Presentation on theme: "Blood Request To Transfusion - Practical Aspects"— Presentation transcript:
1 Blood Request To Transfusion - Practical Aspects Presented by – Dr. Rajesh KucheriaMedical Director,Arpan Chain Of Blood Banks
2 ARPAN’S QUALITY POLICY Arpan is committed to deliverhighest level of quality standard in itsproducts and services.We believe that this can beachieved only with continuousimprovements, global bench marking& ceaseless effort to learn.We aim to set new standardsfor quality in our region & become a rolemodel for all those who want to contribute inthis sphere of public health.
3 PREFACEEmerging from Arpan’s vision, this document is a very specific effort towards bringing entire chain of professionals working in blood transfusion cycle to a common understanding of the complex process.Starting with the point in the hospital where it is decided to opt for blood transfusion to the logical conclusion of patients acceptance of this emergency drug, every step is discussed with detailed medical understanding as well as administrative check points. The purpose is to ensure that there is no error whatsoever at any point in this lifesaving mechanism.We are sure, clinicians, paramedical staff, blood banking staff and administrative professional touching this process would find this document very useful and pragmatic for their day to day work and will make entire cycle error free and thus safest.We would be more than happy to receive your feedback / suggestions on this on- Arpan Family -
5 Blood request ……………………………………………………………………….. 1 To 6 INDEXBlood request ……………………………………………………………………….. 1 To 6Requisition form fillingBlood sample collectionNAT testGuidelines for use of blood componentsPlasma by apheresis (PL-A)Blood groups, Crossmatching & Compatibility……………………… 7 To 32ABO & Rh blood group systemsCrossmatchingABO crossmatchingABO compatibility for Whole blood, PCV, Plasma & PlateletsRh compatibilityCompatibility & selection of unit for neonatal transfusionStorage of blood & blood components…………………………………. 33 To 34In blood bankIn hospitalAdministration of blood & blood components……………………… 35 To 38Pre-administration precautionsAdministrationMonitoring of patient during administrationAdverse transfusion reactions & their management…………… 39 To 44Infectious adverse transfusion reactionsNon infectious adverse transfusion reactionsManagement of adverse transfusion reactionsLeuco-depletion
9 REQUISITION FORM FILLING 1Patient informationAlways write patient’s full name as multiple requests come to blood bank from many hospitals & there are chances of two requests of same name & surname from two different hospitals.Compulsory write patient’s blood group on form. If any discrepancy is noted in blood group written on requisition form and blood group detected in blood bank on patient’s sample, it can be resolved & right blood can be issued to the patient.Product requirementAlways write date & time of requirement of blood / component unit, so that unit can be reserved, if it is going to be available meanwhile.Hospital informationAlways write treating doctor’s name & mobile no. on requisition form, so that in case of any problem or doubt, it can be resolved by talking with him.Always give hospital seal on requisition form. It is legally compulsory & possible malpractices can be avoided.
10 BLOOD SAMPLE COLLECTION 2BLOOD SAMPLE COLLECTIONAlways remove needle & then pour blood in sample bulbNever send sample in syringeAlways label sample bulb properly with patient’s full name & hospital namePatient’s Sample Label StickerPatient’s Full NameFirst Middle SurnameHospital
11 window period reduction (When tested by NAT technology) 3NAT TESTNAT testing lab is established at Arpan Blood Bank, Nashik. It is 2nd Stand alone blood bank in the country to start NAT testing facility. NAT tested blood will be available at all centres of Arpan blood bank across State.NAT – Nucleic Acid Amplification test used to detect HIV, HBV & HCV infection.It is most advanced technology used Worldwide.In this test, viral RNA is captured, amplified & detected.As it detects genetic material, detection is accurate & very early than conventional methods (ELISA & Cheminileuscence).window period reductionInfectionWindow period (When tested by ELISA technology using best 4th generation kits)Window period(When tested by NAT technology)HIV20.3 days5.6 daysHBV53.3 days24.6 daysHCV58.3 days4.9 daysPilot Study –The first Indian study for NAT testing shows that 1 in 1,528 blood units are found to be positive for any of the Three viruses which were seronegative by ELISA technology.A pilot study at AIIMS among 5,818 donors shows that 1 in 1,164 blood units were found to be positive for any of the three viruses which were seronegative by ELISA technology.There is no reported case of either of three infections after transfusion of NAT tested blood.Cost-As NAT test is done in addition to routine ELISA test, extra cost is added for NAT tested unit. But the cost is negligible considering the physical, mental trauma & economic loss for treatment of these diseases.
