Protocols for Blood Transfusion

Transfusion Triggers/ Indications:

  • Severe blood loss > 1.5 liters in patient with normal Hemoglobin.
  • Severe burns > 50% BSA
  • If Hemoglobin level is < 8mg /dl (In unstable angina or MI patient Hemoglobin if    < 13 mg/ dl)
  • Ineffective erythropoiesis
  • To arrest Haemorrhage

Before Starting Transfusion:

Write:

  • Indication
  • ABO/Rh compatibility
  • Time of starting transfusion
  • Vitals
  • Blood bag information:

1.  Date of Expiry

2.  Donor’s Name

3.  Recipient’s Name

4.  Date and time of Transfusion

During Transfusion

  • Start transfusion @ 20 drops per minute and if no reaction then maintain @ 40 drops per minute after 15 minutes.
  • Stay there for 5 —10 minutes then visit frequently thereafter
  • Counsel the attendants in following cases to stop the transfusion and see the doctor on duty i.e.

1.     Rigors

2.     Fever

3.     Increase in respiratory or pulse rate

4.     Itching and rashes

5.     Restlessness

6.     Anxiety

7.     Flushing

8.     Nausea

In case of Transfusion Reaction

  • Immediately stop transfusion
  • Mild pyrexial reaction; observe and antipyretics
  • Severe reactions –Antihistamine –solucortef (& adrenaline in severe cases)
  • Save blood bag with recipient’s blood sample to be sent to blood bank.
  • Ensure normal BP and adequate urine output

FFP Transfusion Protocols

  • FFP should be transfused within 2 hours of thawing.
  • For an average 70kg adult 1 liter FFP i.e. 3 bags in the minimal amount.

Indications

  • Coagulation factor replacement, when there is no concentrate available.
  • To correct abnormal clotting, DIC or massive transfusion.
  • To correct abnormal coagulation, liver disease or poor synthetic function.
  • To reverse oral anticoagulation like over warfarinization.