1

The 5 Rights of Transfusion

Ensure that the Right Patient

is getting the Right Product

in the Right Amount

at the Right Rate

at the Right Time

2
 Contents

S. No. Topic Page No.

1. Pre-transfusion phase 5-17

1.1 Informed consent 5

1.2 Types of Blood Products 6-9

1.3 Blood requisition 10-11

1.4 Process flow from requisition to issue of blood 12-14

1.5 Blood request in extreme emergency ( Life 15

threatening bleed)

1.6 Requisition of Single Donor Apheresis Platelet 16-17

(SDAP)

1.7 Blood group compatibility for blood components 18

1.8 Preparing the patient for transfusion 19

1.9 Need for warming blood before transfusion 20

1.10 Blood transfusion Set 21

1.11 Final Check before transfusion 22

2. Transfusion Phase 23-28

2.1 Starting and Monitoring blood transfusion 23-24

2.2 Documentation 25

2.3 Transfusion reactions 26-28

2.4 Hemovigilance 28

Annexure 1 : Patient Consent form

Annexure 2 : Blood Bag Labels and compatibility report ( Reaction form)

Annexure 3: Transfusion record Sheet

Annexure 4: Process flow for arrangement of blood unit for intrauterine transfusion
3
Blood and blood products are categorised as drugs as

per the Drugs and cosmetics Act, Government of India

and hence the processing, issue and transfusion

should be in compliance with the rules therein.

4
 1.1 INFORMED CONSENT
Reference standards issued by Blood safety Division, National AIDS Control

Organisition Ministry of Health and Family Welfare Government of India

The patient should be informed about his/her need for blood, alternatives available,

as well as risks involved in transfusion and non transfusion. His/ her written consent

should be taken in the language he / she understands best only after providing

information. For minors and unconscious patients the next of kin should sign the

informed consent.

Guidelines for the person obtaining consent:

Describe the blood product to be transfused. Inform the patient or alternate

decision maker of material risks and benefits of the transfusion and any

alternatives.

Give the patient the opportunity to ask questions.

Document that consent was obtained by completing a transfusion consent

form. (Appendix: 1)

Clearly document the reason for transfusion in the patient’s chart.

Whenever possible, consent for transfusion should be discussed early

enough to allow for blood alternatives to be considered

5
 1.2 Types of Blood Products

With advancements in types of blood bags and component preparation

techniques, whole blood from a single blood donor can be divided into three or

four blood components preserving the function of individual component by

storing them at desired temperature and issuing specific component as per

patient’s need. Following are the types of blood Products available in

Department of Transfusion Medicine.

Whole Blood (WB)

Packed Red blood cells (PRBC) in CPDA-1

SAGM-PRBC ( Packed Red Cells in additive solution

Paediatric PRBC units ( Volume 80-100ml)*

Platelet Concentrate (PC)

Fresh Frozen Plasma (FFP)

Cryopoor Plasma (CPP)

Cryoprecipitates (Cryo)

Apheresis Platelets (SDAP)

Granulocyte concentrates

Description of each component about its volume, content, storage conditions,

indications, their administration guidelines are given in Table 1, 2 and 3.

*Paediatric PRBC units are prepared by dividing adult PRBC unit into three parts

using sterile connecting device and transfer bags.

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Table 1: Red Cell products

Parameters Whole blood PRBC (CPDA-1) PRBC-SAGM

Description Whole blood collected from Red blood cell concentrate From Red cell concentrate from which major part of the
blood donor in CPDA-1 Solution which most of plasma has been plasma and the buffy coat layer has been removed with
removed subsequent addition of a nutrient Solution (SAGM).

Volume 399 ml ( 350 blood + 49 ml 200 to 300 ml 250 to 350 ml

CPDA-1) and 513 ml ( 450 blood
+ 63 ml CPDA-1)

Hemoglobin 12 g /100ml 20 g/ 100 ml ( ≥45g /bag) ≥45g /bag

Hematocrit 30-40% 65-75% 55-65%

Storage +2 to +6oC in approved blood +2 to +6oC in approved blood +2 to +6oC in approved blood bank refrigerator, with
conditions bank refrigerator, with fitted bank refrigerator, with fitted fitted temperature chart and alarm
temperature chart and alarm temperature chart and alarm

