Transcript blood groups - Indian Journal of Transfusion Medicine

Management
Of
Adverse
Reactions
Saving Life
BLOOD
TRANSFUSION
PROCESS
START TO END
Adverse
Transfusion
Reactions
Monitoring
Of Patient
During
Administration
Blood
Request
Blood Request To Transfusion
Patient’s
Sample
Collection
- Practical Aspects
Administration
Of
Blood /
Components
Presented by – Dr. Rajesh Kucheria
Medical Director,
Arpan Chain Of Blood Banks
Pre administration
Precautions
Storage of
Blood /
Components
Crossmatching
&
Compatibility
Blood
Grouping
ARPAN’S QUALITY POLICY
Arpan is committed to deliver
highest level of quality standard in its
products and services.
We believe that this can be
achieved only with continuous
improvements, global bench marking
& ceaseless effort to learn.
We aim to set new standards
for quality in our region & become a role
model for all those who want to contribute in
this sphere of public health.
PREFACE
Emerging from Arpan’s vision, this document is a very specific effort towards bringing
entire chain of professionals working in blood transfusion cycle to a common
understanding of the complex process.
Starting with the point in the hospital where it is decided to opt for blood transfusion to
the logical conclusion of patients acceptance of this emergency drug, every step is
discussed with detailed medical understanding as well as administrative check points.
The purpose is to ensure that there is no error whatsoever at any point in this
lifesaving mechanism.
We are sure, clinicians, paramedical staff, blood banking staff and administrative
professional touching this process would find this document very useful and pragmatic
for their day to day work and will make entire cycle error free and thus safest.
We would be more than happy to receive your feedback / suggestions on this on
[email protected]
- Arpan Family -
INDEX
1.
Blood request ………………………………………………………………………..
1 To 6
Requisition form filling
Blood sample collection
NAT test
Guidelines for use of blood components
Plasma by apheresis (PL-A)
2.
Blood groups, Crossmatching & Compatibility………………………
7 To 32
ABO & Rh blood group systems
Crossmatching
ABO crossmatching
ABO compatibility for Whole blood, PCV, Plasma & Platelets
Rh compatibility
Compatibility & selection of unit for neonatal transfusion
3.
Storage of blood & blood components…………………………………. 33 To 34
In blood bank
In hospital
4.
Administration of blood & blood components………………………
35 To 38
Pre-administration precautions
Administration
Monitoring of patient during administration
5.
Adverse transfusion reactions & their management……………
Infectious adverse transfusion reactions
Non infectious adverse transfusion reactions
Management of adverse transfusion reactions
Leuco-depletion
39 To 44
BLOOD REQUEST
REQUISITION FORM FILLING
1
Patient information
1.
Always write patient’s full name as multiple requests
come to blood bank from many hospitals & there are
chances of two requests of same name & surname
from two different hospitals.
2.
Compulsory write patient’s blood group on form. If
any discrepancy is noted in blood group written on
requisition form and blood group detected in blood
bank on patient’s sample, it can be resolved & right
blood can be issued to the patient.
Product requirement
1.
Always write date & time of requirement of blood /
component unit, so that unit can be reserved, if it is
going to be available meanwhile.
Hospital information
1.
Always write treating doctor’s name & mobile no. on
requisition form, so that in case of any problem or
doubt, it can be resolved by talking with him.
2.
Always give hospital seal on requisition form. It is
legally compulsory & possible malpractices can be
avoided.
2
BLOOD SAMPLE COLLECTION
Always remove needle & then pour
blood in sample bulb
Never send sample in syringe
Always label sample bulb
properly with patient’s full name
& hospital name
Patient’s Sample Label Sticker
Patient’s Full
Name
Hospital
First
Middle
Surname
3
NAT TEST
•
NAT testing lab is established at Arpan Blood Bank, Nashik. It is 2nd Stand alone blood bank in the country to start NAT
testing facility. NAT tested blood will be available at all centres of Arpan blood bank across State.
•
NAT – Nucleic Acid Amplification test used to detect HIV, HBV & HCV infection.
•
It is most advanced technology used Worldwide.
•
In this test, viral RNA is captured, amplified & detected.
•
As it detects genetic material, detection is accurate & very early than conventional methods (ELISA & Cheminileuscence).
window period reduction
Infection
Window period (When tested by ELISA
technology using best 4th generation kits)
Window period
(When tested by NAT technology)
HIV
20.3 days
5.6 days
HBV
53.3 days
24.6 days
HCV
58.3 days
4.9 days
Pilot Study –
•
The first Indian study for NAT testing shows that 1 in 1,528 blood units are found to be positive for any of the Three viruses which
were seronegative by ELISA technology.
•
A pilot study at AIIMS among 5,818 donors shows that 1 in 1,164 blood units were found to be positive for any of the three viruses
which were seronegative by ELISA technology.
There is no reported case of either of three infections after transfusion of NAT tested blood.
Cost-
As NAT test is done in addition to routine ELISA test, extra cost is added for NAT tested unit. But the cost is negligible
considering the physical, mental trauma & economic loss for treatment of these diseases.
GUIDELINES FOR USE OF BLOOD COMPONENTS
Transfusion
Indication
Options
Desired Effect
Preference
-Least chances of transfusion reactions as total
plasma is removed.
-Viability of RBCs is better.
-Platelets and Plasma can be utilised for
another patient.
1. Packed Red Cells
In Additive Solution
(PCV)
Hb by 1 g%
HCT by 3%
2. Whole Blood (WB)
Hb by 1 g%
HCT by 3%
1. PCV
As per volume of
PCV


