Category Archives: BLOOD TRANSFUSION

HEALTH CHECK BEFORE DONATING BLOOD

● Basic physical examination: To include a check for swollen glands, skin rashes, signs of intravenous drug use or abnormal bleeding (purpura).

● Weight of the person: Persons weighing 45–50 kg or more can safely donate 450 ml of blood.

● Temperature of the person (to exclude any febrile disease e.g. malaria): A donor should not give blood when their temperature is raised.

● Measurement of blood pressure: A donor should not have an abnormally low blood pressure nor a high blood pressure. The upper acceptable limits are a diastolic pressure of 100 mm Hg and systolic pressure of 180 mm Hg. The minimum acceptable blood pressure is 90/50 mm Hg.

● Pulse rate of the person: The pulse rate should be regular and less than 100 beats/minute (counting for at least 30 seconds).

● Test to check for anaemia: For example, measurement of haemoglobin or PCV or an estimate of haemoglobin level using the Haemoglobin Colour Scale. In most countries persons are accepted as blood donors with a haemoglobin of 120 g/l (12 g/dl) or more and haematocrit of 380 g/l (38%) or more. In some countries the lower limit for men is set at 130 g/l (13 g/dl). Higher haemoglobin levels will be
required at high altitudes.

OBJECTIVES OF QUALITY ASSURANCE (QA) IN BLOOD TRANSFUSION


• To prevent unnecessary blood transfusions.

● To provide blood that is consistently safe and effective, traceable, and available when it is needed.

● To obtain blood from low risk healthy donors and promote non-remunerated voluntary blood donation.

● To ensure appropriate tests and controls are used to screen blood for transfusion transmissible pathogens, and to type (group) and compatibility test blood.

● To minimize errors by implementing concise easy to follow standard operating procedures (SOPs) and monitoring staff compliance.

● To prevent patient misidentification and errors in blood labelling, documentation, and blood records.

● To ensure personnel are well motivated and trained to the standard required with sufficient on-site experience and continuing education to perform blood transfusion related techniques competently and safely

BLOOD TRANSFUSION IN VARIOUS CASES

TREATMENT OF ANAEMIA


For adults, including pregnant women, blood transfusion is indicated when:

  • A patient is in danger of dying of anaemic heart failure or hypoxia before specific medication can raise the haemoglobin.
  • Obstetric delivery is imminent and the mother’s haemoglobin is below 70 g/l (7 g/dl).
  • Emergency major surgery is essential and the haemoglobin is below 80 g/l (8 g/dl) with an anticipated blood loss of more than 500 ml.

In the above situations, the use of concentrated red cells (10 ml/kg body weight), is indicated to avoid cardiac overload. The transfusion should be administered slowly over 4–6 hours. When indicated, a rapidly acting diuretic should be administered. The pulse and respiratory rate should be monitored and the chest examined to detect volume overload.

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For infants and young children, blood transfusion is indicated when:

  • The haemoglobin is below 50 g/l (5.0 g/dl) and is associated with respiratory distress.
  • The haemoglobin is below 40 g/l (4.0 g/dl) and is complicated by malaria or bacterial infection even without respiratory distress.
  • The haemoglobin is below 30 g/l (3.0 g/dl) without apparent infection or respiratory distress.

In the above situations, transfusion with whole blood (not packed cells), 10 ml/kg body weight, without diruretics will be tolerated.
Children with respiratory distress but not profound anaemia should be treated with intravenous colloids, and be transfused only if the haemoglobin falls later to less than 50 g/l.

TREATMENT OF ACUTE HAEMORRHAGE


● Blood transfusion is indicated when there is acute haemorrhage with a loss of more than 30% of apatient’s total blood volume, and blood pressure and oxygenation cannot be maintained by crystalloid solutions (saline or Ringers’ lactate) or colloids (e.g. 5% dextran or 5% hydroxyethylstarch).

Acute blood loss should be managed by
replacement of volume. Only when shock
persists or worsens should whole blood be transfused.

Postpartum haemorrhage: Blood transfusion is indicated when hypotension and reduced cerebral function persist
after at least 50 ml/kg of volume replacement fluid has been given intravenously and all measures have been
taken to stop blood loss.

TREATMENT OF NEONATAL JAUNDICE

For newborn infants with a serum bilirubin above 300 µmol/l, an exchange blood transfusion is indicated.