Shelf life 35 days 35 days 42 days

Indications • Red cell replacement in acute
blood loss
• Exchange transfusion
• Patient needing red cell
transfusions where PRBCs are
not available
Administration • Transfuse using standard blood
transfusion set with 170µm
filter.
• Transfusion should be started
within 30 minutes of removal
from refrigerator & Complete
transfusion within 4 hours of
commencement
• Replacement of red cells in
anaemic patients
• In acute blood loss along with
crystalloids and colloids
• Transfuse using standard blood
transfusion set with 170µm
filter.
• Transfusion should be started
within 30 minutes of removal
from refrigerator & Complete
transfusion within 4 hours of
commencement
• Replacement of red cells in anaemic patients
• Patients who have experienced febrile reactions to
previous red cell transfusion.
• Transfuse using standard blood transfusion set with
170µm filter.
• Transfusion should be started within 30 minutes of
removal from refrigerator & Complete transfusion within
4 hours of commencement

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Table 2: Platelet products

Parameters Platelet concentrate (PC) Apheresis platelets ( SDAP)

Description Platelet Concentrrates are prepared from either 350 ml or Platelet concentrate derived from blood donor using an
450 ml whole blood.They are also called Random donor apheresis machine and disposable kit. It is also called single
platelets (RDP) donor apheresis platelets (SDAP)

Volume 50 to 90 ml 200-300ml

Platelet content 3.5 to 4.5 X 1010 /unit 3 to 7 X 1011 /unit (6 to 8 times the content in RDP)

Dosage 1 unit of platelet concentrate/10 kg body weight: in a 60 or One pack of platelet concentrate collected from a single donor
70 kg adult, 4–6 single donor units by apheresis is usually equivalent to one therapeutic dose

Storage and 3 to 5 days at 20°C to 24°C (with agitation) 5 days at 20°C to 24°C (with agitation)
Shelf life

Do not store at 2°C to 6°C in Refrigerators as it makes them non-functional

Indications • Thrombocytopenia • Same as for RDPs

• Platelet function defects • Patients experiencing frequent febrile
• Prevention of bleeding due to thrombocytopenia, such as Reactions with platelet concentrate
in bone marrow failure

Administration • Transfuse using standard blood transfusion set with Same as Random donor platelets, but ABO compatibility is
170µm filter. more important
• Initiate transfusion slowly for first 15 minutes unless
massive blood loss.
Caution: Platelets are prone to develop bacterial contamination, Transfusion should be started immediately after
receiving the units in the ward and Should be completed over a period of about 30 minutes.

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Table 3: Plasma products

Parameters Fresh frozen plasma (FFP) Cryoprecipitates

Description Plasma separated from one whole blood donation within 6 Prepared from fresh frozen plasma by
hours of collection and then rapidly frozen to –30°C or collecting the precipitate formed during
colder controlled thawing at +4°C.

Volume 150–220 ml 15 to 20 ml

Content Contains normal plasma levels of stable clotting factors, Factor VIII: 80–100 IU/ bag;
albumin and immunoglobulins. Factor VIII level at least 70%
of normal fresh plasma levels. fibrinogen: 150–300 mg/bag

Dosage Initial dose of 15 ml/kg 1 bag / 10 kg body weight

Storage And shelf life At –30°C or colder for up to 1 year At –30°C or colder for up to 1 year

Indications Replacement of multiple coagulation factor deficiencies: • As an alternative to Factor VIII concentrate in
e.g. the treatment of inherited deficiencies of:
 von Willebrand Factor (von
• Liver disease Willebrand’s disease)
• Warfarin (anticoagulant) overdose  Factor VIII (haemophilia A)
• Depletion of coagulation factors in patient receiving large • Factor XIII
volume transfusions • As a source of fibrinogen in acquired
• Disseminated intravascular coagulation (DIC) coagulopathies: e.g.disseminated
• Thrombotic thrombocytopenic purpura (TTP) intravascular coagulation (DIC)

Administration • Must normally be ABO compatible to avoid risk of
haemolysis in recipient.
• Infuse using a standard blood administration set (with
170µm filter) as soon as possible after thawing.
• Labile coagulation factors rapidly degrade; use
within 6 hours of thawing
• Can be transfused across ABO barrier.
• After thawing, infuse as soon as possible
through a standard blood administration set.
• Must be infused within 6 hours of thawing.