- If you want to replace blood loss less than two
liters.
2. Whole Blood
As per volume of
WB


- If you want to replace blood loss more than
two liters quickly.
1. Single Donor
Platelets (SDP)
Increases Platelet
count by 50,00070,000/ml per unit
  
To Increase
HB%
To Replace
Blood Loss
Reasons
To Increase
Platelet
Count
2. Random Donor
Platelets (RDP)
Increases Platelet
count by 5,0008,000/ml per unit
-More chances of transfusion reactions due to
plasma proteins.
-It is like unnecessary multidrug therapy.




-Recipient is exposed to single donor.
-Leucoreduced platelets are obtained so risk
of transfusion reaction and platelet
refractoriness is reduced.
-Recipient is exposed to many donors.
-Risk of alloimmunization and so platelet
refractoriness
-Chances of transfusion reaction are more as
leucoreduction is not always possible.
4
GUIDELINES FOR USE OF BLOOD COMPONENTS
Transfusion
Indication
Options
1. Fresh Frozen
Plasma (FFP)
To Give
Clotting
Factors
To
Increase
HB% And
Platelet
Count
To
Increase
HB% And
Clotting
Factors
Desired Effect
-Raises all clotting
factors (I to XIII)
-Supplies Albumin
Preference

5
Reasons

- Fresh Frozen Plasma can be given when all
clotting factors are required.
- It also supplies Albumin.
- If we want to supply factor VIII (AHF), VWF or
Factor XIII, Cryoprecipitate should be preferred
over FFP as volume is reduced & so chances
of transfusion reactions.
-Raises Factor
VIII, VWF and
Factor XIII &
Fibrinogen


1. PCV + RDP / SDP
As per individual
PCV & RDP or
SDP


2. Fresh Blood
Only increase in
HB% as per
Whole Blood
Fresh blood is not an option because blood
needs to be preserved at 2-60C, till testing is
done and 80-90% platelets become non viable
at 2-60C. Hence this blood will not supply viable
platelets. You will only get RBCs & Plasma from
Fresh Blood.
1. PCV + FFP
/CRYO
As per individual
PCV & FFP or
CRYO


