Key Points for Transfusing Blood Products: Vital signs must be documented at baseline, 15 minutes, hourly during the transfusion and post-transfusion. The transfusionist must remain with the patient for the first fifteen minutes after the start of each unit of a blood product. If the transfusionist must leave the room, a replacement must be physically present in the room before the transfusionist leaves. A patient receiving blood/blood products is not to leave the unit unless accompanied by a licensed nurse. If a reaction is suspected, additional units of blood products are not to be administered until clearance is obtained from the Blood Bank. Each unit of a blood product is considered a single transfusion episode. The policy is to be followed in its entirety for each unit.

The risks of blood transfusion are carefully weighed against the risk of not receiving it and patients are informed of those risks and benefits. Major risks include receiving the wrong type of blood, acquiring certain infectious diseases, and various reactions to blood transfusions.Unfortunately, most reactions to blood transfusions are related to multiple failures to follow established policies and procedures. These failures usually involve the verification of the patients identity when drawing the blood specimen for the blood bank or verifying that the correct unit of blood is being administered to the correct patientPacked Red Blood Cells (PRBCs)Red blood cell (RBC) transfusions increase oxygen-carrying capacity in anemic patients. In deciding whether to transfuse a specific patient the physician should consider the person's age, etiology and degree of anemia, hemodynamic stability, and presence of coexisting cardiac, pulmonary or vascular conditions. If the patient requires volume expanders, fluids such as crystalloid or non-blood colloid solutions should be administered. It is not appropriate to administer packed red blood cells for fluid expansion.Platelet TransfusionsPlatelet transfusions are administered to control or prevent bleeding associated with a low platelet count or a deficiency in platelet function. Prophylactic platelet transfusion may be indicated to prevent bleeding in patients with severe thrombocytopenia. Platelet transfusions at higher platelet counts may be required for patients with systemic bleeding and for patients at higher risk of bleeding because of additional coagulation defects, sepsis, or platelet dysfunction related to medication or disease.Fresh Frozen Plasma Transfusions (FFP)Fresh frozen plasma (FFP) transfusions should be administered only to increase the level of clotting factors in patients with a demonstrated deficiency. Patients with rare conditions such as antithrombin III deficiency and thrombotic thrombocytopenic purpura may benefit from FFP transfusion.Infection and alloimmunization are the major complications associated with transfusion of blood components. Human hepatitis virusesare the infectious agents most frequently transmitted by transfusions. Although non-A, non-B hepatitis may not be clinically evident in the months following transfusion, 30-50 percent of those infected develop chronic active hepatitis and 10 percent of the latter group develops cirrhosis. Human Immunodeficiency virus(es)presently poses a relatively small hazard. The wide range of estimated risk reflects geographic variance. Fatal transfusion reactionsare almost always caused by an ABO incompatibility due to errors in blood product labeling or patient identification.Additional Risks: Other infectious diseases or agentsmay be transmitted via transfusion (e.g. hepatitis B, HTLV-I, cytomegalovirus, and those causing malaria). Antibodiesagainst donor antigens may be produced, i.e.,alloimmunization. This condition can result in an inadequate response to transfusion. Hemolytic transfusion reactions, allergic reactions, febrile reactions, transfusion related lung injury and circulatory overloadmay also occur.

Acute, Non-Infectious Transfusion Reactions Acute transfusion reactions generally occur during or within 2 hours of transfusion. Transfusion reaction manifestations may vary with the type of blood product transfused and the clinical condition of the recipient. When a transfusion reaction is suspected, the transfusion must be discontinued immediately! Meanwhile, a thorough evaluation of the event is performed. (Sometimes, withmild allergic reactions, the transfusion may be restarted after evaluation.) Post-reaction blood and urine samples, along with the blood bag implicated in the reaction, should then be sent to the Blood Bank for further testing. Acute Febrile Reactions Because fever (alone or accompanied by chills) may be the first manifestation of a life-threatening reaction,any significant increase in temperature(1oC or 2oF)occurring during transfusion must be taken seriously.Mild Allergic Transfusion Reaction:Mild allergic transfusion reactions are frequently observed with transfusion and thought to result from an allergic, antibody-mediated response to donor plasma proteins. They are characterized by pruritis, urticaria, erythema and puffiness during a transfusion. Antihistamines are generally effective in treating and/or preventing these reactions.Generalized Allergic & Anaphylactic Transfusion Reactions:Generalized allergic reactions occur less frequently and, in rare cases, can progress rapidly to full-blown anaphylactic shock. Symptoms include: wheezing, GI upset and hypotension with no fever. These reactions can occur with as little as 5 mL of blood component transfused. Antihistamines, steroids and, in severe cases, epinephrine are useful in treatment/prevention of these reactions.If you suspect a blood transfusion reaction:Stop transfusion immediately! Disconnect blood product unit and infusion set. Infuse normal saline through new infusion set using an IV catheter with a large lumen. Notify the physician immediately. Notify the Blood Bank. Obtain blood samples from the patient using a lavender, green and gold toptube for testing. Obtain random urine samples. Complete a Transfusion Reaction Work-up Form. Send theblood specimens, work-up form, andthe blood product bagwith all tubing attached and chart copy of the Transfusion Tag to the laboratory. Treat the patients symptoms according to the physicians instructions. No further transfusion may be given to the patient until the laboratory work-up of the suspected reaction is complete.If you suspect an Allergic Reaction or see Urticaria: Interrupt the transfusion and infuse saline to keep the line open. Notify the physician immediately. Notify the Blood Bank. After the physician has evaluated the patient, the Transfusion Reaction Work-up Form should be completed. Perform a clerical check (comparing the information on the label of the blood product andthe Transfusion Patient Label) for accuracy and record it on the reaction work-up form. Send the completed Transfusion Reaction Work-up Form to the Blood Bank. Blood and urine specimens do not need to be sent to the laboratory for this type of reaction. Treatment is per the physicians instruction and may include an antihistamine. Once the symptoms have been relieved, the transfusion can usually be resumed per the physicians instructions. The transfusion MUST be discontinued at 4 hours from the original start time whether or not the unit is finished. If the unit is not restarted, the unused portion must be returned to the Blood Bank.