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1.3 REQUISITION FOR BLOOD AND BLOOD COMPONENTS

Pre-transfusion Sample collection

Patient Identification:

1. Even if you know your patient, check your patient’s identification on patient file to
make sure it is correct.

2. Include your patient in the identification process by asking specific questions:

• What is your name

• ‘How do you spell your name?’
• AVOID questions that require only a ‘Yes’ or ‘No’
eg. Are you Mr.Vinod.

4. After drawing the sample(s), label the tubes before leaving the patient.

• Labeling samples away from the patient greatly increases the risk of
mislabeling.

5. Document that you drew the blood sample. Never sign for anyone else’s work!

6. If any discrepancies are discovered they must be satisfactorily resolved prior to

collecting a pre-transfusion sample.

ALERT

Errors in sample labelling and patient identification are the leading cause of
Acute Hemolytic Transfusion Reactions – a potentially fatal complication of
transfusions.

If one unit of blood is intended, a 3-5 ml sample in PLAIN vial and 2 ml in EDTA
vial should be collected. For every additional unit 1 ml more blood in plain vial
should be sent.
Note: - From neonates and very anemic patients only EDTA sample may
suffice .

For double volume exchange transfusion (DVET) 3 ml mother’s sample in

plain vial alongwith neonatal EDTA sample is required.

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1. The sample vial must be labeled with gum pasted paper only and other
forms of labels, such as, leucoplast pasted labels will not be accepted.

2. Requisition form should be filled properly showing clinical diagnosis,

indication for transfusion along with pretransfusion Hb. (platelet count,
APTT/PT/PTI in case of blood components), time and date for cross-
matching.

3. Resident’s signature along with full name and designation should be written
on the form.
4. In case of previous transfusion, complete the reaction form and attach it
with the current request for cross match.
5. Tick the appropriate option for cross-matching i.e., blood if required for
planned hemotherapy or elective surgery (*routine cross-matching
including AHG testing), or urgently (*Urgent cross-matching/Immediate
spin cross-matching).
6. All cases for routine cross-matching should be sent 24 hours in advance
and incase of rare blood groups, please discuss with the cross-matching
resident at least 72 hours prior to the planned surgery.
7. Routine samples are received upto 2:30PM on Monday to Friday and
11:00AM on Saturdays. After this specified time, blood samples are
accepted in emergency only, where immediate spin cross-matching
technique is done.
8. For all routine cases, blood donation slips are to be sent along with the
requisition form. In case no donors are available, please discuss well in
advance with the resident on cross match duty.
9. Only those cases in which blood is required to be transfused immediately
should be marked “URGENT” or “IMMEDIATE”.
10. Cross-matched blood will be stored in the Dept. of Transfusion Medicine for
a period of 3 days from the date of cross-match. This date can be
extended only to 7 days after request from physician/surgeon in-charge
and he/she should specify time period to reserve the unit(s). In the
absence of information from the attending doctors, these cross-matched
units will be received back and utilized for other patients to avoid wastage
and outdating of units.

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1.4 Process flow from receiving a requisition at Dept. of
Transfusion Medicine till issue of blood. The time line.

1. Blood requisition is received at Dept. of Transfusion Medicine reception.

Following points are checked before accepting blood requisition
a. Name and CR No. of patient on requisition form and sample should
match precisely.
b. Requisition form is appropriately filled and signed by the resident.
c. Quantity of blood sample is adequate for blood grouping and
crossmatching.
Blood requisition details are entered in blood issue register and DTM
requisition number is issued to the patient’s attendant on a “Patient’s
Identification slip’’.
Time Taken during this process is 5 minutes.

