Blood Transfusion

<table id=cafe_editor_main_table_color bgColor='#ffc4b0' cellpadding=0 cellspacing=0 border=0 width=100%><tr><td id=cafe_editor_main_table class=text><H1 style="MARGIN: 0cm 0cm 0pt"> <H2 style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 0cm"><?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p></H2>Blood Types<o:p></o:p></H1> <o:p> </o:p> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo1">o      ABO system<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo1">o      Rh System: “D” antigen is the most significant.<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -18pt; mso-list: l4 level1 lfo12; tab-stops: list 36.0pt">1.      Rh “-”ve: “D” antigen ABSENT                   <o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -18pt; mso-list: l4 level1 lfo12; tab-stops: list 36.0pt">2.      Rh “+”ve: “D” antigen PRESENT, 85% of the population<o:p></o:p></H2> <o:p> </o:p> <H1 style="MARGIN: 0cm 0cm 0pt">Blood Group Compatibility <o:p></o:p></H1> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo1">o      The NZBS normally provides ABO group specific blood of the appropriate Rh (D) type to patients.<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo1">o      On occasions Group O will be issued to a Non-Group O patient, such as<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo1">o      Emergencies<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo1">o      An excess stock of Group O that would be otherwise expired<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18.5pt; mso-list: l0 level1 lfo1">o    All blood that is ABO compatible must be Rh typed<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18.5pt"><o:p> </o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18.5pt; mso-list: l0 level1 lfo1">o    It is possible to transfuse Rh”D” –ve blood to patients who are Rh”D”+ve.<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18.5pt"><o:p> </o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18.5pt; mso-list: l0 level1 lfo1">o    Rh”D”+ve blood should never be transfused to Rh”D”-ve patients.<o:p></o:p></H2> <o:p> </o:p> <H1 style="MARGIN: 0cm 0cm 0pt">Rh Isoimmunisation in Pregnancy<o:p></o:p></H1> <H2 style="MARGIN: 0cm 0cm 0pt 18.5pt; mso-list: l0 level1 lfo2">o     Rh+ve father and Rh-ve mother<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18.5pt; mso-list: l0 level1 lfo2">o     50 % pregnancy with Rh+ve fetus<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18.5pt; mso-list: l0 level1 lfo2">o     During the first pregnancy, Rh+ve blood enters the mother’s blood both during the pregnancy and when the placenta separates.<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18.5pt; mso-list: l0 level1 lfo2">o     The mother is sensitised and anti-Rh+ve antibodies are formed.<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18.5pt; mso-list: l0 level1 lfo2">o     On the second exposure, the Rh+ve red blood cells are attacked by the anti-Rh+ve antibodies, causing haemolysis in the fetus.<o:p></o:p></H2> <o:p> </o:p> <H1 style="MARGIN: 0cm 0cm 0pt">Blood and Blood Products<o:p></o:p></H1> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo1">o      Defined as medicines when intended for therapeutic use under the Medicine Act 1981.<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo1">o      Blood products:<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo1">o      Whole blood – rarely used<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo1">o      Red blood cells: commonly used<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo1">o      Platelets<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo1">o      Fresh frozen plasma<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt"><o:p> </o:p></H2> <H1 style="MARGIN: 0cm 0cm 0pt">Blood Ordering<o:p></o:p></H1> <o:p> </o:p> <H1 style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 0cm; mso-list: l6 level1 lfo9">o            Group and Hold (G & H)<o:p></o:p></H1> <H2 style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; mso-list: l2 level1 lfo10; tab-stops: list 18.0pt">1.      The patient’s ABO and Rh D tested (Group).<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; mso-list: l2 level1 lfo10; tab-stops: list 18.0pt">2.      The patient’s serum is stored (Hold) for 10 days if the patient has no blood transfusion within the last three months, otherwise, for 3 days also same in those with no transfusion history provided.<o:p></o:p></H2> <o:p> </o:p> <H1 style="MARGIN: 0cm 0cm 0pt">Cross Match<o:p></o:p></H1> <H2 style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; mso-list: l1 level1 lfo11; tab-stops: list 18.0pt">1.      Apart from the first step as in G & H, the patient’s serum is tested directly with the red cells from units of blood.<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; mso-list: l1 level1 lfo11; tab-stops: list 18.0pt">2.      The units compatible are labelled specifically for the patient.<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; mso-list: l1 level1 lfo11; tab-stops: list 18.0pt">3.      The blood bank holds the units and releases them immediately upon request.<o:p></o:p></H2> <o:p> </o:p> <H1 style="MARGIN: 0cm 0cm 0pt">Management of Blood Transfusion<o:p></o:p></H1> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l10 level1 lfo8">o        Informed consent<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l10 level1 lfo8">o        Red blood cells handling:<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -18pt; mso-list: l8 level1 lfo6; tab-stops: list 36.0pt">1.      