# Blood Transfusion

## Overview

This module describes how to order and transfuse blood products safely to prevent potentially fatal transfusion reactions.

## Indications

Although the decision to transfuse blood products should be individualised, the Clinical Guidelines for the Use of Blood Products in South Africa recommend:

Massive infusions (more than 10 units in 24 hours) generally involve giving packed red cells, platelets and fresh frozen plasma in a 1:1:1 ratio.

## Contraindications

## Patient information and consent

Always verify your patient’s identity and obtain written informed consent before proceeding.

### How do I explain this procedure?

“I need to give you some blood, because [explain the indication]. This blood has been matched to be similar to yours, and has been checked in the laboratory to be safe for you to receive. It’s important that you understand and agree to the transfusion. The law requires that you sign a consent form.”

### What can my patient expect?

“I will put up a drip and give you the blood over a few hours. It will sting when I prick your skin with the needle, but receiving the blood itself does not hurt.”

### What is my patient’s role?

“Let me know if you have any allergies or medical conditions. Fearing blood or needles is normal, but tell me if you have fainted from it. It is very rare for patients to get a reaction to the blood, but let the staff know immediately if you start to feel strange or unwell.”

## Preparation

## Site & Positioning

See IV cannulation.

## Procedure

Follow medical asepsis with non-sterile gloves.

## Troubleshooting

I’m unsure whether I should warm the blood.

It is not important to warm blood given slowly and in small volumes, but blood given to infants and in massive transfusions should be warmed in a blood warmer. Do not use a warm water bath or microwave to warm blood, because of the risk of haemolysing the outer layer of blood.

I’m unsure whether I can add antibiotics or other IV medications to the blood bag.

Do not add anything to a blood bag. If there is no other IV access available, you can add a Y-piece to the section of the administration set closest to the patient and infuse medication or fluids in this way.

I’m unsure how to recognise a transfusion reaction.

The patient may complain of chills, pain, shortness of breath, dizziness, a rash, or pruritis. The vital signs may be deranged, with tachycardia, pyrexia, tachypnoea, and hypotension. The patient may develop jaundice, anuria or haemoglobinuria. Severe reactions may present as anaphylaxis.

I’m unsure how to treat a transfusion reaction.

Stop the infusion and keep the IV access patent by using a new administration set with normal saline. Keep the blood and the old administration set. Contact the blood bank for advice.

## Risks

1. See Peripheral Venous Access
2. Transfusion reactions
3. Circulatory overload

## References

1. National Institute for Health and Care Excellence. Blood Transfusion (NG24). 2015. Available from: https://www.nice.org.uk/guidance/ng24
2. Western Cape Blood Service & South African National Blood Service. Clinical Guidelines for the Use of Blood Products in South Africa. 5th edition. 2014. Available from: https://www.wcbs.org.za/wp-content/uploads/2020/06/clinical_guidelines_5th-Edition_2014.pdf
3. Engelbrecht D. How To Give a Blood Transfusion. In: Mash B, Blitz-Lindeque J, eds. South African Family Practice Manual. 2nd ed. Pretoria: Van Schaik Publishers; 2010: 333-335.