2. After receiving the requisition sample is subjected to preliminary ABO and Rh

typing so as to ensure that ABO and Rh matched blood is available in the
current blood inventory.
Time taken during this process is 15 minutes.
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3. If ABO and Rh matched blood is available in the inventory, crossmatching
technique is decided, either Immediate spin (Is) or Antihuman globulin phase
(AHG) depending on the requisition by the clinician as urgent or routine.
This is a decision making point for type of technique. Hence all residents
must understand the merits and demerits of urgent vs routine blood
requisition.
4. Crossmatching
a. Immediate spin crossmatch (Is)
i. Repeat blood group of patient.
ii. Repeat blood group of donor unit.
iii. Major crossmatch is performed by using donor red cells and
patient plasma with tube technique.
iv. Tube is examined for any agglutination or haemolysis.
Time taken during this process is 30 minutes.
5. AHG phase crossmatch
i. Tube of immediate spin crossmatch is incubated in a 37oC
water bath for 90 minutes.
ii. After incubation RBC are washed 3 times with normal saline to
remove unbound antibodies.
iii. After washing two drops of AHG(anti human globulin reagent) is
added and tube is centrifuged and examined for any
agglutination.
iv. If non-reactive, check cells are added to validate the test.
Time taken during this process is 2 hours and 30 minutes.
6. Documentation of results of crossmatch on the requisition form and
crossmatch register. Preparation of “blood bag compatibility label” and
“compatibility form’’ (reaction form) with details of intended recipient of the
blood bag.
Time taken during this process is 10 minutes.

7. Issue of blood bag from Dept. of Transfusion Medicine reception

a. “Patient’s Identification slip” filled and signed by clinician is received at
the counter.
b. If the crossmatch has been performed compatibility report is available
at Dept. of Transfusion Medicine reception. Name and CR No. of
patient is matched on “Patient’s Identification slip” and compatibility
report.

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 c. Blood units are taken out from refrigerator according to compatibility
report.
d. Blood bag front and back label and compatibility report is matched for
Name, CR No. and blood group of patient and blood bag.
e. Blood bag is checked for any abnormal appearance like leakage
,hemolysis, gas formation or discoloration.
f. Blood bag is issued after entering details of blood bag in issue register
and taking receiving from patients attendants.
Time taken during this process is 5 to 10 minutes.

Note: we process requisitions in batches for optimum quality control. However

in life saving situations even single requests are processed.

Collective time from requisition to issue of blood for Immediate spin

crossmatch (Urgent crossmatch) is 1 hour 30 minutes and for AHG
crossmatch( Routine Crossmatch) is 4 hours.

Urgent(Immediate spin) vs. routine cross-matching testing

Immediate spin cross-matching

Routine cross-matching including AHG testing
Designed to detect compatibility of IgM In addition to saline phase compatibility
type of antibodies in patient’s serum testing (IgM antibodies detection), AHG
against antigen on donor’s red cells in saline testing is designed to detect compatibility of
phase i.e., ABO compatibility testing IgG type of antibodies in patient’s serum
against antigen on donor’s red cells

Also detect anti-Lea , - Leb, -I, -P1, -M and N AHG testing detects anti-D, -C, -E, -c, -e, -K, -
but not some other clinically significant Jk, -Fy, -S, -s, - Lea and Leb hence most of the
antibodies. clinically significant antibodies are detected.

Note: - For any queries contact the resident on cross-match duty.

JR on Call: 9914209480, SR on Call: 9914209486

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1.5 Blood request in extreme emergency ( Life threatening bleed)

1. Group Specific Uncrossmatched Blood

When pre-transfusion sample is available. Blood can issued within 15 minutes after
blood grouping of patient and blood bag and later crossmatch can be completed .

2. Emergency O Rh (D) Negative Uncrossmatched Blood

Extreme emergencies, when there is no time to obtain and test a sample,“O

Negative PRBC” if not available “O Positive PRBC” can be issued within minutes.
(Only after consent from clinician as a life-saving measure)

On these occasions, the requesting clinician must take full responsibility for
the use of uncrossmatched blood, which carries a significant risk of severe
transfusion reaction and should therefore be restricted to life threatening
emergencies. The reason must be documented in the medical record.

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1.6 Single Donor Apheresis Platelet (SDAP) Requisition Guidelines

Requisition for SDAP-

1. Requisition should be sent to the Apheresis section of the Department of

Transfusion Medicine on requisition form for blood components.
2. Send 2 ml EDTA sample of the patient along with requisition form and
indication for transfusion with platelet count should be mentioned on the form
with signature, name and phone no. of requesting clinical JR/SR.
3. Send 3-4 healthy donors having same blood group as that of patient along
with requisition form to apheresis section.
4. Separate requisition forms should be sent in case two SDAP units are
required for the same patient.

General SDAP Donor selection Criteria-

1. Donor should be in good health, physically fit and mentally alert.

2. Donor should be 18-60 year of age.
3. Donor should be of the same blood group.
4. Donor should not be first degree relative of the patient,
5. Donor should be more than 60 kg of weight,
6. Donor should have Hb more than 12.5 g/dl,
7. Donor should have platelet count ≥1.5 x 103/µl.
8. Donor should not have taken NSAIDs/ Antibiotics in last 72 hrs.