12 GUIDELINES FOR USE OF BLOOD COMPONENTS 4GUIDELINES FOR USE OF BLOOD COMPONENTSTransfusion IndicationOptionsDesired EffectPreferenceReasonsPacked Red Cells In Additive Solution (PCV)Hb by 1 g%HCT by 3%Least chances of transfusion reactions as total plasma is removed.Viability of RBCs is better.Platelets and Plasma can be utilised for another patient.To Increase HB%2. Whole Blood (WB)Hb by 1 g%HCT by 3%More chances of transfusion reactions due to plasma proteins.It is like unnecessary multidrug therapy.To Replace Blood Loss2. Whole Blood1. PCVAs per volume of PCV- If you want to replace blood loss more than two liters quickly.- If you want to replace blood loss less than two liters.As per volume of WBTo Increase Platelet CountSingle Donor Platelets (SDP)Recipient is exposed to single donor.Leucoreduced platelets are obtained so risk of transfusion reaction and platelet refractoriness is reduced.Increases Plateletcount by 50,000-70,000/ml per unitIncreases Plateletcount by 5,000-8,000/ml per unit2. Random DonorPlatelets (RDP)Recipient is exposed to many donors.Risk of alloimmunization and so platelet refractorinessChances of transfusion reaction are more as leucoreduction is not always possible.
13 GUIDELINES FOR USE OF BLOOD COMPONENTS Transfusion Indication 5GUIDELINES FOR USE OF BLOOD COMPONENTSTransfusion IndicationOptionsDesired EffectPreferenceReasons1. Fresh FrozenPlasma (FFP)To Give Clotting FactorsRaises all clotting factors (I to XIII)-Supplies AlbuminFresh Frozen Plasma can be given when all clotting factors are required.It also supplies Albumin.2. Cryoprecipitate(CRYO)-Raises Factor VIII, VWF and Factor XIII & FibrinogenIf we want to supply factor VIII (AHF), VWF or Factor XIII, Cryoprecipitate should be preferred over FFP as volume is reduced & so chancesof transfusion reactions.1. PCV + RDP / SDPAs per individual PCV & RDP or SDPFresh blood is not an option because blood needs to be preserved at 2-60C, till testing is done and % platelets become non viable at 2-60C. Hence this blood will not supply viable platelets. You will only get RBCs & Plasma from Fresh Blood.To Increase HB% And Platelet Count2. Fresh BloodOnly increase in HB% as per Whole BloodFresh Blood is not an option because all labile clotting factors get destroyed at 2-60C within 6 hrs. And it usually takes more than 6 hrs from collection to issue. Hence fresh blood will not supply clotting factors.To Increase HB% And Clotting Factors1. PCV + FFP/CRYOAs per individual PCV & FFP or CRYO2. Fresh BloodOnly increase in HB% as per Whole Blood
14 PLASMA BY APHERESIS (PL-A) 6PLASMA BY APHERESIS (PL-A)In western India, Arpan blood bank, Nashik is the only blood bank to have Plasma Apheresis facility.As platelets are collected by apheresis, 500ml plasma can also be collected by apheresis. The unit of 500 ml plasma collected by apheresis is called PL-A.Advantages of plasma by Apheresis (PL-A).As plasma is collected & frozen within 2 hours, the quality of product is much superior & the yield of clotting factors is much high than routine FFP.The desired effect of 4 FFP unit is achieved by single unit of PL-A. So the risk of exposure to four different donors & therefore TTI is significantly reduced.The same donor can donate another unit of PL-A after 15 days.
