SAFE BLOOD
TRANSFUSION
Blood component
in HSM
Packed cell
Packed cell
Description Obtained from by removing most of
the plasma from whole blood.
Indication To increase oxygen-carrying capacity
of blood due to loss red cell loss or
reduced erythropoiesis
Storage 2-6ºC
Transportaion 2-10ºC
Insulated box with coolant pack
AVOID direct contact
Platelet
Platelet
Description Derived from whole blood containing
majority of the original platelet content,
suspended in plasma.
Indication 1. Prophylactic platelet transfusion
(preop, platelet count< 10 with
active bleeding).
2. provide platelet replacement
Storage 20-24ºC
Transportaion Insulated box
NO ICE!
Fresh frozen plasma
FFP
Description Derived from whole blood donation
(within 24 hour of collection), Contains
proteins such as all clotting factors,
immunoglobulin and albumin
Indication Bleeding patient with coagulopathy,
warfarin reversal, prophylactic FFP
transfusion
Storage -18ºC to -25ºC
Transportaion Received it with frozen component
(ONCE THAWED, FFP CANNOT
REFROZEN)
Thawing : soak in water bath with water
flow
Cryoprecipitate
Cryoprecipitate
Description Concentrated source of certain protein
derived from FFP
Indication Massive bleeding, acquired fibrinogen
deficiency, Factor XIII deficiency.
Storage -18ºC to -25ºC
Transportaion Received it with frozen component
(ONCE THAWED, FFP CANNOT
REFROZEN)
Thawing : soak in water bath with water
flow
ORDERING BLOOD AND
BLOOD COMPONENTS
FOR TRANSFUSION
Decision to transfuse
Assess benefit and risks
Risks:
Transfusion reaction
Transmission of infectious
disease agents
Consent for transfusion:
Written informed consent prior
to blood transfusion
POSITIVE
PATIENT
IDENTIFICATI
ON
Ask patient full name and
identity card (IC) number in open
ended questions
Use at least 2 identifiers
Check answers given with
patient's identification
wristband or case notes
May ask relative or caretaker
to identify the patient
Taking and labelling patient's
blood sample
Critical process!
To ensure that right blood sample is collected from the right patient.
ONE PROCESS by ONE PERSON at bedside.
ONE PATIENT attended at any ONE TIME until completion.
Label immediately after blood taking at patient's bedside.
Infant up to 4 months
old Older than 4 months old
1.5ml-2ml 3-5ml
Patient's full name
Label IC number
information
Test : GSH/GXM
The initial of
phlebotomist
Code GXM
Patient identification
Diagnosis
Blood component
Phlebotomist Initial, Cop
Request Date/ time taken blood
forms Phlebotomist witness, 2nd checker
Slip pengambilan darah & komponen darah
WHOLE BLOOD / PC • FFP / CROPRECIPITATE • PLATELET
2-6ºC • 2-6ºC • 20-24ºC
Blood box with ice • Blood box with ice • Blood box WITHOUT ice
TRANSPORTATION
CORRECT MODE OF TRANSPORTATION FOR BLOOD AND BLOOD PRODUCT
PATIENT IDENTIFICATION
WHAT TO
Full name of patient
IC number
CHECK
ABO and RhD blood group of patient
BLOOD / BLOOD COMPONENT
DURING Unique pack number (donation barcode
number) of the blood product
COLLECTION Date of issue
Type of component
Transfusion process
TRANSFUSION PROCESS
Identification check prior to transfusion
Bedside identification checks by two
person
• Blood bag label
• Blood compatibility label
• Full name
• Identity card or passport
number
• Hospital registration
number
• Donation barcode number
of blood product
• Date of issue
• Type of component
• Request form
• Patient's identity
Positive patient identification
Check to ensure patient’s information on
the blood compatibility label match with:
Blood bag label
Patient’s wristband
Patient’s blood request form
Case notes
Identification Check
Prior to Transfusion –
Final Bedside Check
WHAT TO CHECK
Expiry date
Appearance
• No change in colour
• Absence of clots or
clumps
• No foamy appearance
• No leakage
MONITORING OF
PATIENT
Closely observe and monitor patient during
transfusion
Blood pressure
Pulse rate
Temperature
Clinical features of acute transfusion reactions
Vital signs monitored and recorded:
Before starting transfusion.
