BLOOD TRANSFUSION COURSE-Lecture 3
GOOD TRANSFUSION PRACTICES Dr. Akram Al-Hilali 2009
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PROPER INDICATIONS OF EACH COMPONENT Packed red cells vs. whole blood. Equivalent package of whole blood. Cut-off Hb value for preoperative transfusion Cut-off platelet count value for platelet transfusion. Indications for FFP vs. Cryoprecipitate Do not give too little, while trying to avoid hazards.
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CONSIDER TYPE-ANDSCREEN PROCEDURE Make a policy for your surgical procedures and implement. Generate incident report if BB fails to comply with the policy by providing blood promptly. Don’t push the resident to keep unnecessarily crossmatched blood in OR
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FORMULATE ORDERING GUIDELINES FOR SURGICAL PROCEDURES Such guidelines are not the blood bank’s job, but hematologist’s assistance can be listed. Guidelines can go to the Blood Utilization Committee to discuss. Make sure your department, or subspecialty, complies with the C/T ratio of 2.0 or less.
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Establish SOP’s for Blood Transfusion Practices SOP’s for nurses within nursing department. SOP’s for doctors, surgeons, pediatricians, etc. Hematologist can help both sides Proposals are being prepared to compare to existing SOP’s, if any.
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KEEP HAZARDS OF TRANSFUSION IN MIND
Viral and bacterial infections are not completely ruled out, in spite of all efforts. Immune modulation GVHD Iron overload Cold temperature and K overload in massive transfusions. Blood warmer for Trauma & Emergency. Development of sensitization and resistance to transfusion effectiveness.
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Think of blood-saving agents
Local hemostatic measures -fibrin gel, fibrinogen-thrombin.
Systemic agents
Factor concentrates
Desmopressin & ethamsylate Tranexamic acid Aprotinin- now out of pharmacopoeia Prothrombin complex concentrate
Activated coagulation factors
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Recombinant activated FVII (Novo7) 7
BE ALERT TO POSSIBLE REACTIONS Immediate reaction will be evident clinically. Nurse should stay with transfused patients for the first 10 minutes of a unit. Delayed reactions very often missed. Do not throw the empty or partially transfused bag at once. Send to Blood Bank to investigate or dispose of
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THINK OF THE DISADVANTAGES OF LEUKOCYTE CONTENT IN BLOOD Transfer of viruses- especially CMV Transfer of CJD prion Sensitization against leukocyteplatelet antigen Immune modulation leading to more aggressive cancer and higher infection rate GVHD
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Methods of Leukodepletion Removal of “buffy coat” Leukodepletion by bedside filters Universal leukodepletion in blood bank. What time after donation? Current filters leave 1 or less out of 10,000 leukocytes in blood.
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LEUKODEPLETION OF BLOOD AND PLATELETS UNITS Needed for specific patients Immune deficient and immune compromised Neonates Patients on chemotherapy Chronically transfused patients Those destined for BMT or PBSCT Those who develop febrile transfusion reactions Universal leukodepletion is more practical 08/06/14
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BLOOD IRRADIATION This is meant for killing T lymphocytes in red cell and platelet units. • T lymphocytes of donor could react against recipients tissue causing a highly dangerous GVHD. • More likely to happen in the immune deficiency recipient, due to deficiency in patient’s T lymphocyte number and/or function • More likely if donor and recipient are close relatives, due to restricted differences in HLA types. • Currently done in Sharja BB. 08/06/14 12 •
COMMUNICATE Blood Bank staff with nurses and clinical staff. Clinical staff with the hematologist/hematopathologist. Air your complaints in Blood Utilization Committee and, if necessary by incident reports. Discuss your complicated cases within a consultation team, to include the hematologist
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ACTIVATE HOSPITAL BLOOD UTILIZATION COMMITTEE
Each hospital with >100 beds ought to have such a committee. It should meet at least 10 times a year. Attached to Medical Director’s Office. Studies utilization, availability, incident reports and reactions. Suggests and supervises improvements on consumer and producer sides. Maintains the professional relations required for better patient’s care
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