+ Dr. Megan Rowley Consultant in Transfusion Medicine Blood Transfusion
Dec 26, 2015
+
Dr. Megan RowleyConsultant in Transfusion Medicine
Blood Transfusion
+What would you like to know?
Is blood safe and what
happens if it goes wrong?
How do you decide
when to transfuse? And how much?
Where does my blood come from?
What happens to blood once it has been collected?
What is in a bag of blood?
Who are all the people who make this work?
+There are lots of people who work hard to get blood to you
EXPERTS
PEOPLE WHO ADVISE ON
BEST PRACTICE
REGULATORS
PEOPLE WHO OVERSEE ADVERSE EVENTS
+
Where does my blood come from?www.blood.co.ukLook on the website – lots of interesting facts, figures and video clips
HealthyBlood donors aged 17-65 can donate
every 4 months
Fill out a donor health questionnaire and have a haemoglobin check
Fixed and mobile donor sessions – a masterpiece of organisation!
+What happens to blood once it has been collected?
Blood group ABO D positive or negative Other blood group antigens
Viruses and other infections Hepatitis B and C HIV 1 and 2 and HTLV1 Syphilis (Malaria) (Cytomegalovirus)
1. Tested
+What happens to blood once it has been collected?
No such thing as ‘whole blood’
What we need are ‘components’ RED CELLS PLATELETS PLASMA
And the white cells have to be removed LEUCODEPLETION
2. Processed
+What is in a bag of blood?
Red Cells in Optimal Additive Solution (SAG-M)
Shelf-life 35 days at 4°C
No white cells or platelets and
very little plasma
UK Blood Donors
Blood Group
RhDPositive
RhDNegative Total
OO 37%37% 7%7% 44%44%AA 35%35% 7%7% 42%42%BB 8%8% 2%2% 10%10%
ABAB 3%3% 1%1% 4%4%
Distribution of Distribution of blood groups varies blood groups varies
across the worldacross the world
Distribution of Distribution of blood groups varies blood groups varies
across the worldacross the world
+How do we choose which blood group to give?
+
Serological (XM) Serological (XM) is where the patientis where the patient’’s plasma is mixed with the s plasma is mixed with the donordonor’’s red cellss red cellsTakes 40 minutesTakes 40 minutes
Electronic Issue (EI) Electronic Issue (EI) is where the computer checks there are two is where the computer checks there are two patient blood groups that agree, there is a is valid (recent) G&S patient blood groups that agree, there is a is valid (recent) G&S
sample and a negative antibody screen sample and a negative antibody screen Takes 10 minutesTakes 10 minutes
Serological (XM) Serological (XM) is where the patientis where the patient’’s plasma is mixed with the s plasma is mixed with the donordonor’’s red cellss red cellsTakes 40 minutesTakes 40 minutes
Electronic Issue (EI) Electronic Issue (EI) is where the computer checks there are two is where the computer checks there are two patient blood groups that agree, there is a is valid (recent) G&S patient blood groups that agree, there is a is valid (recent) G&S
sample and a negative antibody screen sample and a negative antibody screen Takes 10 minutesTakes 10 minutes
Before transfusion of red cells the blood has to Before transfusion of red cells the blood has to be appropriately matched to the patient be appropriately matched to the patient
The transfusion lab will select the correct ABO/D The transfusion lab will select the correct ABO/D red cell group for the patientred cell group for the patient
Some patients also have ‘special requirements’ Some patients also have ‘special requirements’ e.g. IRRADIATED, KELL NEGe.g. IRRADIATED, KELL NEG
Matching blood
A blood bag with a compatibility label
attached
All the information on the blood bag
label is bar-coded as well as eye readable
Labelling and Issue
+Is blood safe?
Yes! Most of the time….If blood transfusion is the only
treatment for your condition and the consequences of not having a blood transfusion outweigh the the risks of having one then it is then having a blood transfusion is the
right thing to do
Patient blood management
+Patient Blood Management
Minimise anaemia
Patient information and valid consent
Consider and discuss alternatives
Give the right
amount of blood
Consider special
requirements
Review the outcome
+Patient Information and Consent‘Valid’ consent is required for transfusion
(verbal)
Alternatives should be offered if appropriate
If transfused in an emergency, patient must be informed afterwards
Involve patients in the process to ensure they get the right blood and the right ‘special requirements’
+Why and when do we give blood?The decision to transfuse is based
on the whole clinical picture
Is the patient bleeding?
What are the blood results?
Is the patient symptomatic?
Will a transfusion solve the problem?
What are the risks of transfusion?
Are there alternative treatments?
‘The decision to transfuse must be based
on a thorough clinical assessment of the patient and their
individual needs. The rationale for the decision
to transfuse and the specific components to be transfused should be
documented in the patients’ clinical records’
BCSH guidelines 2012
‘The decision to transfuse must be based
on a thorough clinical assessment of the patient and their
individual needs. The rationale for the decision
to transfuse and the specific components to be transfused should be
documented in the patients’ clinical records’
BCSH guidelines 20124mL/kg will typically give a Hb increment of 10g/L = 1unit RBC gives a Hb increment of 10g/L in a 70-80 kg patient
+What happens if it goes wrong?
Investigate incidents locally ROOT CAUSE ANALYSIS
Report serious hazards via a national system SHOT
Clinical audit PROCESS and APPROPRIATNESS of TRANSFUSION
Learn and continuously improve DOCTORS and NURSES TRANSFUSION LABORATORIES BLOOD SERVICES EXPERTS and REGULATORS
+What reactions occur with red cells?
+Serious Hazards of Transfusion 1996-2012 (n=11570)
Getting the wrong
blood
Getting an infection
from blood
Having a reaction to bloodGetting
too much blood too quickly
+
Carson J L et al. Ann Intern Med doi:10.1059/0003-4819-156-12-201206190-00429
©2012 by American College of Physicians
Fluid overload
from blood transfusion
and patients with a fever
during transfusion
is quite common
Fluid overload
from blood transfusion
and patients with a fever
during transfusion
is quite common
Hepatitis and HIV
transmitted by
transfusion is very rare
Hepatitis and HIV
transmitted by
transfusion is very rare
Adverse effects of RBC transfusion contrasted with other risks
+Conclusion
Blood is a precious gift given by a blood donor Each bag costs £120 but all of that goes towards collecting
blood making it safe and getting it to the hospital – no money goes to the donor
There are many people working behind the scenes to get you the right blood at the right time, every time If it goes wrong we do our best to understand why and
continually improve
It is important that you understand the risks and benefits of transfusion and give your consent to receive this treatment The team caring for you need to tailor your blood support to
you personally and to check it is having the desired effect