2. Fresh Blood
Only increase in
HB% as per
Whole Blood
Fresh Blood is not an option because all labile
clotting factors get destroyed at 2-60C within 6
hrs. And it usually takes more than 6 hrs from
collection to issue. Hence fresh blood will not
supply clotting factors.
2. Cryoprecipitate
(CRYO)
6
PLASMA BY APHERESIS (PL-A)
• In western India, Arpan blood bank, Nashik is the only blood bank to have Plasma
Apheresis facility.
• As platelets are collected by apheresis, 500ml plasma can also be collected by
apheresis. The unit of 500 ml plasma collected by apheresis is called PL-A.
• Advantages of plasma by Apheresis (PL-A).
1.
As plasma is collected & frozen within 2 hours, the quality of product is much
superior & the yield of clotting factors is much high than routine FFP.
2.
The desired effect of 4 FFP unit is achieved by single unit of PL-A. So the risk
of exposure to four different donors & therefore TTI is significantly reduced.
3.
The same donor can donate another unit of PL-A after 15 days.
BLOOD GROUPS,
CROSSMATCHING
&
COMPATIBILITY
7
BLOOD GROUPS
1. ABO blood grouping system
ABO Blood Group
Antigens on RBCs
Antibodies in plasma
O
-
A&B
A
A
B
B
B
A
AB
A&B
-
Rh Blood Group
Antigens on RBCs
Antibodies in plasma
Rh Positive
D
-
Rh Negative
-
-
2. Rh blood grouping system
• ABO antibodies are naturally occurring i.e. opposite antibody (to antigen on RBCs)
appears in plasma naturally within few months after birth.
• In contrast Rh antibodies are not naturally occurring. They are immune antibodies.
They develop against antigenic stimulus i.e. when Rh positive RBCs enter in
circulation of Rh negative person.
8
CROSSMATCHING
Patient sample
Blood unit (Donor)
Sample
P
D
Patient’s plasma
(Antibody)
Donor RBCs
(Antigen)
Major crossmatch
•
P
D
Patient’s RBCs
(Antigen)
Donor plasma
(Antibody)
Minor crossmatch
If Major crossmatch is incompatible, then donor cells (which are less in volume) will react with
antibodies in patient’s plasma (which is large in volume) & will get destructed completely to cause
serious hemolytic reaction. So it is called Major.
•
If Minor crossmatch is incompatible, then donor’s plasma (which is less in volume) will get diluted in
patient’s plasma (which is large in volume) and there are less chances of reaction between
antibodies in donor’s plasma with antigens on patients cells & so least chance of hemolytic reaction.
So it is called Minor.
9
COMPATIBILITY
Results :
Agglutination reaction
Incompatible
No agglutination reaction Compatible

Interpretation :
Major

Minor

Compatibility
Compatible groups
Optional groups


Incompatible groups
(Can be given in emergency,
when compatible group is not
available.)
(Can not be transfused)
The unit is called compatible if it is compatible for both blood grouping systems i.e.
1.
ABO blood group system
2.
Rh blood group system
10
ABO Crossmatch of ‘O’ blood group patient with all blood groups
Major
Blood Group
Patient Sample
O
P
Bl. Unit Sample
O
D
Antibodies A & B
Antigen -
Minor
P
Antigen -
Patient Sample
O
P
D
Antibodies A & B
Bl. Unit Sample
A
D
No agglutination
reaction
(X-compatible)
No agglutination
reaction
(X-compatible)
Major
Blood Group
Patient Sample
O
P
Bl. Unit Sample
B
D
Antibodies A & B
Antigen B
Agglutination
reaction
(X-incompatible)
Major
Blood Group
D
Antigen Antibody A
No agglutination
reaction
(X-compatible)
Antigen A
P
D
Agglutination
reaction
(X-incompatible)
Minor
P
Antibodies A & B
Minor
Antibody B
No agglutination
reaction
(X-compatible)
Major
Blood Group
Antigen -
Minor
Patient Sample
O
P
Antibodies A & B
P
Antigen -
Bl. Unit Sample
AB
D
Antigens A & B
D
Antibodies -
Agglutination
reaction
(X-incompatible)
No agglutination
reaction
(X-compatible)
11
ABO Compatibility table of ‘O’ blood group patient
Patient’s Blood Group
O
Bag’s Blood
Group
O
Major
Minor


A

B

AB

12
ABO Crossmatch of ‘A’ blood group patient with all blood groups
Major
Blood Group
Patient Sample
A
P
Bl. Unit Sample
O
D
Antibody B
Antigen -
Minor
P
D
No agglutination
reaction
(X-compatible)
Patient Sample
A
P
Bl. Unit Sample
B
D
Antibody B
Antigen B
Agglutination
reaction
(X-incompatible)
Antibodies A & B
Patient Sample
A
P
Bl. Unit Sample
A
D
Agglutination
reaction
(X-incompatible)
Major
Blood Group
Antigen A
Major
Blood Group
Antigen A
P
D
No agglutination
reaction
(X-compatible)
Minor
Antigen A
Patient Sample
A
P
D
Antibody A
Bl. Unit Sample
AB
D
Antibody B
Antigens A & B
Agglutination
reaction
(X-incompatible)
Antigen A
Antibody B
No agglutination
reaction
(X-compatible)
Major
Blood Group
P
Agglutination
reaction
(X-incompatible)
Antibody B
Minor
Minor
P
Antigen A
D
Antibodies -
No agglutination
reaction
(X-compatible)
13
ABO Compatibility table of ‘A’ blood group patient
Patient’s Blood Group
A
Bag’s Blood
Group
Major
O

