Blood Transfusion

Blood Transfusion: A Comprehensive Guide

Blood transfusion is a medical procedure in which donated blood or blood components are transferred into a recipient’s bloodstream. It is a critical procedure for treating various conditions, including severe blood loss, anaemia, and certain medical disorders like hypovolemic shock, thalassemia & RTA cases.

Objectives of Blood Transfusion:

1. Replace lost blood due to surgery, injury, or trauma.
2. Treat conditions like severe anaemia or haemoglobin disorders.
3. Support patients undergoing chemotherapy or bone marrow transplants.
4. Correct clotting deficiencies or platelet disorders.

Components of Blood for Transfusion:

1. Whole Blood: Contains red blood cells, white blood cells, platelets, and plasma. Rarely used today.
2. Red Blood Cells (Packed RBCs): Used to treat anaemia and significant blood loss.
3. Platelets: Help in clotting; used for conditions like thrombocytopenia.
4. Plasma: Contains clotting factors and proteins; used in clotting disorders & plasmapheresis.
5. Cryoprecipitate: Rich in fibrinogen, used for specific clotting deficiencies.

Indications for Blood Transfusion:

1. Acute Blood Loss: Due to trauma, surgery, or childbirth.
2. Anaemia: When the haemoglobin level is critically low.
3. Bleeding Disorders: Such as hemophilia or von Willebrand disease.
4. Cancer Treatment: To replenish blood cells reduced during chemotherapy.
5. Chronic Illnesses: Conditions like sickle cell anaemia or thalassemia.

Procedure Steps for Blood Transfusion:

1. Preparation:

• Doctor’s Order: Ensure the transfusion is medically necessary.
• Blood Typing and Cross-Matching:
  • Confirm the patient’s blood type and match it with the donor’s blood.
  • Perform a cross-match test to ensure compatibility and prevent reactions.
• Informed Consent: Explain the procedure, risks, and benefits to the patient and obtain consent.

2. Equipment Required:

• IV cannula and BT set with a blood filter.
• Blood product (stored at appropriate temperature).
• Normal saline (to flush the IV line).
• Monitoring equipment (blood pressure cuff, thermometer).
• Emergency drugs and equipment for managing transfusion reactions.

3. Starting the Transfusion:

1. Check the Blood Bag:
   • Verify the label for blood type, expiration date, and volume.
   • Inspect the bag for clots, discolouration, or leaks.
2. Prepare the IV Line:
   • Insert an IV cannula into the patient’s vein.
   • Prime the tubing with saline to prevent blood clotting in the line.
3. Begin Transfusion:
   • Start at a slow rate (e.g., 2 mL/min) to monitor for immediate reactions.
   • Check for vitals including temperature, heart rate and BP.
   • After 15 minutes, if no reaction occurs, increase to the prescribed rate.

4. Monitoring During Transfusion:

• Check vital signs (temperature, blood pressure, heart rate) in every 15 minutes initially, then periodically.
• Observe the patient for symptoms of adverse reactions (see below).

5. After the Transfusion:

• Flush the IV line with saline.
• Document the procedure, including the type of blood product, start and end times, and patient’s response.
• Dispose of used materials as per medical waste protocols.

Signs of Transfusion Reactions:

Reactions are rare but can be life-threatening. Monitor the patient closely for:

1. Fever or Chills: Indicates febrile reaction or infection.
2. Shortness of Breath or Chest Pain: May indicate a hemolytic reaction or fluid overload which may lead to heart failure.
3. Rash or Itching: Suggests an allergic reaction.
4. Back Pain or Dark Urine: Signs of haemolysis (destruction of red blood cells).
5. Drop in Blood Pressure: Possible anaphylaxis which may lead to anaphylactic shock or septic shock.

What to Do in Case of a Reaction:

1. Stop the transfusion immediately.
2. Keep the IV line open with saline.
3. Notify the healthcare provider and follow emergency protocols.
4. Administer medications (e.g., antihistamines, corticosteroids, epinephrine) as prescribed.
5. Return the blood bag and tubing to the blood bank for investigation.

Post-Transfusion Care:

1. Monitor the patient for delayed reactions (e.g., jaundice or fever) for 24–48 hours.
2. Encourage the patient to report symptoms like fatigue, dark urine, or persistent fever.
3. Check haemoglobin levels to ensure the transfusion achieved its purpose.

Risks of Blood Transfusion:

1. Infections: Extremely rare due to stringent blood screening.
2. Iron Overload: With multiple transfusions.
3. Allergic Reactions: Hives, itching, or fever.
4. Haemolytic Reaction: Occurs when there is a mismatch between donor and recipient blood.
5. Fluid Overload: Especially in elderly or cardiac patients.

Would you like more detailed information about blood products, managing specific complications, or patient education for blood transfusions?