17 BLOOD GROUPS ABO blood grouping system Rh blood grouping system 7ABO blood grouping systemABO Blood GroupAntigens on RBCsAntibodies in plasmaO-A & BABABRh blood grouping systemRh Blood GroupAntigens on RBCsAntibodies in plasmaRh PositiveD-Rh NegativeABO antibodies are naturally occurring i.e. opposite antibody (to antigen on RBCs) appears in plasma naturally within few months after birth.In contrast Rh antibodies are not naturally occurring. They are immune antibodies. They develop against antigenic stimulus i.e. when Rh positive RBCs enter in circulation of Rh negative person.
18 CROSSMATCHING Patient sample Patient’s plasma (Antibody) 8Patient samplePatient’s plasma(Antibody)PPatient’s RBCs(Antigen)Blood unit (Donor)SampleDonor RBCs(Antigen)Donor plasma(Antibody)DMajor crossmatchMinor crossmatchIf Major crossmatch is incompatible, then donor cells (which are less in volume) will react with antibodies in patient’s plasma (which is large in volume) & will get destructed completely to cause serious hemolytic reaction. So it is called Major.If Minor crossmatch is incompatible, then donor’s plasma (which is less in volume) will get diluted in patient’s plasma (which is large in volume) and there are less chances of reaction between antibodies in donor’s plasma with antigens on patients cells & so least chance of hemolytic reaction. So it is called Minor.
19 COMPATIBILITY Results : Interpretation : 9Results :Agglutination reactionIncompatibleNo agglutination reactionCompatibleInterpretation :MajorMinorCompatibilityCompatible groupsOptional groups (Can be given in emergency, when compatible group is not available.)Incompatible groups (Can not be transfused)The unit is called compatible if it is compatible for both blood grouping systems i.e.ABO blood group systemRh blood group system
20 ABO Crossmatch of ‘O’ blood group patient with all blood groups 10ABO Crossmatch of ‘O’ blood group patient with all blood groupsDPNo agglutination reaction (X-compatible)Patient SampleAntibodies A & BAntigenMajorMinorBl. Unit SampleAntigen -Blood GroupO-DPAgglutination reaction (X-incompatible)No agglutination reaction (X-compatible)Patient SampleAntibodies A & BAntigenMajorMinorBl. Unit SampleAntigen AAntibody BBlood GroupAO-No agglutination reaction (X-compatible)DPAgglutination reaction (X-incompatible)No agglutination reaction (X-compatible)Patient SampleAntibodies A & BAntigenMajorMinorBl. Unit SampleAntigen BAntibody ABlood GroupBO-DPAgglutination reaction (X-incompatible)No agglutination reaction (X-compatible)Patient SampleAntibodies A & BAntigenMajorMinorBl. Unit SampleAntigens A & BAntibodies -Blood GroupABO-
21 ABO Compatibility table of ‘O’ blood group patient 11ABO Compatibility table of ‘O’ blood group patientOMajorMinorBag’s Blood GroupPatient’s Blood GroupABAB
22 ABO Crossmatch of ‘A’ blood group patient with all blood groups 12ABO Crossmatch of ‘A’ blood group patient with all blood groupsDPNo agglutination reaction (X-compatible)Agglutination reaction (X-incompatible)Patient SampleAntibody BAntigen AMajorMinorBl. Unit SampleAntigen -Antibodies A & BBlood GroupOADPNo agglutination reaction (X-compatible)Patient SampleAntibody BAntigen AMajorMinorBl. Unit SampleAntigen ABlood GroupADPAgglutination reaction (X-incompatible)Patient SampleAntibody BAntigen AMajorMinorBl. Unit SampleAntigen BAntibody ABlood GroupBADPAgglutination reaction (X-incompatible)No agglutination reaction (X-compatible)Patient SampleAntibody BAntigen AMajorMinorBl. Unit SampleAntigens A & BAntibodies -Blood GroupABA
