When a patient is found to have a clinically significant antibody(ies), additional time is always needed to find compatible units. The time required can be hours, days, or in rare instances, weeks. For some patients compatible donors may never be found. In these situations, an antibody report is placed in the chart and an advisory consultation is given. It is important that the information contained in the report be included in all correspondence, transfer notes, and discharge summaries which form the patient's permanent medical history. In urgent cases, the Blood Bank pathologist or Blood Bank resident will contact the attending physician or resident.
The presence of an auto or alloantibody may cause in vitro incompatibility between the donor's RBC's and the recipient's plasma and yet not affect the survival of that donor's red cells within the recipient. To prove that this is the case, an in vivo crossmatch may be necessary. This study is arranged by contacting the Blood Bank resident. At least 24 hours are usually required from the time the study is scheduled until the results are available.
In the event that a serious reaction is suspected (rise in temperature of greater than
2° F, dyspnea, shock, hemolysis) immediately:
1. STOP THE TRANSFUSION!
2. Notify the Blood Bank (ext. 686-5867). The Blood Bank technologist will notify the
Blood Bank physician.
3. Label an EDTA tube with complete identification including time
drawn and designate as "post transfusion sample". Samples should be drawn from
the opposite arm from that into which blood was transfused.
4. Complete the Transfusion Reaction Report available at the nursing station.
5. Take the closed blood container with the attached entire administration set,
post-transfusion blood samples, and completed Transfusion Reaction Report to the Blood
Bank for evaluation. Do not send spiked bag through tube system.
6. Submit a urine specimen (15 ml minimum) for "gross" hemoglobinuria to the
Clinical Laboratory.
The Blood Bank resident will notify the house officer taking care of the patient of the
results of initial testing, the type of reaction, whether the reaction was blood-related,
and assist with current and future management. A written report will be issued in
follow-up.
Signs and symptoms of transfusion reactions are listed on the reverse
side of the blood tag copies 1 and 2 and below:
1. Hemolytic - Shock, chills, fever, dyspnea, back pain, headache, and/or abnormal
bleeding
2. Febrile - Chills, fever
3. Allergic - Local erythema, hives, itching; flushing, nausea, vomiting, diarrhea;
anaphylaxis
4. Circulatory Overload - Coughing, cyanosis, dyspnea
Other reactions may occur and may not be apparent until much later. Any suspected
reactions must be reported to the blood bank. Notify Pathology Resident (688-2820) and the
Blood Bank Technologist (ext. 686-5867). Any jaundice in a patient who has received blood
in the last six (6) months should be reported to the Blood Bank.
Send a secure transmittal form stamped with the patient's name and medical record number to the Blood Bank. A technologist will compare the information on the slip with the desired component. NAME AND MEDICAL RECORD NUMBER MUST AGREE.
1. Infuse as soon as possible. DO NOT refrigerate on the ward with the exception of the OR. NEVER refrigerate platelet products. If the component cannot be infused immediately, return to the Blood Bank within 15 minutes.
2. Patient identification is done at the bedside by two persons comparing the information on the Blood Tag with that on the patient's ARM BAND and with the blood component label. Both persons must sign the Blood Tag.
3. All components require in-line filters. The standard blood product infusion set has a pore size of 170u. Special filters for platelets are issued from the Blood Bank at the time the product is dispensed. I-med Filters and neonate syringes are in the Omni-Cells.
4. Solutions and Blood: Only physiologic saline (0.9%) should be added to blood products. Use a Y recipient set and flush the line if other solutions have been running. Calcium containing solutions can cause clotting. Low ionic strength solutions as D5W can lead to hemolysis. Drugs are NEVER added to blood. Blood must not be pumped through small gauge needles nor warmed to above 42oC.
5. Rate of infusion is determined by the clinical situation. Start the infusion slowly to observe for possible reactions. Take vital signs before the infusion and record on the Blood Tag. No blood component should hang for more than four (4) hours at room temperature. If the patient's status requires a very slow infusion, contact the Blood Bank staff to see if the product can be split so that only one half is out of the Blood Bank at one time.
6. When the transfusion is completed, record the vital signs on the Blood Tag and complete the date and time that the transfusion was completed without incident. The first white copy of the Blood Tag is for the patient's chart. Return the cardboard copy to the Blood Bank.