Blood Transfusion Policy and Procedures - UK Blood Transfusion
BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing...
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BLOODTRANSFUSION
BRI BUDLOVSKY R3
JANUARY 2015
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OVERVIEW
• The process
• Blood components
• Testing
• Consent
• Transfusion reactions
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DONATION
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DONATION
TEST SPECIFIC AGENTS TESTS
GroupABO,Rh
AlloantibodiesABO and Rh antigen testing
Virus
HIVHep BHep CHTLV
West Nile
Antibodies, nucleic acid testing
BacteriaSyphilis
Bacterial contaminationSerology
Bacterial Culture (plt only)
ParasitesChagas in
at risk donorsantibody
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BLOOD COMPONENTS
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CONSENT: HISTORY
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CONSENT
• Time to think of alternatives
• Describe the product
• Describe benefits & risks
• Describe alternatives
• Answer questions/confirm understanding
• Complete consent form
• Document in chart
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RISKS• Hep B: 1/ 153,000
• Hep C: 1/ 2.3 million
• HIV: 1/ 7.8 million
• Minor urticaria: 1/100
• Febrile non-hemolytic: 1/300
• ABO incomp/serious immune: 1/ 40,000
• Sepsis: 1/ 10,000 plts, 1/ 500,000 pRBCs
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TESTING
TESTTIMIN
G(min)
Group 5 Patient tested for ABO and Rh antigen
Screen 45Patient tested for alloantibodies from prior
transfusion/pregnancy
Xmatch 45Incubate patient’s blood with donor blood, checks for
immune reaction due to alloantibodies
Computer Xmatch
2Computer picks appropriate unit based on patient and
donor testing. Blood is not actually mixed.
DAT45
RBCs from patient are washed, and then mixed with Coombs Reagent. If they stick together, it means they
have antibodies on their surface (+ for immune transfusion reaction)
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TRANSFUSION REACTIONS
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56F – POD#3
• L hemi-colectomy for diverticulitis
• Transfusion for low Hb
• You are called for FEVER
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DDX: FEVER
• Usual post-op fever causes
• Transfusion specific:
• Febrile non-hemolytic• Hemolytic• Septic
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FEBRILE TRANSFUSION REACTION
During or within 4 hours of transfusion:
• >38°C
• Increase by 1°C
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MANAGEMENT
• STOP THE TRANSFUSION
• Maintain IV access
• Check patient ID and blood product
• Notify the blood bank
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RED FLAGS
• T>39°C• Hypotension/shock• Tachycardia• Dyspnea• Back/chest pain• Oliguria/Hematuria• Nausea/vomiting• Bleeding from IV sites
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NON-HEMOLYTIC
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HEMOLYTIC BACTERIAL CONTAMINATION
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BACTERIAL CONTAMINATION
• From:
• Donor skin/blood• Poor handling
• 10% of transfusion mortality
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BACTERIAL CONTAMINATION
• Cultures
• Two patient sites• Bag/line lab
• Antibiotics
• Pip-tazo• Vanco
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HEMOLYTIC REACTION
• ABO incompatibility
• ½ from proper labeling wrong patient• Others from improper labeling, testing
error etc.• Non-ABO incompatibility
• From pregnancy/previous transfusion
• >50%: No morbidity• <10%: Fatal
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MANAGEMENT
• Check labels
• Call blood bank
• UA for Hb
• DAT
• Fluids
• Supportive
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60F – VAGINAL BLEEDING
• Transfused 2U pRBC
• You are called for:
• SOB• SaO2
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DDX: DYSPNEA
• Usual post-op SOB causes
• Transfusion specific:
• TACO• TRALI• Anaphylaxis
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TACO
• Fluid overload
• Impaired cardiac function +/-• Fast rate of transfusion
• 1/700 transfusions
• Management
• Stop transfusion• Oxygen• Diurese
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TACO
• Prevention is key
• Identify at risk patients• Diuretics between/after units• Slow speed (4 hours/U)• Divide products into smaller aliquotes
• Reduce speed without waste
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TRALI
• Acute onset:
• Hypoxemia
• Bilateral lung infiltrates on CXR
• No cardiac cause
• No ALI before transfusion, and now ALI present
• DURING or WITHIN 6 hours of transfusion
• No other risk factors for ALI
ALI
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TRALI
• Etiology
• Passive transfer of antibodies• Neutrophil reaction to biologically active
compounds in blood• Most common cause of transfusion
related death (up to 10% of TRALI)
• Usually 1-2 hours post (up to 6)
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TRALI - MANAGEMENT
• Supportive care
• No evidence for steroids or diuretics
• Reducing risk:
• No plasma/plasma products from multip females• Platelets from males or nullip females• Pool platelets in male plasma• Testing of & deferral of donors with TRALI hx• 2/3 reduction
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ANAPHYLAXIS
• Mechanism unclear
• Transfusing IgA / IgE• Antibodies to serum proteins• Transfusion an allergen consumed by donor
• Rare
• 1/40,000• 3% of transfusion fatalities
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URTICARIA
• 1/100 transfusions
• Management:
• Interrupt transfusion• Benadryl 25-50mg IV• Resume if:
• Urticaria improving/mild• No associated symptoms
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72M – DIALYSIS PATIENT
• Transfused 2U pRBC for chronic support
• Complaining of palpitations
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HYPERKALEMIA
• Prolonged storage & irradiation K leakage
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62F – LGIB
• 6U pRBC for massive LGIB in ER
• C/O:
• Anxiety• Foot and hand “cramping”• Peri-oral tingling
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CITRATE TOXICITY
• Rare!
• Massive transfusion or plex only
• Replace PO or IV
• More common:
• Metabolic alkalosis
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SUMMARY
• Know the risks
• Know the benefits
• Know the alternatives
• Document
• Have a high suspicion
• Stop the transfusion and investigate
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TO STOP OR NOT?
• Sick or severe
• TRALI
• Hemolysis
• Lab/clerical error
• Sepsis
• Anaphylaxis
• Urticaria
• Febrile non-hemolytic
• TACO
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• Fever• NHTR• Sepsis• HTR
• Dyspnea• TRALI• TACO• Anaphylaxis
• Allergic• Urticaria• Anaphylaxis
• Hypotension• Sepsis• Anaphylaxis• HTR
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REFERENCES• Bloody Easy
• Rosen’s
• Up-to-date
• CMPA
• www.hemophilia.ca
• TRALI: A clinical review. The Lancet. Sept 2013. Vlaar et al.
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EXTRA SLIDES
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STORAGE
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