Transfusion reactions

Emergencies Infants and young children below 5 years of

age with life threatening anemiasWomen with severe anemia or acute blood

loss relating to pregnency or child birth

Blood is used only when it is absolutely necessary after a careful clinical assessment and measurement of a patient’s haemoglobin (or PCV).But contraindicated in patients with stable

anemiaAcute blood loss when crystalloids can be given

HIGH RISK BLOODhas been collected from a high risk donor.has not been collected aseptically using a

sterile technique.has not been transported or stored correctly.has not been screened for important

pathogens using sensitive assays.has not been typed (grouped) and

compatibility tested correctly using standardized controlled procedures.

Guidelines for blood transfusionTreatment of anemia

In adultsIn childrenTreatment of acute haemorrhageTreatment of neonatal jaundiceAutologous blood transfusion

IN Adults a patient is in danger of dying of anaemic heart failure

or hypoxia before specific medication can raise the haemoglobin.

Obstetric delivery is imminent and the mother’s haemoglobin is below 70 g/l (7 g/dl).

Emergency major surgery is essential and the haemoglobin is below 80 g/l (8 g/dl) with an anticipated blood loss of more than 500 ml.

NOTEthe use of concentrated red cells (10 ml/kg body weight),

is indicated to avoid cardiac overload.should be administered slowly over 4–6 hours.rapidly acting diuretic should be administered

For infants and young childrenthe haemoglobin is below 50 g/l (5.0 g/dl) and is

associated with respiratory distress, orthe haemoglobin is below 40 g/l (4.0 g/dl) and is

complicated by malaria or bacterial infection even without respiratory distress, or

the haemoglobin is below 30 g/l (3.0 g/dl) without apparent infection or respiratory distress.

NOTE:In the above situations, transfusion with whole blood (not

packed cells), 10 ml/kg body weight, without diuretics will be tolerated.

Children with respiratory distress but not profound anaemia should be treated with intravenous colloids, and be transfused only if the haemoglobin falls later to less than 50 g/l.

Transfusion of concentrated red cells is also indicated

when a patient has an incurable anaemia, e.g. thalassaemia

or aplastic anaemia

Treatment of acute haemorrhageBlood transfusion is indicated when there is

acutehaemorrhage with a loss of more than 30% of

total blood volume, and blood pressure and oxygenation cannot be maintained by crystalloid solutions (saline or Ringers’ lactate) or colloids (e.g. 5% dextran or 5% hydroxyethylstarch).

Acute blood loss should be managed by replacement of volume. Only when shock persists or worsens should whole blood be transfused.

TREATMENT OF NEONATAL JAUNDICEFor newborn infants with a serum bilirubin

above300 μmol/l, an exchange blood transfusion isindicated.

Autologous blood transfusion(autotransfusion)a patient’s blood is collected and reinfused.

This removes the risk of an adverse immunological reaction

transmitting a blood transmissible diseasefor patients undergoing elective (planned) surgery. In developing countries, autologous blood

transfusion is mainly used as a life-saving measure during emergency surgery, e.g. for ruptured ectopic pregnancy.

This is referred to as intraoperative blood salvage.

blood is collected from a sterile uncontaminated

body cavity using a sterile dish or bowl

filtered through several layers of sterile gauze

into a sterile bottle

bottle containing acid citrate dextrose (ACD) or

citrate phosphate dextrose (CPD) anticoagulant.

The filtered blood is then returned to the

patient through a standard blood transfusion

giving set.

QUALITY ASSURANCE IN BLOODmisuse of blood, donation of blood, storage and testing of blood, documentation errors, and failure to carry out checking procedures,

Errors can also result in blood shortages, expensive reagents being wasted and a lack of confidence by patients and blood donors in blood transfusion services.

SOPUse of blood, blood products and blood

substitutes,to include:Information which must accompany a request for blood.How to calculate the volume of blood to use,

particularly when the patient is a child.Identity checks and documentation required when

collecting blood from a patient, from the blood bank and before setting up a blood transfusion at the bedside of a patient.

Procedure to follow when a patient is being transfused and what action to take should there be an adverse reaction to the blood.

System for auditing how blood is used.

Donation of blood, to include:– Criteria for accepting a person as a blood donor and details

of medical screen and pretesting procedures.

– Questionnaire to be used with potential donors covering personal medical history and life style.

– Policy and procedure for counselling donors with regard to HIV screening and testing and maintaining the confidentiality of blood donor information.