Procedure related Cost

1. Ensure about the affordability of patients attend of SDAP procedure,

disposable kit needed for SDAP procedure cost around Rs. 7000 to 8000.
2. A new disposable kits is required for each procedure.
3. Donor screening charges Rs 550.(Blood grouping and mandatory infectious
disease testing)

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Time involved in the SDAP Procedure- 4 to 4.30 hours (on an average)

5 minutes

15 minutes

45-60 minutes

10-15 minutes

30 minutes

1-2 hours

10 minutes

30 minutes

Storage- Recommended Storage temperature for SDAP is 20-24oC in a platelet

incubator and agitator.

Shelf Life- 5 days

All platelet products (SDAP/RDP) should be transfused as and when they are issued
and received by patient bedside after proper identification of patient.

NEVER KEEP THE PLATELET COMPONENTS IN REFRIGERATOR

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1.7 Blood Components can be transfused across ABO and Rh blood groups,
when group specific blood component is not available next compatible
available group component can be safely transfused as shown in Table 4.

Table 4: Compatibility Chart for blood components

Patient Compatible donor blood group

Blood Red Blood Cells Platelets Plasma/ Cryoprecipitate
Group Cryosupernatant
Plasma
O Positive O Positive Rh Positive Any Group Any Group
O Negative or
Negative
O preferred
O Negative O Negative Rh Negative Any Group Any Group
O preferred
A Positive A Positive Rh Positive A, AB Any Group
A Negative or
O Positive Negative
O Negative A preferred
A Negative A Negative Rh Negative A, AB Any Group
O Negative A preferred
B Positive B Positive Rh Positive B, AB Any Group
B Negative or
O Positive Negative
O Negative B preferred
B Negative B Negative Rh Negative B, AB Any Group
O Negative B preferred
AB Positive Any Group Rh Positive AB Any Group
Positive/Negative or
Negative
AB preferred
AB Negative Any Group Rh Negative AB Any Group
Negative AB preferred

Note: Whole blood is always transfused blood group specific.

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 1.8 Preparing the patient for transfusion: Determine if your patient has
had any problems or reactions with previous transfusions. If so premedication
may be required.

Indication Premedication

History of repeated allergic reactions Antihistamine and/or Steroid

History of repeated febrile reactions Antipyretic

Determine the correct IV access required for transfusion

Blood Product Rate of infusion IV Access

Red blood Cells Rapid Transfusion in adults 16 to 18 G (Gauge)

Red blood Cells Routine Transfusion in 20 to 22 G

adults

Other blood products Any size

Paediatrics 22 to 25 G

Transfusing rapidly and under pressure through too small an IV access can cause
hemolysis of red blood cells.

Ensure that the IV access is dedicated to the transfusion.

Blood products must not come in contact with medications or incompatible solutions
(e.g. 5% Dextrose, hydroxyethyl starch, Ringer Lactate).

When transfusing through a central line with multiple lumens, medications/solutions

can be infused through other lumens without damaging the blood product.

IV pumps, blood warmers, and rapid infusers must be suitable for transfusion and do
not damage the blood product. Do not use devices that have not been approved for
use with blood products.

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1.9 Need for warming of blood before transfusion
There is no need of warming of blood in elective transfusion where a unit of blood is
transfused over 2 to 4 hours.

However, warming of blood can be useful when rapid transfusion of components

is required, especially in trauma or surgery settings, because the infusion of cold
components can cause hypothermia and cardiac complications, increasing morbidity
and mortality for the patient.

Warmed blood is most commonly required in:

a) Large volume rapid transfusions:

— Adults: greater than 50 ml/kg/hour

— Children: greater than 15 ml/kg/hour

b) Transfusions to neonates
c) Exchange transfusion in infants
d) Patients with clinically significant cold agglutinins.

Blood should not be warmed by placing it in a microwave, on a heat source, or in hot

water or by using other devices not specifically approved for blood warming. Blood
should only be warmed in a blood warmer. Blood warmers should have a visible
thermometer and an audible warning alarm and should be properly maintained.