A

Minor

B
AB

14
ABO Crossmatch of ‘B’ blood group patient with all blood groups
Major
Blood Group
Patient Sample
B
P
Bl. Unit Sample
O
D
Antibody A
Antigen -
Minor
P
D
No agglutination
reaction
(X-compatible)
Patient Sample
B
P
Bl. Unit Sample
B
D
Antibody A
Antigen B
No agglutination
reaction
(X-compatible)
Antibodies A & B
Patient Sample
B
P
Bl. Unit Sample
A
D
Agglutination
reaction
(X-incompatible)
Major
Blood Group
Antigen B
Major
Blood Group
Antibody A
Antigen A
Minor
P
Antigen B
D
Antibody B
Agglutination
reaction
(X-incompatible)
Minor
Agglutination
reaction
(X-incompatible)
Major
Blood Group
Minor
P
Antigen B
Patient Sample
B
P
Antibody A
P
Antigen B
D
Antibody A
Bl. Unit Sample
AB
D
Antigens A & B
D
Antibodies -
No agglutination
reaction
(X-compatible)
Agglutination
reaction
(X-incompatible)
No agglutination
reaction
(X-compatible)
15
ABO Compatibility table of ‘B’ blood group patient
Patient’s Blood Group
B
Bag’s Blood
Group
O
Major
Minor

A
B
AB



16
ABO Crossmatch of ‘AB’ blood group patient with all blood groups
Major
Blood Group
Patient Sample
AB
P
Bl. Unit Sample
O
D
Antibody -
Antigen -
Minor
P
Antigens A & B
Patient Sample
AB
D
Antibodies A & B
Bl. Unit Sample
A
No agglutination
reaction
(X-compatible)
Patient Sample
AB
P
Bl. Unit Sample
B
D
Antibody -
Antigen B
No agglutination
reaction
(X-compatible)
P
D
Antibody -
Antigen A
Minor
P
D
No agglutination
reaction
(X-compatible)
Agglutination
reaction
(X-incompatible)
Major
Blood Group
Major
Blood Group
Minor
Minor
P
Antigens A & B
Patient Sample
AB
P
Antibody -
P
D
Antibody A
Bl. Unit Sample
AB
D
Antigens A & B
D
Agglutination
reaction
(X-incompatible)
No agglutination
reaction
(X-compatible)
Antibody B
Agglutination
reaction
(X-incompatible)
Major
Blood Group
Antigens A & B
Antigens A & B
Antibody -
No agglutination
reaction
(X-compatible)
17
ABO Compatibility table of ‘AB’ blood group patient
Patient’s Blood Group
AB
Bag’s Blood
Group
Major
O

A

B

AB

Minor

18
WHOLE BLOOD ABO CROSSMATCH TABLE
Patient’s Blood Group
Bag’s
Blood
Group
O
Major
Minor
Major


A


B


O
AB

A
B
Minor
Major
AB
Minor

Minor





Major





19
WHOLE BLOOD ABO COMPATIBILITY TABLE
Patient’s Group
Compatible Group
Optional Group
O
O
-
A
A
O
B
B
O
AB
AB
A, B, O
20
PCV (WITH ADDITIVE SOL) ABO CROSSMATCH
Patient sample
Blood unit (Donor)
sample
Patient’s plasma
Patient’s RBCs
Donor RBCs
--------
Major crossmatch
Minor crossmatch
Not Applicable
As total plasma is removed from blood unit while preparing PCV, minor crossmatch is
not applicable for PCV transfusion.
PCV (WITH ADDITIVE SOL) ABO CROSSMATCH TABLE
Patient’s Blood Group
Bag’s
Blood
Group
O
A
Major
Minor
NA