– Details of how to collect blood from a donor.

– Labelling donor blood.

– Care of the donor following donation and frequency

of donation.

– Special requirements of mobile blood donation and transportation of blood.

– Blood donation records.

Storage of blood, to include:Temperature requirement, checking and

recording the temperature of the blood bank refrigerator.

– Sectioning of refrigerator and location of prescreened,

screened, and crossmatched blood.– Procedure for checking the appearance of blood

for signs of contamination before it is issued and documentation checks to be performed.

– Blood bank records.– Locally important procedures, pertaining to theuse and security of a blood bank refrigerator.

Screening of donor blood for infectious agents andblood typing (grouping), to include

– Infectious agents for which screening is required and details of reagents, controls, equipment, techniques, recording results.

– Procedure for typing blood including details of antisera, test cells, controls, techniques, recording results and labelling of blood unit.

Compatibility testing (crossmatching) of blood, to include:– Details of the request form and patient’s blood

sample.– Procedure for compatibility testing including

use of controls, interpretation and recording of test results.

– Procedure for emergency compatibility testing.– Labelling compatible blood.– Preparation of concentrated red cells.– Procedure for investigating a transfusionreaction.

Safety issues, to include

– Safe handling of blood and blood products.– Decontamination of work surfaces and

laboratory-ware and preparation of sodium hypochlorite

solutions – Disposal of ‘sharps’– Disposal of contaminated and expired blood.

Procurement of supplies, to include:

– Procedures for ordering essential reagents, HIV and other test kits.

– Recording expenditures and keeping financial accounts.

– Reliable systems for transporting essential supplies.

– Checking expiry date and specifications, and recording supplies upon their receipt.

– Storage requirements of antisera, reagents, and test kits.

Blood donor requirements– Disclosure of medical history and details of life style

which can help to exclude a high risk donor i.e. one whose blood is at high risk of transmitting a blood-borne pathogen such as HIV.

– A basic health check to assess a person’s fitness to donate blood.

– Appropriate tests to screen blood for transfusion transmissible infections with the donor having the option to know the results of the HIV test performed (with counseling provided).

Self-exclusionA person is requested not to donate blood if he orshe:– Has sexual relationships with several people.– Has in the last year contracted a sexually

transmitteddisease.

– Injects drugs and shares needles and syringeswith others.

– Has a partner with AIDS or a partner in hospitalwith suspected HIV disease.

- pregnant should not donate blood.

Health check before donating bloodAt the time of donation a person should be • in good health and • not anaemic, malnourished, or dehydrated. • The person should not have donated blood

within the previous 3 months. • Food should have been eaten on the day of

donation. Alcohol should not be consumed prior to donating

• blood. • Drinking water should be made freely

available to donors before donation, particuarly in hot climates.

16–18 years up to 50–65 years.

Basic physical examination: To include a check for

swollen glands, skin rashes, signs of intravenous drug use or abnormal bleeding (purpura).

● Weight of the person: Persons weighing 45–50 kg or more can safely donate 450 ml of blood.

Note: In some Asian countries where height/weight are

normally small, 350 ml blood donations are routine.

Temperature of the person (to exclude any febrile disease e.g. malaria): A donor should not give

blood when their temperature is raised.● Measurement of blood pressure: A donor

should not have an abnormally low blood pressure nor a high blood pressure. The upper acceptable limits are a diastolic pressure of 100 mm Hg and systolic pressure of 180 mm Hg. The minimum acceptable blood pressure is 90/50 mm Hg.

● Pulse rate of the person: The pulse rate should be regular and less than 100 beats/minute

(counting for at least 30 seconds).

● Test to check for anaemia: For example, measurement of haemoglobin or PCV or an estimate of haemoglobin level using the Haemoglobin Colour Scale. In most countries persons are accepted as blood donors with a

haemoglobin of 120 g/l (12 g/dl) or more and haematocrit of 380 g/l (38%) or more. In some countries the lower limit for men is set at 130 g/l

(13 g/dl). Higher haemoglobin levels will be required at high altitudes.

Screening blood for transfusion transmitted infections● Human immunodeficiency virus (HIV) 1 and

2● Hepatitis B virus (HBV)● Hepatitis C virus (HCV)● Treponema pallidum (agent of syphilis)● Plasmodium species (agents of malaria).● Trypanosoma cruzi (agent of Chagas’

disease)