Dr Megan Rowley - diamondblackfan.org.uk

Report
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Blood Transfusion
Dr. Megan Rowley
Consultant in Transfusion Medicine
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What would you like to know?
Where does my
blood come from?
What happens to
blood once it has
been collected?
What is in a bag
of blood?
Is blood safe
and what
happens if it
goes wrong?
How do you
decide
when to
transfuse?
And how
much?
Who are all the people who make
this work?
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There are lots of people who work
hard to get blood to you
Blood donor and the blood collection
teams
NHS Blood and Transplant
Hospital Transfusion Department
Doctors and nurses who look after you
EXPERTS
PEOPLE WHO
ADVISE ON
BEST
PRACTICE
REGULATORS
PEOPLE WHO
OVERSEE
ADVERSE
EVENTS
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Healthy
Blood 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!
Where does my blood
come from?
www.blood.co.uk
Look on the website – lots of interesting
facts, figures and video clips
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What happens to blood once it has
been collected?
1. Tested

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)
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What happens to blood once it has
been collected?
2. Processed

No such thing as ‘whole blood’

What we need are
‘components’


RED CELLS

PLATELETS

PLASMA
And the white cells have to be
removed

LEUCODEPLETION
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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
Distribution of
blood groups varies
across the world
Blood
Group
RhD
Positive
RhD
Negative
Total
O
A
B
AB
37%
35%
8%
3%
7%
7%
2%
1%
44%
42%
10%
4%
How do we choose which blood
group to give?
DONOR
BLOOD GROUP
PATIENT BLOOD GROUP
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ANTIBODI
ES IN THE
PATIENT
O
A
B
AB
O
Anti-A
and AntiB
GOOD
BAD
BAD
BAD
A
Anti-B
GOOD
GOOD
BAD
BAD
B
Anti-A
GOOD
BAD
GOOD
BAD
AB
None
GOOD
GOOD
GOOD
GOOD
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Matching blood
Before transfusion of red cells the blood has to
be appropriately matched to the patient
The transfusion lab will select the correct ABO/D
red cell group for the patient
Some patients also have ‘special requirements’
e.g. IRRADIATED, KELL NEG
Serological (XM) is where the patient’s plasma is mixed with the
donor’s red cells
Takes 40 minutes
Electronic Issue (EI) is where the computer checks there are two
patient blood groups that agree, there is a is valid (recent) G&S
sample and a negative antibody screen
Takes 10 minutes
Labelling and Issue
A blood bag with a
compatibility label
attached
All the information
on the blood bag
label is bar-coded as
well as eye readable
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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
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Patient Blood Management
Patient
information
and valid
consent
Give the
right amount
of blood
Consider
and discuss
alternatives
Consider
special
requirements
Minimise
anaemia
Review the
outcome
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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’
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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?
4mL/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
‘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
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What happens if it goes wrong?

Investigate incidents locally


Report serious hazards via a national system


SHOT
Clinical audit


ROOT CAUSE ANALYSIS
PROCESS and APPROPRIATNESS of TRANSFUSION
Learn and continuously improve

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
DOCTORS and NURSES
TRANSFUSION LABORATORIES
BLOOD SERVICES
EXPERTS and REGULATORS
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What reactions occur with red
cells?
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Serious Hazards of Transfusion
1996-2012 (n=11570)
Getting an
infection
from
blood
Getting
too much
blood too
quickly
Having a
reaction
to blood
Getting
the wrong
blood
+ Adverse effects of RBC transfusion
contrasted with other risks
Hepatitis and
HIV
transmitted
by
transfusion is
very rare
Carson J L et al. Ann Intern Med doi:10.1059/0003-4819156-12-201206190-00429
©2012 by American College of Physicians
Fluid
overload
from blood
transfusion
and patients
with a fever
during
transfusion is
quite
common
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Conclusion
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Blood is a precious gift given by a blood donor


There are many people working behind the scenes to get you
the right blood at the right time, every time


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
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

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