NA
A
NA

NA
B
NA
NA
AB
NA
NA
O
Major
Minor

B
AB
Major
Minor
Major

NA


NA


NA
NA

NA
NA
Minor
NA
NA
PCV (WITH ADDITIVE SOL) ABO COMPATIBILITY TABLE
Patient’s Group
Compatible Group
Optional Group
O
O
-
A
A,O
-
B
B,O
-
AB
AB,A,B,O
-
21
22
PLASMA(FFP) ABO CROSSMATCH
Patient sample
Blood unit (Donor)
sample
Patient’s plasma
Patient’s RBCs
---------
Donor plasma
Major crossmatch
Minor crossmatch
Not Applicable
After separating RBCs from blood unit plasma is prepared, so major crossmatch is
not applicable for plasma transfusion.
23
PLASMA (FFP) ABO CROSSMATCH TABLE
Patient’s Blood Group
Bag’s
Blood
Group
O
A
Major
Minor
Major
O
NA
NA
A
NA


B
NA
NA
AB
NA


NA
NA
B
Minor

Major
Minor
Major
NA
NA
NA
NA
NA

AB
NA


Minor
NA
NA

PALASMA (FFP) ABO CROSSMATCH
Patient’s Group
Compatible Group
Optional Group
O
O,AB,A,B
-
A
A,AB
B,O
B
B,AB
A,O
AB
AB
A,B,O
24
PLATELET COMPATIBILITY
• ABO antigens are not usually expressed on platelets. They are expressed
on platelets in only 7% population, in which they are expressed weakly and
on some platelets.
• So platelet cross matching is not applicable for platelet transfusion.
Platelet can be transfused across group safely i.e. any group platelets can
be given to any group patients.
25
PLATELET ABO COMPATIBILITY TABLE
Patient’s Blood Group
Bag’s
Blood
Group
O
A
Major
Minor
O
NA
A
B
Major
Minor
NA
NA
NA
NA
B
NA
AB
NA
AB
Major
Minor
Major
Minor
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
PLATELET ABO COMPATIBILITY (AS PER PREFERENCES)
Patient’s Group
Compatible Group
Optional Group
O
O,AB,A,B
-
A
A,AB,B,O
-
B
B,AB,A,O
-
AB
AB,A,B,O
-
26
COMPARISON OF WHOLE BLOOD Vs PCV COMPATIBILITY
Whole Blood ABO Compatibility
Patient’s Group
Compatible Group
Optional Group
O
O
-
A
A
O
B
B
O
AB
AB
A, B, O
PCV (with Additive sol.) ABO Compatibility
Patient’s Group
Compatible Group
Optional Group
O
O
-
A
A,O
-
B
B,O
-
AB
AB,A,B,O
-
So it is always better to give ‘O’ group PCV with 0 (zero)% risk rather than ‘O’ group whole blood
when same group is not available in blood bank.
27
COMPARISON OF PLASMA Vs PLATELET ABO COMPATIBILITY
Plasma ABO Compatibility
Patient’s Group
Compatible Group
Optional Group
O
O,AB,A,B
-
A
A,AB
B,O
B
B,AB
A,O
AB
AB
A,B,O
Platelet ABO Compatibility
Patient’s Group
Compatible Group
Optional Group
O
O,AB,A,B
-
A
A,AB,B,O
-
B
B,AB,A,O
-
AB
AB,A,B,O
-
28
Rh COMPATIBILITY
•
‘Rh positive’ patient can receive ‘Rh positive’ as well as ‘Rh negative’
blood or blood components.
•
'Rh negative' person should receive ‘Rh negative’ whole blood and
PCV.
•
For plasma & platelet transfusion, when ‘Rh negative’ units are not
available, ‘Rh positive’ units can be transfused weighing the need of
transfusion and risk of Rh alloimmunisation. While transfusing ‘Rh
positive’ unit to ‘Rh negative’ woman with child bearing potential, Rh Ig
prophylaxis should be given.
•
For cryoprecipitate transfusion Rh compatibility is not applicable.
29
COMPATIBILITY & SELECTION OF UNIT FOR NEONATAL TRANSFUSION
Neonate: Patient under the age of 4 months are neonates for blood transfusion purpose.
Blood Request: Write compulsory ‘whether you suspect HDN or not’ on requisition form .
Blood Samples: Send blood samples of both –
1. Baby
2. Mother
Compatibility Testing:
1. First direct coomb’s test (DCT) on baby’s RBCs & indirect commb’s test (ICT) on maternal
plasma are performed to r/o HDN.
Test
Results
DCT on baby’s RBCs
–
+
–
+
–
ICT on maternal plasma
–
+
+
–
–
Clinically suspected case of HDN
–
±
±
±
+
Interpretation:
No e/o HDN
e/o HDN
30
2.
If there is no e/o HDN: Select unit of same ABO & Rh blood group as that of neonate.
ABO COMPATIBILITY, IF NO E/O HDN
Neonate’s Group
Compatible Group
Optional Group
O
O
-
A
A
O
B
B
O
AB
AB
A, B, O
NOTE: If mother’s group is same as that of baby, additional major crossmatch with maternal plasma
should be done.
3.
If there is e/o HDN: Use ABO & Rh compatible unit to both baby’s & mother’s sample.
Group is optional, if
Group is compatible, if
With baby’s
sample
With mother’s
sample
Major
Major
Minor



