Blood Matters better safer transfusion program

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Blood Mattersbetter safer transfusion program
Essential Elements with STIR Part 2 Risk and
Reactions with Transfusion Lisa Stevenson
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Is the transfusion necessary?

• Benefit of transfusion must outweigh any
  potential risk
• Evidence-based national practice guidelines
  available providing recommendations as to when
  transfusion is appropriate

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Appropriate product

• Consideration of blood grouping is essential
  for certain blood components to avoid haemolytic
  transfusion reactions.

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Appropriate Product
Blood grouping essential for certain
products Compatible ABO Groups for Red Cell
Products
Donor Blood Type
Recipient Blood Type
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Transfusion Risk

• Receiving the wrong blood component 1 in 12,000
  to 1 in 77,000
• Headache, mild fever, itching hives 1 in 100
• HIV AIDS Approximately 1 in 35.2 million
• Hepatitis C Approximately 1 in 3.2 million
• Hepatitis B Approximately 1 in 1.9 million
• (Data Ref ARCBS 2006-07)

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Types of transfusion reactions.Acute transfusion
reactions

• Haemolytic transfusion reaction
• Febrile non-haemolytic transfusion reaction
  (FNHTR)
• Allergic transfusion reaction
• Anaphylaxis- IgA deficiency
• Bacterial contamination
• Transfusion-associated circulatory overload
  (TACO)
• Transfusion-related acute lung injury (TRALI)

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Types of transfusion reactionDelayed transfusion
reaction

• Infectious agents Hepatitis A, B, C, D, G. HIV,
  Cytomegalovirus (CMV), Epstein-Barr virus (EBV),
  Human T-cell lymphotrophic virus Type I (HTLV-I),
  syphilis, malaria, parvovirus B19
• Iron overload
• Transfusion-associated graft versus host disease
  (TA-GVHD)
• Alloimmunisation HLA antigens

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Adverse Reactions

• Signs and symptoms to observe
• Shivering/ chills, restlessness, anxiety,
  dyspnoea, chest pain, back pain, urticaria
  (hives), facial flushing, feelings of impending
  doom, headache, or nausea.
• Changes in vital signs include, fever,
  tachycardia and hypotension

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Adverse Reactions

• Reporting of Reaction
• Recognise ?
• React
• Report ?

?
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Adverse Reactions
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• Recognise
• Signs and symptoms may be a
• transfusion adverse event

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Adverse Reactions
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• React
• Immediately the transfusion, manage any
  life threatening symptoms
• Monitor vital signs
• Keep IV open with N/Saline
• Do a clerical check at the bedside
• Follow Doctors instructions to manage
  complication

STOP
Check patient ID, blood bag, paperwork
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Adverse Reactions

• Report ?
• Doctor
• Blood bank/ pathology provider
• Complete a Hospital Incident Form ?
• May need to collect samples of urine and blood to
  send to laboratory.
• Document all events ? ?

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Monitoring

• Priority Patient Safety, assessed through
  monitoring for signs of potential complication of
  transfusion.
• Requirements of observations recorded vary per
  hospital policy.
• Pre Post observations essential with close
  observation of the patient in the first 15
  minutes (Most likely time for severe reactions)

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For further information -websites

• Blood Matters-better safer transfusion program
• Australian Red Cross Blood Service (ARCBS)
• National Blood Authority Australia
• Serious Hazards of Transfusion
• New Zealand Blood Service
• Australian and New Zealand Association of Blood
  Transfusion (ANZSBT)