23 ABO Compatibility table of ‘A’ blood group patient 13ABO Compatibility table of ‘A’ blood group patientAMajorMinorBag’s Blood GroupPatient’s Blood GroupOABB
24 ABO Crossmatch of ‘B’ blood group patient with all blood groups 14ABO Crossmatch of ‘B’ blood group patient with all blood groupsDPNo agglutination reaction (X-compatible)Agglutination reaction (X-incompatible)Patient SampleAntibody AAntigen BMajorMinorBl. Unit SampleAntigen -Antibodies A & BBlood GroupOBDPAgglutination reaction (X-incompatible)Patient SampleAntibody AAntigen BMajorMinorBl. Unit SampleAntigen AAntibody BBlood GroupABDPNo agglutination reaction (X-compatible)Patient SampleAntibody AAntigen BMajorMinorBl. Unit SampleAntibody ABlood GroupBDPAgglutination reaction (X-incompatible)No agglutination reaction (X-compatible)Patient SampleAntibody AAntigen BMajorMinorBl. Unit SampleAntigens A & BAntibodies -Blood GroupABB
25 ABO Compatibility table of ‘B’ blood group patient 15ABO Compatibility table of ‘B’ blood group patientBMajorMinorBag’s Blood GroupPatient’s Blood GroupOABA
26 ABO Crossmatch of ‘AB’ blood group patient with all blood groups 16ABO Crossmatch of ‘AB’ blood group patient with all blood groupsDPNo agglutination reaction (X-compatible)Agglutination reaction (X-incompatible)Patient SampleAntibody -Antigens A & BMajorMinorBl. Unit SampleAntigen -Antibodies A & BBlood GroupOABBlood GroupMajorMinorPatient SampleDPAntibody -ABDPAntigens A & BBl. Unit SampleAAntigen AAntibody BNo agglutination reaction (X-compatible)Agglutination reaction (X-incompatible)DPNo agglutination reaction (X-compatible)Agglutination reaction (X-incompatible)Patient SampleAntibody -Antigens A & BMajorMinorBl. Unit SampleAntigen BAntibody ABlood GroupBABDPNo agglutination reaction (X-compatible)Patient SampleAntibody -Antigens A & BMajorMinorBl. Unit SampleBlood GroupAB
27 ABO Compatibility table of ‘AB’ blood group patient 17ABO Compatibility table of ‘AB’ blood group patientMajorMinorBag’s Blood GroupPatient’s Blood GroupOABAB
28 WHOLE BLOOD ABO CROSSMATCH TABLE 18WHOLE BLOOD ABO CROSSMATCH TABLEPatient’s Blood GroupO A B ABMajor Minor Major Minor Major Minor Major MinorBag’s Blood GroupOABAB
30 PCV (WITH ADDITIVE SOL) ABO CROSSMATCH 20PCV (WITH ADDITIVE SOL) ABO CROSSMATCHBlood unit (Donor)samplePatient sampleDonor RBCsPatient’s plasmaMajor crossmatchPatient’s RBCsMinor crossmatchNot ApplicableAs total plasma is removed from blood unit while preparing PCV, minor crossmatch is not applicable for PCV transfusion.
31 PCV (WITH ADDITIVE SOL) ABO CROSSMATCH TABLE NA O A 21Patient’s Blood GroupBag’s Blood GroupOABABO A B ABMajor Minor Major Minor Major Minor Major MinorNAPCV (WITH ADDITIVE SOL) ABO COMPATIBILITY TABLEPatient’s GroupCompatible GroupOptional GroupOAA,OBB,OABAB,A,B,O-
32 PLASMA(FFP) ABO CROSSMATCH 22PLASMA(FFP) ABO CROSSMATCHBlood unit (Donor)samplePatient samplePatient’s plasmaMajor crossmatchPatient’s RBCsMinor crossmatchDonor plasmaNot ApplicableAfter separating RBCs from blood unit plasma is prepared, so major crossmatch is not applicable for plasma transfusion.