During the transfusion
Close observation for first 5-10minutes
Then half hourly
Then hourly
After completion of transfusion
Following information for each transfusion shall be
recorded into the patient's case note:
-Type of product transfused
Record - Identification of product transfused
-Time of transfusion start and end
keeping - Date of transfusion
- Adverse transfusion, if any
A copy of the blood request form (with clear compatibility
test results from the blook bank) shall be kept with the
patient's case notes.
DURATION FOR
TRANSFUSION OF BLOOD
Red cells Platelets • Plasma
Transfused within 30 minutes of Transfused as soon as • Transfused as soon as
removal from the blood possible thawed unit is received.
refrigerator Should not exceed 30 • Should be completed wi
Transfusion of each unit shall minutes thin 4 hours of
not exceed 4 hours *Keep platelets at room issues out of
*risk of bacterial contamination temperature (20-24C) controlled temperature
if kept at room temperature for environment
too long.
BLOOD
ADMINISTRATION
SETS
ALL blood and blood components shall
be transfused through a blood
administration set containing special IV
tubing with and integrated filter (170-
260 micron) to remove blood clots and
particles
The tubing shall be primed with 0.9%
NaCl or with the component itself
Fresh transfusion set should be used for
transfusing other blood component
Safe O
• Uncrossmatched group O RhD positive packed red
cells, preferably fresh (within 2 weeks
old) with negative DCT test.
• Safe ‘O’ is used for resuscitation in emergencies where
immediate transfusion is necessary to safe the patient’s life
when waiting for the group-
specific crossmatched blood would be harmful
to the patient.
Confirm the ABO grouping of the
selected blood bags.
Perform the DCT testing to the
selected blood bags.
Attached ‘SAFE O’ sticker onto
the blood bag and PPDK 1card.
Filling the PPDK 1 card with the
blood bag number, date and time
of supply.
Record in the ‘Rekod Safe ‘O’
Unit Patologi dan Transfusi’
Hospital Sultanah Maliha’
Supply together with the
PPDK 1 card.
Record the identity of the
person who collect the blood
bag in the record book.
The client is responsible for
the handling and
documentation of the Safe ‘O’
in the irrespective department.
Safe ‘O’ blood is used/transfused in A&E, the
officer responsible for the transfusion shall
provide the followings to blood bank:
A complete ‘Borang Permohonan
Transfusi Safe O’ (red color)
Used blood bag
Patient sample(pre transfusion sample
in 2 EDTA tube-label the sample)
A completely filled blood tag (PPDK1)
If the blood is not used, it shall be returned to
blood bank TWO (2) weeks before the expiry
date and to be exchanged with new units of
Safe ‘O’ blood.
Adverse
effect of
transfusion
Acute : arise during transfusion or
within 24 hours of transfusion
Delayed : after 24 hours (up to
months or years)
Adverse Effect of Transfusion
Acute adverse effects Delayed adverse effects
(≤ 24 hours of transfusion) (>24 hours of transfusion)
Immune Immune
Acute Hemolytic Transfusion Reaction Acute Hemolytic Transfusion Reaction
Transfusion-Related Acute Lung Injury Transfusion-Related Acute Lung Injury
(TRALI) (TRALI)
Anaphylaxis/Anaphylactoid Reactions Anaphylaxis/Anaphylactoid Reactions
Allergic Reaction Allergic Reaction
Febrile Non-Haemolytic Transfusion Febrile Non-Haemolytic Transfusion
Reaction (FNHTR) Reaction (FNHTR)
Non-immune Non-immune
Transfusion Associated Circulatory Transfusion Transmitted Infection (TTI)
Overload (TACO) Transfusion Associated Haemosiderosis
Bacterial Contamination/Septic Transfusion
Reaction
Transfusion Associated Dyspnoea (TAD)
Hypotensive Transfusion Reaction
Signs and symptoms
Feeling of Fever (1°C rise from Chills with or without Pain at infusion site, chest,
apprehension/restlessness baseline) rigors abdomen or flanks
Respiratory distress
Hypotension or
(wheezing, dyspnoea and Skin manifestations Nausea/vomiting
hypertension
cynosis)
Acute onset of sepsis Anaphylaxis Abnormal bleeding
Flowchart for management of
acute transfusion reaction
Request form for transfusion
reaction investigation
THANK
YOU
Reference : Handbook on Clinical Use of Blood