Blood should never be warmed in a bowl of hot water as this could lead to

haemolysis of the red cells which could be life-threatening.

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1.10 Blood Transfusion Set (BT Set)

The following blood products must be transfused through blood tubing containing a
170 micron filter to capture any fibrin debris:

Red blood cells, platelets, plasma, cryosupernatant plasma and

cryoprecipitate.

BT Set must be changed after every 2-4 units and at least 12-hourly during blood
component transfusion.

Note that: Platelets are best transfused through blood tubing not previously used for
red cells. Platelets will adhere to fibrin captured in the filter.

Used blood tubing can be a breeding ground for bacteria. Do not leave it attached to
the patient.

ALERT
Blood transfusion set is required for transfusion of blood products and must
be changed at prescribed intervals to decrease risk of bacterial sepsis.

Do not store blood units in freezer compartment or chill tray of the refrigerator.
Red cells will hemolyse.

Do not refrigerate platelets. They become non-viable.

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1.11 Final check before transfusion

Visually check the blood unit for clots, unusual colour, and any leaks.

Completely hemolysed packed red blood cell unit can be recognised by

change in colour from red to black. In case of any doubt you can get blood
units checked from Dept. of Transfusion Medicine staff before transfusion.

Check the expiration date on the blood bag label (Annexure 2) .

Check the transfusion order and verify that consent was obtained.

Patient and blood unit identity Check

1. Ask the patient to identify himself/herself by family name. If the patient is

unconscious, ask a relative or a second member of staff to state the patient’s
identity.
2. Check that the following details on the compatibility label attached to the
blood bag exactly match the details on the patient’s file:
• Patient’s family name and given name
• Patient’s central registration number (CR NO.)
• Patient’s ward or operating room
• Patient’s blood group.
3. Check that there are no discrepancies between the ABO and RhD group on:
• Blood bag Label ( front Label)
• Compatibility label ( Back Label)
• Compatibility report (Reaction form)

5 Check that there are no discrepancies between the donation number on:

• Blood bag
• Compatibility label.
• Compatibility report (Reaction form)
• If you find any discrepancy do not proceed. Contact the Dept. of
Transfusion Medicine immediately
___________________________________________________________________

ALERT: Checking blood immediately prior to the transfusion is the LAST

opportunity to catch any errors.

22
2 Transfusion Phase

2.1 Starting and monitoring blood transfusion

Before starting blood:

Record baseline vital signs and assessment before starting each unit:

Temperature

Blood pressure

Pulse

Respiration

Oxygen saturation if available

Auscultation for patients at risk for overload (elderly, pediatric, cardiovascular
disease)

After starting blood:

1. For the first 15 minutes:

Start initially with a slow rate unless transfusion is extremely urgent.

Monitor your patient closely.

2. After the first 15 minutes:

Reassess your patient and repeat vital signs.

Increase flow to prescribed rate if no reaction observed.
Monitor the patient

At least every hour during transfusion

On completion of the transfusion

4 hours after completing the transfusion

If there is suspected reaction

ALERT
Start blood with caution as serious reactions can present early in the
transfusion. Some patients are at greater risk for circulatory overload –
transfuse more slowly.

23
Repeat monitoring with each subsequent unit.

Repeat vital signs more often for patients:

At greater risk for circulatory overload
(elderly, pediatric, cardiovascular disease).

Who have experienced previous reactions.

Who are unstable.

When possible, instruct your patient to notify you if they experience:

Hives or itching.

Feeling feverish or chills.

Difficulty breathing.

Back pain or pain at the infusion site.

Any feeling different from usual.

ALERT
Patients must be appropriately monitored to detect transfusion reactions as
soon as possible

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2.2 Documentation of Transfusion

The record you make in the patient’s case-notes is your best protection if there
is any medico-legal challenge later on.

The record should include: .

1. Whether the patient and/or relatives have been informed about the
proposed transfusion treatment.

2. The reason for transfusion.

3. Signature of the prescribing clinician.

4. Pre-transfusion checks of:

Patient’s identity

Blood pack

Compatibility label

Signature of the person performing the pre-transfusion identity check.

5. The transfusion:

Type and volume of each product transfused

Unique donation number of each unit transfused

Blood group of each unit transfused

Time at which the transfusion of each unit commenced

Signature of the person administering the blood component

Monitoring of the patient before, during and after the transfusion.