33 PLASMA (FFP) ABO CROSSMATCH TABLE PALASMA (FFP) ABO CROSSMATCH 23PLASMA (FFP) ABO CROSSMATCH TABLEPatient’s Blood GroupBag’s Blood GroupOABABO A B ABMajor Minor Major Minor Major Minor Major MinorNAPALASMA (FFP) ABO CROSSMATCHPatient’s GroupCompatible GroupOptional GroupOO,AB,A,B-AA,ABB,OBB,ABA,OABA,B,O
34 PLATELET COMPATIBILITY 24PLATELET COMPATIBILITYABO antigens are not usually expressed on platelets. They are expressed on platelets in only 7% population, in which they are expressed weakly and on some platelets.So platelet cross matching is not applicable for platelet transfusion. Platelet can be transfused across group safely i.e. any group platelets can be given to any group patients.
35 PLATELET ABO COMPATIBILITY TABLE 25PLATELET ABO COMPATIBILITY TABLEPatient’s Blood GroupBag’s Blood GroupOABABO A B ABMajor Minor Major Minor Major Minor Major MinorNAPLATELET ABO COMPATIBILITY (AS PER PREFERENCES)Patient’s GroupCompatible GroupOptional GroupOO,AB,A,B-AA,AB,B,OBB,AB,A,OABAB,A,B,O
36 COMPARISON OF WHOLE BLOOD Vs PCV COMPATIBILITY 26COMPARISON OF WHOLE BLOOD Vs PCV COMPATIBILITYWhole Blood ABO CompatibilityPatient’s GroupCompatible GroupOptional GroupO-ABABA, B, OPCV (with Additive sol.) ABO CompatibilityPatient’s GroupCompatible GroupOptional GroupO-AA,OBB,OABAB,A,B,OSo it is always better to give ‘O’ group PCV with 0 (zero)% risk rather than ‘O’ group whole blood when same group is not available in blood bank.
37 COMPARISON OF PLASMA Vs PLATELET ABO COMPATIBILITY 27COMPARISON OF PLASMA Vs PLATELET ABO COMPATIBILITYPlasma ABO CompatibilityPatient’s GroupCompatible GroupOptional GroupOO,AB,A,B-AA,ABB,OBB,ABA,OABA,B,OPlatelet ABO CompatibilityPatient’s GroupCompatible GroupOptional GroupOO,AB,A,B-AA,AB,B,OBB,AB,A,OABAB,A,B,O
38 'Rh negative' person should receive ‘Rh negative’ whole blood and PCV. 28Rh COMPATIBILITY‘Rh positive’ patient can receive ‘Rh positive’ as well as ‘Rh negative’ blood or blood components.'Rh negative' person should receive ‘Rh negative’ whole blood and PCV.For plasma & platelet transfusion, when ‘Rh negative’ units are not available, ‘Rh positive’ units can be transfused weighing the need of transfusion and risk of Rh alloimmunisation. While transfusing ‘Rh positive’ unit to ‘Rh negative’ woman with child bearing potential, Rh Ig prophylaxis should be given.For cryoprecipitate transfusion Rh compatibility is not applicable.