With baby’s
sample

NA
With mother’s
sample

Minor
NA
31
ABO COMPATIBILITY, IF E/O HDN
Neonate’s ABO Group
O
A
B
AB
Mother’s ABO group
Compatible Group
Optional Group
O
O
-
A
O
-
B
O
-
O
-
O
A
A
O
B
-
O
AB
A
O
O
-
O
A
-
O
B
B
O
AB
B
O
A
A
O
B
B
O
AB
AB
O,A,B
NOTE: If mother’s group is ‘AB’, then baby’s group can not be ‘O’ and if mother’s group is ‘O’, then
baby’s group can not be ‘AB’
32
Rh compatibility if e/o HDN:
If there is e/o HDN, unit should be Rh compatible to both baby’s & mother’s group i.e. if either
of two is Rh negative, then select Rh negative unit.
General rules of neonatal transfusion:
1.
Don’t use PCV with SAGM solution (additive solution) for neonatal transfusion, as it contains
mannitol. Neonatal transfusion is the only contraindication for using PCV with SAGM solution.
2.
If you are transfusing blood of optional group (whether there is e/o HDN or not), use semi-PCV
(i.e. whole blood from which plasma is removed partially) with low anti-A or anti-B titre.
3.
Use fresh blood (<48hrs old preferably) for neonatal transfusion. It should not be more than 5
days old to avoid risk of hyperkalemia.
4.
For plasma & platelet transfusion, same group unit as that of baby, should be used. If there is
e/o HDN & mother is Rh negative, use unit of Rh negative group.
STORAGE OF BLOOD
&
BLOOD COMPONENTS
33
STORAGE OF BLOOD & BLOOD COMPONENTS
In Blood Bank
Product
Temp
Shelf life
WB
20 – 60 c
35 Days
PCV (with
Additive Sol)
20 - 60 c
42 Days
FFP, CRYO
<-300 c
1 Year
RDPC, SDPC
200 – 240 c
5 Days
Platelets should be kept continuously agitating till issued to patient.
34
STORAGE OF BLOOD & BLOOD COMPONENTS
In Hospital
Product
Temp
Shelf life
WB
20 - 60 c
24 Hrs.
PCV (with
SAGM)
20 - 60 c
24 Hrs.
FFP, CRYO
20 – 60 c 12 Hrs.
RDPC, SDPC
Room
Temp.
-
Platelets should be kept continuously agitating till transfused to patient.
Ideally blood/component units should not be stored in hospital as temp. of the
hospital refrigerator is not controlled. Ask the patient’s relatives to bring blood
unit from blood bank just before transfusion.
ADMINISTRATION OF BLOOD
&
BLOOD COMPONENTS
35
PRE-ADMINISTRATION PRECAUTIONS
Check For
Case Paper
Issue Report
(Sent by Blood
Bank)
Patient’s Name
Blood Group of
patient


Blood bag No.
Blood Group
of bag
Cross-match
Label
(On blood unit)
(On blood unit)