6. Any transfusion reactions.

Documentation can be done in transfusion sheet ( Annexure 3)

25
2.3 Transfusion reactions

Recognizing acute transfusion reactions

Acute reactions usually occur during or up to 24 hours following the end of a

transfusion and may present with signs and symptoms given in Table: 5.

Table 5: Acute Transfusion Reactions

Type of Reaction Clinical Signs and Symptoms

1. Hemolytic transfusion reaction Fever/chills, hypotension/tachycardia, cola

coloured urine, nausea, vomiting, pain in
flanks/back/abdomen/chest etc.

2. Bacterial contamination Fever, chills, hypotension, nausea, vomiting,

dyspnoea and diarrhoea.

3.Transfusion related acute lung Dyspnoea or cyanosis, fever, tachycardia,

injury (TRALI) hypotension

4.Febrile non hemolytic transfusion Fever, chills, rigors, cold, headache, nausea,
vomiting
reaction (FNHTR)

5.Allergic/anaphylactic reaction Pruritis, urticaria, flushing, angioedema,

hoarseness, stridor, wheezing, chest tightness,
dyspnoea, cyanosis, anxiety, nausea, vomiting,
abdominal cramps and diarrhoea.

Note: Signs and symptoms of various acute transfusion reactions often

overlap; hence, complete workup is necessary.

26
Transfusion Reaction management and investigation

Suspected reaction management:

1. Stop the transfusion immediately.

2. Maintain IV access for treatment if necessary but do not flush the blood tubing

3. Check vital signs

4. Take necessary resuscitative measures to stabilize the patient.

5. Verify that patient ID matches the compatibility label and compatibility report.

6. Verify that the blood unit number matches the compatibility label and compatibility
report (Annexure: 2).

7. Notify the physician but remain with the patient.

8. Notify the Dept. of Transfusion Medicine of the reaction.

Send the following to the Department of Transfusion Medicine:

i) Blood bag with BT set
ii) Post transfusion samples
• 2 ml EDTA sample.
• 3 ml plain vial sample.
iii) Completely filled and signed reaction form indicating
signs/symptoms of reactions) In case of suspected bacterial
contamination: Send cultures both from the patient as well as blood
bag at the bedside immediately.
Please return un-utilized blood bag in fully preserved condition as soon as
possible to the Deptt. of Transfusion Medicine (ideally within 2 hours of
issue).

27
Following investigation should be done: as per symptoms in transfusion reaction.

Complete hemogram

Plasma hemoglobin

Coagulation profile

Bilirubin (Unconjugated/conjugated)

Urea

Creatinine

Serum electrolytes

Next voided urine for hemoglobin testing:

Monitor urine output if hemolysis suspected

Chest X-Ray if patient has new respiratory symptoms

Blood cultures from the patient:
• Drawn from a different vein
• Antibiotics should be started immediately if bacterial sepsis
suspected.

Transfusion Reaction must be reported immediately to the Department of

Transfusion Medicine as some time this can prevent companion transfusion
reaction.

2.4 Hemovigilance
This is set of surveillance procedures, from the collection of blood and its
components to the follow up of recipients to collect and assess information on
unexpected or undesirable effects resulting from the therapeutic use of labile
blood products and to prevent their occurrence or recurrence.

National Hemovigilance program of India was launched in December 2012 by

National institute of biological (NIB), Noida, Ministry of health and family welfare
Govt. of India.

The major aim of the program is to track adverse events related to blood transfusion
and help to identify trends and recommend best practices and interventions required
to improve blood safety in the country.

Department of Transfusion Medicine, PGIMER Chandigarh is actively participating in

the program. All the clinical colleagues are requested to kindly participate in the
program by reporting all transfusion reaction related to blood transfusion so as to
increase transfusion safety in our institute and in our country.

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 Annexure: 1
Post Graduate Institute of Medical Education and Research

CONSENT FORM FOR THE TRANSFUSION OF BLOOD / BLOOD COMPONENTS

Patient Name ______________CR. Number_________________ Ward/Bed No._______________

Blood transfusion is a life saving medical procedure. Blood can be given as “whole blood” or as
components such as: Red cells, Platelets, Plasma and Cryoprecipitate.