39 COMPATIBILITY & SELECTION OF UNIT FOR NEONATAL TRANSFUSION 29COMPATIBILITY & SELECTION OF UNIT FOR NEONATAL TRANSFUSIONNeonate: Patient under the age of 4 months are neonates for blood transfusion purpose.Blood Request: Write compulsory ‘whether you suspect HDN or not’ on requisition form .Blood Samples: Send blood samples of both –BabyMotherCompatibility Testing:First direct coomb’s test (DCT) on baby’s RBCs & indirect commb’s test (ICT) on maternal plasma are performed to r/o HDN.TestResultsDCT on baby’s RBCs–+ICT on maternal plasmaClinically suspected case of HDNInterpretation:No e/o HDNe/o HDN
40 ABO COMPATIBILITY, IF NO E/O HDN 30If there is no e/o HDN: Select unit of same ABO & Rh blood group as that of neonate.ABO COMPATIBILITY, IF NO E/O HDNNeonate’s GroupCompatible GroupOptional GroupO-ABABA, B, ONOTE: If mother’s group is same as that of baby, additional major crossmatch with maternal plasma should be done.If there is e/o HDN: Use ABO & Rh compatible unit to both baby’s & mother’s sample.Group is compatible, ifGroup is optional, ifMajorMinorWith baby’s sampleWith mother’s sampleMajorMinorWith baby’s sampleWith mother’s sampleNANA
41 ABO COMPATIBILITY, IF E/O HDN 31ABO COMPATIBILITY, IF E/O HDNO,A,BABOB-AMother’s ABO groupOptional GroupCompatible GroupNeonate’s ABO GroupNOTE: If mother’s group is ‘AB’, then baby’s group can not be ‘O’ and if mother’s group is ‘O’, thenbaby’s group can not be ‘AB’
42 Rh compatibility if e/o HDN: 32Rh compatibility if e/o HDN:If there is e/o HDN, unit should be Rh compatible to both baby’s & mother’s group i.e. if either of two is Rh negative, then select Rh negative unit.General rules of neonatal transfusion:Don’t use PCV with SAGM solution (additive solution) for neonatal transfusion, as it contains mannitol. Neonatal transfusion is the only contraindication for using PCV with SAGM solution.If you are transfusing blood of optional group (whether there is e/o HDN or not), use semi-PCV (i.e. whole blood from which plasma is removed partially) with low anti-A or anti-B titre.Use fresh blood (<48hrs old preferably) for neonatal transfusion. It should not be more than 5 days old to avoid risk of hyperkalemia.For plasma & platelet transfusion, same group unit as that of baby, should be used. If there is e/o HDN & mother is Rh negative, use unit of Rh negative group.
45 STORAGE OF BLOOD & BLOOD COMPONENTS 33STORAGE OF BLOOD & BLOOD COMPONENTSIn Blood BankProductTempShelf lifeWB20 – 60 c35 DaysPCV (with Additive Sol)c42 DaysFFP, CRYO<-300 c1 YearRDPC, SDPC200 – 240 c5 DaysPlatelets should be kept continuously agitating till issued to patient.
46 STORAGE OF BLOOD & BLOOD COMPONENTS 34STORAGE OF BLOOD & BLOOD COMPONENTSIn HospitalProductTempShelf lifeWBc24 Hrs.PCV (with SAGM)FFP, CRYO20 – 60 c12 Hrs.RDPC, SDPCRoom Temp.-Platelets should be kept continuously agitating till transfused to patient.Ideally blood/component units should not be stored in hospital as temp. of the hospital refrigerator is not controlled. Ask the patient’s relatives to bring blood unit from blood bank just before transfusion.
49 PRE-ADMINISTRATION PRECAUTIONS 35PRE-ADMINISTRATION PRECAUTIONSBlood bag No.Blood Group of patientPatient’s NameCheck ForCase PaperIssue Report(Sent by BloodBank)Cross-match Label(On blood unit)Testing Label(On blood unit)Blood Groupof bagExpiry DateCheck unit for – Leakage/damageClotS/o hemolysisS/o contamination
50 36ADMINISTRATIONBT Set – Use BT set for transfusion of all blood products i.e. WB, PCV, FFP, RDPC, SDPC, & Cryoprecipitate.Change BT set every 12 hrs., if patient is requiring ongoing transfusion.Warming – Warming of blood unit is not needed. Infusion of 2-4 units of refrigerated blood over several hours causes no harm.Warming is needed in following conditions –Infants receiving exchange transfusion.Patients receiving rapid transfusion through central venous line.Patients receiving rapid & massive transfusions.Patients with cold – antibodies.(If warming is needed, unit should not be warmed above 370 c. Excessive warming may cause hemolysis in unit & can lead to serious transfusion reaction).Don’t add any medication to unit. You can add only normal saline or 5% albumin to dilute.