Expiry Date
Testing Label



Check unit for – Leakage/damage
Clot
S/o hemolysis
S/o contamination
36
ADMINISTRATION
• BT Set –
Use BT set for transfusion of all blood products i.e. WB, PCV,
FFP, RDPC, SDPC, & Cryoprecipitate.
Change BT set every 12 hrs., if patient is requiring ongoing transfusion.
• Warming –
Warming of blood unit is not needed. Infusion of 2-4 units of
refrigerated blood over several hours causes no harm.
Warming is needed in following conditions –
• Infants receiving exchange transfusion.
• Patients receiving rapid transfusion through central venous line.
• Patients receiving rapid & massive transfusions.
• Patients with cold – antibodies.
(If warming is needed, unit should not be warmed above 370 c.
Excessive warming may cause hemolysis in unit & can lead to serious
transfusion reaction).
• Don’t add any medication to unit. You can add only normal saline or 5% albumin to dilute.
37
TIME LIMITS FOR TRANSFUSION
• WB / PCV – Within 3-4 hours.
• FFP
– Within 15-20 mins.
• Cryo
– Within 5-10 mins.
• Platelets
– Within 15-20 mins.
(RDPC & SDPCs)
( If room temp. is 22-250c.
At higher room temp., there should be
shorter out of refrigerator time).
38
MONITORING OF PATIENT DURING TRANSFUSION
- WHEN -
- FOR -
• Before starting transfusion
•
General appearance
• As soon as transfusion started
•
Pulse, B.P., Temp.
•
Respiratory rate
•
Signs of adverse reactions
• At 15 mins
• Every hour
– Fever
• On completion
– Chills
• 4 hrs. after completion
– Rash
– Back pain
– Respiratory distress
– s/o anaphylaxis
ADVERSE TRANSFUSION
REACTIONS
&
THEIR MANAGEMENT
39
INFECTIOUS ADVERSE TRANSFUSION REACTIONS
Reaction
Presentation
Transfusion transmitted
infections
HIV, HBV, HCV, Malarial
parasite, T.pallidum (causative
agent of syphilis) are the
organisms which can get
transmitted through transfusion.
Presentation will be as per
infection transmitted.
Transfusion associated
sepsis
Fever, chills hypotension, septic
shock, DIC
Cause
1. During window
period, HIV, HBV &
HCV infections can
not be detected. The
test results in blood
bank are negative.
2. Technical &
interpretational errors
Bacterial
contamination due to
technical errors
How to avoid
- Risk of transmission of HIV, HBV &
HCV through transfusion can be
reduced to nearly zero %, by using
NAT tested blood.
- By using advanced fully automated
systems for testing, technical &
interpretational errors can be
minimized.
- Take aseptic precautions during
blood collection, product
preparation & at the time of
transfusion.
40
NON INFECTIOUS ADVERSE TRANSFUSION REACTIONS
Reaction
Presentation
Cause
How to avoid
Allergic reactions
(Very common)
Urticaria, pruritis,
flushing, rashes
Antibody to donor
plasma proteins
- Use PCV instead of WB
- Use cryoprecipitate instead of
FFP, when indicated
Non hemolytic febrile
transfusion reactions
(NHFTR)
(Very common)
Fever,
chills/rigors,
headache,
vomiting
Leukocytes
- Accumulated
cytokines
- Antibody to donor
leukocytes
- Use leuco-depleted components
Anaphylaxis
Urticaria,
hypotension, bronchospasm,
respiratory distress,
local edema
- Antibody to donor
plasma proteins
- Accumulated
cytokines
- Use leuco-depleted components
Transfusion associated
acute lung injury
(TRALI)
Respiratory failure,
hypotension, fever,
bilateral pulmonary edema,
hypoxemia
- Antibodies to
donor leukocytes
- Use leuco depleted components
Platelet refractoriness
No rise in platelet count on
platelet therapy
- Leukocytes
- Allomunisation,
HLA antigens
- Use leuco depleted components
41
NON INFECTIOUS ADVERSE TRANSFUSION REACTIONS
Reaction
Presentation
Cause
How to avoid
Hemolytic transfusion
reaction
(Immune hemolysis)
Chills, fever,
hypotension, back pain,
pain along infusion vein, oozing
from IV sites, hemoglobinuria,
renal failure with oliguria
Mismatched blood
transfusion
- Avoid sample collection errors
- Write blood group on requisition
form
- Pre administration check details
- Use of advanced gel technology
for crossmatching
Hemolytic transfusion
reaction
(Non immune
hemolysis)
Chills, fever,
hypotension, hemoglobinuria,
