RATIONAL USE OF BLOOD
Dr. Tulika Chandra
Assistant Professor
Department of Transfusion Medicine
C.S.M.Medical University, Lucknow
The aim is to provide the right blood product, in the right quantity, for the
right patient.
The appropriate use of blood and blood and blood products can be defined as "Transfusion of safe blood products only to treat conditions leading to significant morbidity or
mortality that cannot be prevented or managed effectively by other means"
TRANSFUSION SHOULD NOT BE THE FIRST CHOICE - WHY?
The answer lies in the fact that it carries risk of adverse reactions (acute and delayed
complications) and transfusion transmissible infections (TTI). Besides this plasma transmit
most of infections present in whole blood.
Appropriate and inappropriate transfusion
Which blood to transfuse?
Blood from appropriately selected donors (Voluntary non renumerated donors)
should be transfused
Blood should be screened for TTI
Compatible blood should be transfused to the patient
When transfusion may be unnecessary?
Transfusion can be avoided / minimized by prevention / early diagnosis and
treatment of anemia and conditions causing it. Transfusion is only needed if effects
of chronic anemia are severe enough to require rapid raising of hemoglobin level
Blood is often unnecessarily given to raise a patient's hemoglobin before surgery or
allow early discharge from hospital. These are rarely valid reasons for transfusion
Transfusions of whole blood, PRBC, plasma are given when other treatments such as infusion of normal saline or other intravenous replacement fluids would be safer,
less expensive and equally effective for treatment of acute blood loss
Transfusion requirements may be minimized by good anesthetic and surgical
management. The techniques to minimize blood loss during surgery should be used.
Stop anticoagulant/antiplatelet drugs if safe before planned surgery. Alternative
approaches such as desmopressin, aprotinin or erythropoietin can be used.
If blood is given when not needed, patient receives no benefit and is exposed to
unnecessary risk.
Blood is an expensive, scarce resource. Unnecessary transfusions cause shortage
of blood and blood products for patients in real needs
but
Safe blood products used correctly can be lifesaving
CLINICAL TRANSFUSION PROCEDURES
Getting right blood to the right patient at the right time
Assess patients clinical need for blood and when it is required
Inform the patients / relatives about the proposed transfusion treatment and put it in
recording
Record the indications for transfusion
Select the blood product and quantity required
Complete the blood request form accurately and legibly
Patients identity name, ward, bed no.
Product and no. of units required
Reason for transfusion
Urgency of patients requirement for transfusion
Obtain and correctly label a blood sample for compatibility testing.
Patients blood sample is placed in a sample tube correctly labeled and uniquely
identifiable with the patient.
All details on the blood sample tube match those on the blood request form and are
uniquely identifiable with the patient.
Send blood request form and blood sample for compatibility testing.
Safe transfusion depends on avoiding incompatibility between donors red cells and
antibodies in patients plasma.
Record patients note
Type and volume of product transfused
Unique donation no. of each unit transfused
Blood group of each unit transfused
Time at which transfusion commenced
Signature of person administering the blood
Monitor the patient before, during and on completion of the transfusion
Record the completion of transfusion
Identify and respond immediately to any adverse effects
Key Points
Every hospital should have standard operating procedures for each stage of clinical
transfusion process and all staff trained in it.
Communication is essential between clinical and blood bank staff
Blood bank cannot issue blood without correctly labelled sample and blood requisition form
Blood products must be kept in correct storage condition in clinical area before
transfusion
For each transfusion patient must be monitored by trained member of staff.
AIM OF BLOOD ORDERING Responsibility of the clinician
Correctly complete the blood request form with three patients identifiers
Collect the blood sample from the right patient in the right sample tube and correctly
label the sample tube
Provide the blood bank with clear information on
The products and no. of units required
Reason for transfusion
Urgency of patients requirement for transfusion
When and where blood is required
Who will deliver or collect blood
Assess Patients need for transfusion
Emergency
Definite need
Possible need
< 1 hr
elective surgery
obstetrics,
elective
ABO / Rh
Compatible
(O group)
ABO / Rh
available
group requested
Ab screen and hold
Blood ordering schedule
Develop a blood ordering schedule which is a guide to normal transfusion requirements for
common surgical procedures.
Ordering blood in an emergency
Clear and simple procedures. Insert iv canula for sampling. Set iv infusion of N saline
/ balanced salt solution.
Clearly label blood sample tube and blood request form. If patient is unidentified use
emergency admission no.
If another request has to be send use same identifiers as on the first request form
and blood sample so blood bank knows they are dealing with same patient.
If several staff working on emergency cases, one person should take charge of
ordering blood. Urgency of blood requirement to be communicated by predecided
words.
Blood bank may send group O (possibly neg 0 bld) if there is any risk of patient
identification. Safest way to avoid serious mismatch
Precautions
If the patient is conscious ask him details of name etc. In unconscious patients ask
relatives or second member of staff. Blood sample is taken in tubes / vials and
labelled with patients name, ward, bed no, date, signature of person taking sample.
Ensure patients name is spelt correctly. Do not label tubes before taking blood sample or
patients blood may be put in wrong tube
If patient needs further red cell transfusions send new samples for compatibility
testing. Fresh blood sample ensures that patient does not receive incompatible
blood.
Misconceptions and Myths regarding blood transfusion are present. These have
to be removed by the following awareness
Fresh" Blood: No. concept of fresh blood is present in transfusion medicine.
Single Unit Transfusion should not be done.
Empirical Transfusion should not be done.
Nutritional Anemia is not an indication for blood transfusion.
Pre Surgical, Wound Healing and Enhancement of well being are not indications for
blood transfusion.
Checklist for clinicians
What improvement in patients clinical condition I am aiming to achieve?
Can I minimize blood loss to reduce patients need for transfusion?
Are there any other Treatment I can give (IV replacement fluids) before deciding to
transfuse?
What are specific clinical / lab indications for transfusion of this patient?
What are risks of transmitting TTI?
Do benefits of transfusion outweigh the risk for this particular patient?
What other options if no blood is available in time?
Have I recorded my decision and reasons for transfusion on patients chart and blood
request form?
If still in doubt ask yourself?
If this blood was for myself or my child would I accept the transfusion in these
circumstances?