51 TIME LIMITS FOR TRANSFUSION 37TIME LIMITS FOR TRANSFUSIONWB / PCV – Within 3-4 hours. ( If room temp. is c At higher room temp., there should be shorter out of refrigerator time).FFP – Within mins.Cryo – Within 5-10 mins.Platelets – Within mins.(RDPC & SDPCs)
52 MONITORING OF PATIENT DURING TRANSFUSION 38MONITORING OF PATIENT DURING TRANSFUSION- WHEN -Before starting transfusionAs soon as transfusion startedAt 15 minsEvery hourOn completion4 hrs. after completion- FOR -General appearancePulse, B.P., Temp.Respiratory rateSigns of adverse reactionsFeverChillsRashBack painRespiratory distresss/o anaphylaxis
55 INFECTIOUS ADVERSE TRANSFUSION REACTIONS 39INFECTIOUS ADVERSE TRANSFUSION REACTIONSReactionPresentationCauseHow to avoidTransfusion transmittedinfectionsDuring window period, HIV, HBV & HCV infections can not be detected. The test results in blood bank are negative.Technical & interpretational errorsRisk of transmission of HIV, HBV & HCV through transfusion can be reduced to nearly zero %, by using NAT tested blood.By using advanced fully automated systems for testing, technical & interpretational errors can be minimized.HIV, HBV, HCV, Malarial parasite, T.pallidum (causative agent of syphilis) are the organisms which can get transmitted through transfusion.Presentation will be as per infection transmitted.Transfusion associated sepsisFever, chills hypotension, septic shock, DICBacterial contamination due to technical errors- Take aseptic precautions during blood collection, product preparation & at the time of transfusion.
56 NON INFECTIOUS ADVERSE TRANSFUSION REACTIONS 40NON INFECTIOUS ADVERSE TRANSFUSION REACTIONSReactionPresentationCauseHow to avoidAllergic reactions(Very common)Urticaria, pruritis,flushing, rashesAntibody to donor plasma proteinsUse PCV instead of WBUse cryoprecipitate instead of FFP, when indicatedNon hemolytic febrile transfusion reactions(NHFTR)(Very common)Fever,chills/rigors,headache,vomitingLeukocytesAccumulated cytokinesAntibody to donor leukocytesUse leuco-depleted componentsAnaphylaxisUrticaria,hypotension, bronchospasm, respiratory distress,local edemaAntibody to donor plasma proteinsAccumulated cytokinesUse leuco-depleted componentsTransfusion associated acute lung injury (TRALI)Respiratory failure, hypotension, fever,bilateral pulmonary edema, hypoxemia- Antibodies to donor leukocytesUse leuco depleted componentsPlatelet refractorinessNo rise in platelet count on platelet therapyLeukocytesAllomunisation, HLA antigensUse leuco depleted components
57 NON INFECTIOUS ADVERSE TRANSFUSION REACTIONS 41NON INFECTIOUS ADVERSE TRANSFUSION REACTIONSReactionPresentationCauseHow to avoidHemolytic transfusion reaction(Immune hemolysis)Chills, fever,hypotension, back pain,pain along infusion vein, oozing from IV sites, hemoglobinuria,renal failure with oliguriaMismatched blood transfusion- Avoid sample collection errors- Write blood group on requisition form- Pre administration check details- Use of advanced gel technology for crossmatchingHemolytic transfusion reaction(Non immune hemolysis)Chills, fever,hypotension, hemoglobinuria, hemoglobinemiaPhysical or chemical destruction of RBCs (heating, freezing, adding drugs to blood unit)Avoid warmingDon’t add any medications to blood unitDemand blood from Blood bank at the time of transfusion(Don’t store blood units in hospital)Graft Vs host disease(Delayed reaction)Erythroderma, maculopapcular rash, Nausea, vomiting, diarrhea, Jaundice,fever,pancytopeniaDonor lymphocytes engraft in recipient & mount attack on host tissueAvoid use of fresh blood (<48 hr old) from blood related donorsIrradiate blood unit before transfusion in immunocompromised patientsCirculatory overloadDyspnea, orthopnea, cough, tachycardia, hypertensionVolume overload-
