregate irreversibly. Platelets have a shelf life of 5 or 7 days. Platelet transfusion should be started as soon as possible after the component arrives in the clinical area.
What is FFP?
Clotting factors and a small amount of fibrinogen.
What is cryoprecipitate?
Fibrinogen (and VIII, vWF).
How is FFP and cryoprecipitate stored and what is their shelf life?
Stored at -25 degrees for up to 3 years. Once a request is received, the component is thawed in the lab at 37 degrees, which can take 15-30 minutes. These components should be transfused as soon as possible and must be completed within 4 hours of removal from TCS.
What transfusion product has the highest risk of bacterial contamination?
Platelet transfusion
What needs to be done when requesting blood from the bank in general terms?
- Check informed consent from patient for blood transfusion
- Check patient’s identity
- Fill in blood collection form
- Only collect one unit at a time
- Ensure the patient has patent IV access
- Undertake pre-transfusion observations (which must be taken within 60 minutes of the transfusion commencing)
When requesting blood from the blood bank on a blood form, what do you need to write on the form?
- Group and Save and Cross Match sample for pre-transfusion screening
- Hand labelled sample
- What type of blood product and how many units
- Any special blood e.g irradiated
- When you need the blood
When gaining informed consent for a blood transfusion, what information do you need to give the patient?
- Why they need it?
- The risks if they don’t
- The benefits if they do
- Other options
- Give them a PIL
- Ask if they have any questions
What are the indications for CMV negative blood?
- Neonates up to 28 days expected delivery date
- Pregnant women.
What does irradiation do?
Inactivates any T lymphocytes that could lead to graft vs host disease.
Which patients need irradiated blood?
- previous stem cells transplant
- hodgkin’s lymphoma
- pregnant women
- neonates
- immunodeficiency (SCID or immunosuppressants)
What is the difference between group and save/screen and a cross match sample?
- group and save - a test to determine the blood group and antibody status of a patient prior to receiving a blood transfusions
- cross matching - refers to the testing that is performed prior to the release of blood for a blood transfusion, in order to determine in the donor unit(s) are compatible with the blood of the intended recipient
How long can plasma from a patient be held from a group and save for cross matching?
14 days. If pregnant or had a transfusion in the last 3 months, then 3 days.
How long does an average RBC and platelet transfusion take?
RBC: 90-120 minutes. Platelets: 30-60 minutes.
in what scenarios does blood need to be warmed before transfusion?
What pre transfusion observations are recorded?
Done within 60 minutes before transfusion: temperature, pulse, BP, RR.
What observations are done during a blood transfusion and when?
- pulse, BP, RR, o2 sats and temperature
- done 15-20 minutes after the start of transfusion, 60 minutes after start and then for each new unit of blood
- monitor for upto 24 hours after for late reactions
When do most transfusion reactions happen and how can the patient present?
First 20 minutes. Stop immediately if symptoms!
How is donated blood screened?
Essential
- HIV
- Hep B and C
- syphillis
- Hep E
- HTLV
Case by case basis
- malaria
- west nile virus
- CMV
- T-Cruzi
What patients can’t donate blood?
- if they have received blood donation before
- HIV/HepB/HepC
- injected drugs
- sex workers (wait 3 months)
- recent tattoo
- illness in the last 7 days or antibiotics in the last 14 days
- gay men with more than one partner in the last 3 months
- travel to particular areas
What are the indications for a transfusion of red cells?
- Hb under 70
- acute blood loss >30%-40% of blood volume
- Hb 70-90 and symptomatic
How can anaemia and red cell transfusion be avoided in the surgical area?
- take FBC and G&S before any elective surgery
- correct any iron deficiency anaemia with iron supplements
- consider red cell salvage