Transfused within 2-3 hours of release of blood bank.<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -18pt; mso-list: l8 level1 lfo6; tab-stops: list 36.0pt">2.      Administration must begin within 30 minutes of leaving the blood fridge.<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -18pt; mso-list: l8 level1 lfo6; tab-stops: list 36.0pt">3.      Blood and blood products are administered only through a filtered blood giving set.<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -18pt; mso-list: l8 level1 lfo6; tab-stops: list 36.0pt">4.      The only IV fluid that can be administered through the same giving set is 0.9% NαCI. <o:p></o:p></H2> <o:p> </o:p> <H2 style="MARGIN: 0cm 0cm 0pt 18.5pt; mso-list: l0 level1 lfo1">o    The unit is checked by 2 nurses for<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; mso-list: l5 level1 lfo7; tab-stops: list 18.0pt">1.      Appearance<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; mso-list: l5 level1 lfo7; tab-stops: list 18.0pt">2.      Labels of unit on blood<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; mso-list: l5 level1 lfo7; tab-stops: list 18.0pt">3.      Identity of patient<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; mso-list: l5 level1 lfo7; tab-stops: list 18.0pt">4.      Compatible ABO and Rh types<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18.5pt"><o:p> </o:p></H2> <H1 style="MARGIN: 0cm 0cm 0pt">Monitoring<o:p></o:p></H1> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo1">o      Before commencement of each unit of blood transfusion, baseline observations must be recorded.<o:p></o:p></H2> <H3 style="MARGIN: 0cm 0cm 0pt 38.05pt; TEXT-INDENT: -19.5pt; mso-list: l0 level1 lfo3">n       Temperature<o:p></o:p></H3> <H3 style="MARGIN: 0cm 0cm 0pt 38.05pt; TEXT-INDENT: -19.5pt; mso-list: l0 level1 lfo3">n       Pulse<o:p></o:p></H3> <H3 style="MARGIN: 0cm 0cm 0pt 38.05pt; TEXT-INDENT: -19.5pt; mso-list: l0 level1 lfo3">n       Respiratory rate<o:p></o:p></H3> <H3 style="MARGIN: 0cm 0cm 0pt 38.05pt; TEXT-INDENT: -19.5pt; mso-list: l0 level1 lfo3">n       Blood pressure<o:p></o:p></H3> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo2">o        Remain in and around patient for the first 15 minutes of the commencement of each unit.<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo2">o        Repeat baseline recordings at 15 minutes of the commencement.<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 22.5pt; TEXT-INDENT: -22.5pt; mso-list: l0 level1 lfo2">o        Record pulse and respiration rate every 30 minutes and all the baseline observations hourly until the unit is finished plus visually observe the patient.<o:p></o:p></H2> <H1 style="MARGIN: 0cm 0cm 0pt"><o:p> </o:p> </H1> <H1 style="MARGIN: 0cm 0cm 0pt">Transfusion Reactions<o:p></o:p></H1> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -18pt; mso-list: l9 level1 lfo5; tab-stops: list 36.0pt">·        Febrile<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18.5pt">      Pyrexia, rigours, anxiety, restlessness <o:p></o:p></H2> <o:p> </o:p> <H1 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -18pt; mso-list: l7 level1 lfo4; tab-stops: list 36.0pt">·        Circulatory overload <o:p></o:p></H1> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -36pt">       Distension of cervical veins, pulmonary oedema, dyspnoea, cough, headache,  </H2> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -36pt">              heaviness in limbs<o:p></o:p></H2> <o:p> </o:p> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -18pt; mso-list: l7 level1 lfo4; tab-stops: list 36.0pt">·        Allergic <o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -36pt">            Urticaria, facial oedema, dyspnoea, sometimes cyanosis and peripheral collapse <o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 18.5pt"><o:p> </o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -18pt; mso-list: l7 level1 lfo4; tab-stops: list 36.0pt">·        Haemolytic<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -36pt">            Collapse with hypotension, pain in lumbar, chest or abdominal regions,     pyrexia, rigours, haemoglobinuria, oliguria, haemoglobinaemia, later uraemia, sometimes pain in the vein with the IV line in <o:p></o:p></H2> <H1 style="MARGIN: 0cm 0cm 0pt"><o:p> </o:p></H1> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -18pt; mso-list: l7 level1 lfo4; tab-stops: list 36.0pt">·        Infected blood<o:p></o:p></H2> <H2 style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -36pt">            Hyperpyrexia, pain in limbs and chest, profound collapse and shock, dyspnoea, headache, low blood pressure, rapid pulse <o:p></o:p></H2> <o:p> </o:p> Compatible IV fluids used in blood transfusion <OL style="MARGIN-TOP: 0cm" type=1> <LI class=MsoNormal style="MARGIN: 0cm 0cm 0pt; mso-list: l3 level1 lfo13; tab-stops: list 36.0pt">normal saline 0.9%</LI> <LI class=MsoNormal style="MARGIN: 0cm 0cm 0pt; mso-list: l3 level1 lfo13; tab-stops: list 36.0pt">plasmalyte</LI> <LI class=MsoNormal style="MARGIN: 0cm 0cm 0pt; mso-list: l3 level1 lfo13; tab-stops: list 36.0pt">albumin 4%</LI></OL> <o:p> </o:p></tr></td></table>