58 MANAGEMENT OF ADVERSE TRANSFUSION REACTIONS 42MANAGEMENT OF ADVERSE TRANSFUSION REACTIONSReactionPresentationTreatmentMild reactionsUrticaria,Rashes,ItchingSlow the transfusionGive IM antihistaminicIf no improvement or worsening then treat as moderately severe reactionModerately severe reactionsFever,Rigors/chills, Tachycardia, Urticaria,Flushing, Restlessness, Headache,Mild dyspneaStop transfusion, replace set & keep IV line open with NS.Notify the treating doctorAdminister IM antihistaminic, oral antipyreticGive IV steroid & bronchodilator if indicatedIf improved, can restart transfusion slowly with new blood unitSend blood unit with BT set, post transfusion blood sample collected from vein opposite to infusion site & post transfusion urine sample to blood bank along with reaction reportIf worsen, treat as severe reaction
59 MANAGEMENT OF ADVERSE TRANSFUSION REACTIONS 43MANAGEMENT OF ADVERSE TRANSFUSION REACTIONSReactionPresentationTreatmentSevere reactionFever with rigors,Headache,Dyspnea,Chest pain,Back pain,Pain at infusion site,Respiratory distress,Restlessness,Hypotension (>20%),Tachycardia (>20%), Hemoglobinuria,Unexplained bleeding1. Stop transfusion, replace set & keep IV line open with NS.2. Infuse NS to maintain BP.3. Maintain airway & give high flow O2.4. Give adrenaline in severe allergic reactions.5. Give IV steroids & bronchodilators if indicated.6. Give diuretics to maintain urine output.7. If e/o DIC, give platelets along with cryoprecipitate or FFP.8. If bacteremia is suspected, send blood culture & start broad spectrum antibiotics.9. If renal failure is suspected, maintain fluid balance accurately.10. Send blood unit with BT set & post transfusion blood & urine sample to blood bank along with reaction report.
60 LEUCO-DEPLETION By removing buffy coat at the time of separation 44LEUCO-DEPLETIONBy removing buffy coat at the time of separationBy filtration using leukocyte filtersAfter collection & before component separation using in-line leukocyte filter bagsAt the time of transfusion using leukocyte filters
61 ABOUT ARPANArpan Blood Bank is Not-for-profit organization run by a Charitable Trust. We have been serving this domain of public health for last 15 years on 24X7 basis. We run 08 blood banks across Maharashtra State.MISSIONArpan Blood Bank is working with single minded focus of creating a role model at national level by becoming the best blood bank of the country by year By this way, we would have inspired enough souls to spread this great work and wipe out all exploitations in this critical domain of public health.
62 ARPAN - MAJOR MILESTONES 1996: Established first blood bank at Nashik.2000: Introduced Apheresis Technology first time in North Maharashtra.2002: Formed State level Association of blood banks operating on Not-for-Profit principle.2003: Replication of successfully build model at other locations in Maharashtra state started.2009: Developed in-house ERP to ensure Quality.2010: Only 3rd large sized Blood Bank to get NABH Accreditation to raise Quality Standard further.2011: Established NAT laboratory at Nashik to raise safety of blood transfusion.
63 ARPAN – FUTURE INITIATIVES An Independent Thalassemia Care CenterCord Blood BankLeuco - Depletion Facility In Blood BankIrradiation Facility In Blood BankCertification Course For Transfusion MedicineDNB Course For Transfusion Medicine