hemoglobinemia
Physical or chemical
destruction of RBCs
(heating, freezing,
adding drugs to
blood unit)
- Avoid warming
- Don’t add any medications to
blood unit
- Demand blood from Blood bank at
the time of transfusion
(Don’t store blood units in hospital)
Graft Vs host disease
(Delayed reaction)
Erythroderma, maculopapcular
rash, Nausea, vomiting,
diarrhea, Jaundice,
fever,
pancytopenia
Donor lymphocytes
engraft in recipient &
mount attack on host
tissue
- Avoid use of fresh blood (<48 hr
old) from blood related donors
- Irradiate blood unit before
transfusion in immunocompromised
patients
Circulatory overload
Dyspnea, orthopnea, cough,
tachycardia, hypertension
Volume overload
-
42
MANAGEMENT OF ADVERSE TRANSFUSION REACTIONS
Reaction
Mild reactions
Presentation
Treatment
Urticaria,
- Slow the transfusion
Rashes,
- Give IM antihistaminic
Itching
- If no improvement or worsening then treat as moderately severe
reaction
Moderately severe
Fever,
- Stop transfusion, replace set & keep IV line open with NS.
reactions
Rigors/chills,
- Notify the treating doctor
Tachycardia,
- Administer IM antihistaminic, oral antipyretic
Urticaria,
Flushing,
Restlessness,
Headache,
Mild dyspnea
- Give IV steroid & bronchodilator if indicated
- If improved, can restart transfusion slowly with new blood unit
- Send blood unit with BT set, post transfusion blood sample collected
from vein opposite to infusion site & post transfusion urine sample to
blood bank along with reaction report
- If worsen, treat as severe reaction
43
MANAGEMENT OF ADVERSE TRANSFUSION REACTIONS
Reaction
Severe reaction
Presentation
Treatment
Fever with rigors,
1. Stop transfusion, replace set & keep IV line open with NS.
Headache,
2. Infuse NS to maintain BP.
Dyspnea,
3. Maintain airway & give high flow O2.
Chest pain,
4. Give adrenaline in severe allergic reactions.
Back pain,
5. Give IV steroids & bronchodilators if indicated.
Pain at infusion site,
6. Give diuretics to maintain urine output.
Respiratory distress,
7. If e/o DIC, give platelets along with cryoprecipitate or FFP.
Restlessness,
8. If bacteremia is suspected, send blood culture & start broad
Hypotension (>20%),
spectrum antibiotics.
Tachycardia (>20%),
9. If renal failure is suspected, maintain fluid balance accurately.
Hemoglobinuria,
10. Send blood unit with BT set & post transfusion blood & urine sample
Unexplained bleeding
to blood bank along with reaction report.
44
LEUCO-DEPLETION
1.
By removing buffy coat at the time of separation
2. By filtration using leukocyte filters
a.
After collection & before component separation
using in-line leukocyte filter bags
b.
At the time of transfusion using leukocyte
filters
ABOUT ARPAN
Arpan Blood Bank is Not-for-profit organization run by a Charitable Trust.
We have been serving this domain of public health for last 15 years on 24X7
basis. We run 08 blood banks across Maharashtra State.
MISSION
Arpan Blood Bank is working with single minded focus of creating a role
model at national level by becoming the best blood bank of the country by
year 2015. By this way, we would have inspired enough souls to spread this
great work and wipe out all exploitations in this critical domain of public
health.
ARPAN - MAJOR MILESTONES
• 1996: Established first blood bank at Nashik.
• 2000: Introduced Apheresis Technology first time in North Maharashtra.
• 2002: Formed State level Association of blood banks operating on Not-for-Profit
principle.
• 2003: Replication of successfully build model at other locations in Maharashtra
state started.
• 2009: Developed in-house ERP to ensure Quality.
• 2010: Only 3rd large sized Blood Bank to get NABH Accreditation to raise Quality
Standard further.
• 2011: Established NAT laboratory at Nashik to raise safety of blood transfusion.
ARPAN – FUTURE INITIATIVES
•
An Independent Thalassemia Care Center
•
Cord Blood Bank
•
Leuco - Depletion Facility In Blood Bank
•
Irradiation Facility In Blood Bank
•
Certification Course For Transfusion Medicine
•
DNB Course For Transfusion Medicine
ARPAN
Chain of blood banks