Blood Transfusion

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Contents 1 More Specific Terms 2 Introduction 3 Indications 4 Procedure 5 Complications 6 More General Terms 7 Additional Terms 8 References

More Specific Terms

• intrauterine transfusion
• massive blood transfusion (washout)

Introduction

• Emergencies

• group O erythrocytes can be transfused to anyone
• Rh-positive patients can safely receive D-positive or D-negative blood, but Rh-negative patients must receive D-negative blood & platelets
• group AB plasma may be tranfused to anyone
• transfusion of incompatible blood in patients with severe autoimmune hemolytic anemia may be life-saving ( autoantibody reacts with both donor & patient's erythrocytes)

Indications

• hemoglobin < 7 g/ dL (most patients)
• hemoglobin < 8 g/ dL ( post-surgical patients) [5]
• hemoglobin < 9 g/ dL (critically ill patients on ventilatory support)
• hemoglobin < 10 g/ dL ( acute myocardial infarction)

Procedure

• normal saline (0.9%) is the only IV solution to be used with a blood transfusion
  
• An RN must start the infusion
• Another person must verify the patient's identity

• an MD, an RN or an LPN
  

• Vital signs must be checked

• before the transfusion starts
• 15 minutes after transfusion starts
• hourly until the transfusion is complete
• 15 minutes post completion of transfusion
  

• Transfusion of blood must be initiated within 30 minutes of release from the blood bank
  
• Transfusion of 1st 50 mL of blood over a period of 15 minutes, remainder should be tranfused in < 3-4 hours
  
• Verification prior to starting transfusion:

• patient's id
• patient's ABO type
• patient's RH type
• transfusion number
  

• Patients may be observed for transfusion reactions by

• RN, LPN, nursing assistant
  

• Development of fever during transfusion requires the tranfusion be stopped until a hemolytic reaction can be ruled out [2]
  
• Prophylaxis

• hepatitis B vaccine for any patients requiring frequent blood transfusions

Complications

• iron overload: deferoxime for iron overload

More General Terms

• blood banking (transfusion medicine)
• clinical procedure

Additional Terms

• autologous blood donation (transfusion)
• blood products
• blood transfusion reaction
• crossmatch
• indications for CMV seronegative blood products
• indications for irradiation of cellular blood products
• transfusion-associated viral infection
• type & screen

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 613-616
2. Medical Knowledge Self Assessment Program (MKSAP) 14, 15 American College of Physicians, Philadelphia 2006, 2009
3. Veterans Administration
4. No authors listed] Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the american society of anesthesiologists task force on perioperative blood transfusion and adjuvant therapies. Anesthesiology. 2006 Jul;105(1):198-208. No abstract available. <PubMed> PMID: [1] <Internet> [2]
5. Carson JL et al Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB Annals of Internal Medicine, March 26, 2012 <PubMed> PMID: [3] <Internet> [4]
   - Vincent JL Indications for Blood Transfusions: Too Complex to Base on a Single Number? Annals of Internal Medicine, March 26, 2012 <PubMed> PMID: [5] <Internet> [6]
6. Blood/Blood Transfusion: NIH Institute and Center Resources [7]
7. National Guideline Clearinghouse Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. ngc-guideline: [8]
   - Blood transfusion: indications, administration and adverse reactions. Finnish Medical Society Duodecim ngc-guideline: [9]

blood transfusion