1. I /My patient have been informed of the transfusion options available and expected benefits
of transfusion of blood and / or components.
2. I /My patient agree to the administration of blood and / or components in the interest of
proper medical care.
3. I /My patient understand that blood / blood components to be administered have been
prepared and tested in accordance with rules established by National Regulation. However,
there is still a very small chance that an adverse reaction can occur such as: fever with or
without chills and rigor, itching and hives, which are treatable. Rarely an unpredictable life
threatening event can also occur.
4. I/My patient have been informed that despite mandatory screening for blood borne
infections such as HIV, Hepatitis B, Hepatitis C, Syphilis and Malaria, the risk of acquiring
these infections is not totally eliminated.
5. I/My patient have had the opportunity to ask questions about transfusions, alternatives to
transfusion, risk of not transfusing, the procedures to be used and the relative risks and
hazards involved.
6. I/My patient believe that I have been sufficiently informed to make a decision to give a
consent for transfusion of blood / blood components.
7. I/My patient have been informed and explained the above in a language that I/my patient
understand.

AUTHORIZATION BY PATIENT
Signature/Thumb impression_______________ Signature/Thumb impression:___________
Name of the Patient______________________ Name of Witness:_____________________

Date__________________ Doctor _______________________

Designation_____________________

PATIENT’S ATTENDANT/NEXT OF KIN

The patient is unable to give consent because _____________________________________
And I_________________________________________(name / relationship to patient),
therefore consent for the patient. I acknowledge that I have had an opportunity to discuss
this procedure, as stated above, with my physician, physician designee and hereby consent
to this procedure.

Signature/Thumb impression_______________ Signature/Thumb impression:___________

Name of the Patient attendant/Next of kin________________ Name of Witness:________

Date:____________
Doctor____________________
Designation_________________

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Annexure: 2

Compatibility Label
Blood Bag label

To be retained
in patient’s file
Compatibility Report

To be completed and
sent back to Dept. Of
To be retained Transfusion Medicine
in patient’s file With next requisition

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Annexure: 3

Post Graduate Institute of Medical Education and Research

Blood Transfusion Sheet

Patient’s Name ________________________________CR No.____________________________________ Age /Sex__________

Patient’s Blood Group_____________

Blood Blood Vitals Transfusion Vital Transfusion Vitals at Name and Remarks/Transfusion
Bag group and before Starting 15 min End Time The end of Signature Reaction
Number Type of starting Time and after of and Date Transfusion of person
Blood Transfusion Date starting Transfusing
component transfusion and
counter
checking
1st Blood Temp: Temp: Temp:
PR: PR: PR:
Bag BP: BP: BP:
RR RR RR
2nd Temp: Temp: Temp:
PR: PR: PR:
Blood BP: BP: BP:
Bag RR RR RR
3rd Temp: Temp: Temp:
PR: PR: PR:
Blood BP: BP: BP:
Bag RR RR RR
4th Blood Temp: Temp: Temp:
PR: PR: PR:
Bag BP: BP: BP:
RR RR RR
5th Blood Temp: Temp: Temp:
PR: PR: PR:
Bag BP: BP: BP:
RR RR RR

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 Annexure : 4

Department of Transfusion Medicine, PGIMER, Chandigarh

Flow for arrangement of Intrauterine Transfusion (IUT) Blood unit

Inform Senior Resident (9914209486) about IUT procedure at least two days in
advance

Requisition
Ask patient’s attendants to arrange for blood donor (preferably O Negative)

Send the properly labelled patient requisition form and blood sample for IUT
along with relevant clinical history:
Rh clinic number, ICT status and titer levels (if known), previous IUT details

Extended Rh phenotyping and other minor antigen typing, if indicated in the

Preparation mother, of the available O Negative blood units is performed
of IUT
blood unit 3-5 hours*
If phenotype matches, cross matching is performed

2-3 hours*
If cross match is compatible, the blood unit is reserved and then OBG SR/JR
to confirm the date and time of IUT to SR Transfusion Medicine

Blood unit is sent to Component preparation Lab for preparation of IUT bag

2-3 hours*

When IUT blood unit is ready, it is issued along with Reaction form after
Issue of receiving properly filled Identification (ID) Slip of the patient
unit

Post-IUT Send the pre-IUT and post-IUT samples and give the feedback of the IUT
Assessment procedure to
SR Transfusion Medicine

*The time lines are indicative only, it may take even more time in patients with multiple 32
alloantibodies and during shortage of O Negative units.