Right blood, right patient, right time, right place
The steps shown in this section are intended to minimise the risk of a patient receiving a wrong blood component unit or one that arrives too late. Failure to follow these steps led to at least 787 patients receiving the wrong blood transfusion in the UK in the period 2003−2004, contributing to the death of three patients (Table 25): www.shotuk.org
Inform the patient (or relative)
It is important to explain the proposed transfusion treatment to the patient (or to a responsible person if the patient is unable to communicate), and to record in the case notes that you have done so. The patient or relative may be worried about the risks of transfusion and may wish to know more about the risks, the expected benefits and the possible alternatives to transfusion (see Informing patients). Patient information leaflets are available from the UK blood services. Some patients’ religious beliefs preclude transfusion (see Patients not accepting transfusions).
Prescribing blood components for transfusion: responsibilities and records
It is currently a medical responsibility to prescribe blood components or blood products. Before any blood product is administered, the reason for transfusion, the type of blood component or product to be given, and the prescriber’s signature must be recorded in the patient’s medical record. Accurate documentation of the transfusion episode assists with the investigation of any serious adverse effects of transfusion. The prescriber’s signed note in the medical record, detailing the fact that the patient has been given information and that their questions have been answered, may be extremely important in any future medico-legal case.
Infusion rates and times for blood components
For adult patients
Infusion rates and times depend on the individual situation and must be specified by the clinician who orders the transfusion. Use of a suitable infusion pump allows a precise rate to be specified.
Rapid infusion may be required − a unit over 5−10 minutes − in managing major haemorrhage, while in a frail elderly patient at risk of circulatory overload, a slow infusion rate is appropriate.
There is extensive experience of safely administering red cell units to stable patients over a period of 90 minutes for each unit.
The infusion of each pack should not take more than four hours (see Figure 5).
Platelets have a short storage life and are generally infused in not longer than 30−60 minutes per pack.
Fresh frozen plasma
Rapid infusion may be appropriate when it is given to replace coagulation factors during major haemorrhage. There is anecdotal evidence that acute reactions may be more common with faster rates of administration.
Infusion rates and times are critically important. Guidance is given in 'Transfusion of the newborn infant'.