Basics Of Transfusion Medicine In Sri Lanka

National blood transfusion service (NBTS) in Sri Lanka works in collaboration with WHO to improve the standards of blood transfusion services to a level where it can be set as a unique model for the world.

As a medical officer we are responsible to ensure that, it is a safe transfusion for the patient.

Safe Transfusion

It is very important to maintain blood transfusion safety. This will prevent the patient from getting mismatch blood transfusions and minimize adverse reactions related to transfusion.


Therefore, can follow several simple steps to guide us in the correct path

  1. Appropriate indication of transfusion
  2. Correct patient identification 
  3. Bed side labeling of blood 
  4. Check previous transfusion records
  5. Proper collection, documentation and transport to labs for sampling and preparation of blood 
  6. Correct identification of patient prior to transfusion 
  7. Monitoring of the patient while transfusion and documentation 
 
 
Components Of Transfusion With Volume Of Each Pack 
 
Blood has several components. They can be separated using different techniques and each products can be given according to the patient’s indication.
 
Commonly transfused blood and blood products are….
  • Red cell concentrates (RCC) [230 – 300ml]
  • Buffy coat
  • Platelet concentrates [50ml]
  • Fresh frozen plasma (FFP) [200ml]
  • Cryoprecipitate (Cryo) [5 – 10ml]
  • Cryosupernatant (CSP / CPP) 
  • Immunoglobulins


Doses Of Blood Components

  • Adults
    • RCC – 1 unit at a time
    • FFP, CSP – 15 ml/kg
    • Platelets – 4 to 6 units 
    • Cryo – 10 units 
 
  • Paediatrics
    • RCC – 10 – 15 ml/kg
    • FFP. CSP – 10 – 15 ml/kg
    • Platelets – 10 ml/kg or if child more than 15 kg can give 4 units at a time 
    • Cryo – 10 ml/kg or 1 unit per 5 kg body weight



Nice to know 

  • 1 unit of Cryo has 100 IU of Factor VIII
  • Factor VIII requirements = ( % Correction x Body weight) / 2
  • Thal major Hb requirement = (14 – current Hb) x 4 x body weight 
  • Transfusion dependent patients require special RCC requirements 
    • Fresh blood ( Less than 14 days) 
    • Leuko depleted
    • Washed



Process Of Blood Transfusion

It is comprised of several steps

  1. Fill the request form 
    • There are different types of forms for different components of blood, such as….
      • Request for red cell products
      • Request for platelets and plasma components
      • Request for irradiation of blood and blood components
  2. Positive identification of the patient 
    • Patient details on BHT and request form should be the exact same 
  3. Sample collection 
    • Collecting and labeling should be done uninterruptedly by the same person
    • Should be collected in correct volumes in correct tubes according to the requirement
      • For ABO, Rh typing and cross matching, 5cc sample is collected in a plain tube
      • For DAT / Direct Coombs test, 2cc sample is collected in an EDTA bottle
      • For antibody test, 5cc sample collected in a plain tube
      • For babies < 4 months 
        • 4cc sample of maternal blood in a plain tube
        • 1cc sample of baby’s blood in an EDTA bottle 
    • Should never pre-label sample tubes 
  4. Documentation to release blood and the BHT should be sent to the blood bank along with a foam box 
    • The following should be written on the BHT in order to issue blood components from the blood bank
  5. When blood arrives at the ward, prior to transfusion – Must check compatibility reports (Blue chit) and compatibility label (Pink chit)
    • Check whether BHT, blue chit, pink chit tallies each other
  6. Positive patient identification
    • Ask the patient’s name without calling out for their name 
  7. Pre-transfusion assessment and documentation
    • Check PR, BP, RR, temperature, oxygen saturation and document them on the BHT
  8. Counsel the patient and initiate transfusion
    • Tell the patient what is being done
    • Ask the patient to evacuate bladder, to avoid unnecessary interruptions during transfusion 
    • Educate about adverse effects and emphasize the importance of informing the staff immediately upon any discomfort  
    • Use transfusion set administer blood through a wide bore cannula
    • Start transfusion within 30 mins 
    • If any delay occurs discuss with the blood bank and return the pack 
    • RCC should be transfused over 4 hours ; Others over 1 – 2 hours
  9. Monitoring of the patient
    • Pre-transfusion assessment – To obtain base line values
    • During transfusion – After 15 mins of transfusion assess PR, BP, Temperature
    • Check RR, if there is a change from baseline
    • Frequent monitoring of the patient
  10. Completion of transfusion and documentation
    • Time of completion should be mentioned
    • Post-transfusion assessment – PR, BP, Temperature 
    • Close observation for 24 hours 
  11. Adverse events management and reporting  
    • There is a separate form to report such incidents 



Transfusion Reactions

  • Acute reactions
    • Reactions that occur during or within 24 hours following transfusion
      1. Acute haemolytic transfusion reaction 
      2. Allergic reaction 
      3. Febrile reaction 
      4. Anaphylaxis
      5. Transfusion related acute lung injury
      6. Sepsis
      7. Acidosis
      8. Fluid overload
 
  • Delayed reactions
    • Reactions that occur after 24 hours 
      1. Delayed haemolytic transfusion reaction 
      2. Iron overload
      3. Graft versus host disease
      4. Transfusion transmitted disease (Hep B, Malaria, HIV)
 
 
Clinical Features Of Acute Transfusion Reaction

  1. Fever +/- chills and rigors
  2. Nausea, vomiting
  3. Myalgia
  4. Urticaria, skin rash, pruritus
  5. Angio oedema
  6. Dyspnoea, tachypnoea, wheezing, stridor 
  7. Hypotension 
  8. Pain at cannula site
  9. Loin pain 
  10. Feeling of impending doom
  11. Bleeding, oozing 
If any of those above mentioned features occur during a blood transfusion….

  • Stop the transfusion temporarily
  • Obtain a venous access
  • Recheck patient identification
  • Assess the patient
  • Administer IV Hydrocortisone 200mg stat, IV Chlorpheniramine 10mg stat
  • If anaphylaxis occur – IM Adrenalin  
  • Connect to the monitor 
  • Inform seniors 
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Kum
Kum
6 months ago

Excellent. Most SL students are confused due to calling these as pink and blue chits, because in reality they are not. All practical info given in consice manner. And these are the answers to questions asked in viva.