Red Cells & Whole Blood

Main Uses

• Symptomatic oxygen carrying deficit
• Red cell replacement for traumatic or surgical blood loss

Precautions

• Consider the cause of anaemia. Is a transfusion required?
• Treat nutritional anaemia with nutritional supplements. Consider transfusion when clinical condition is unstable.

Dosage

• One unit of red cells is approximately 240mL
• One unit raises patient Hb by approximately 10g/L in adults

One paediatric unit is approximately 50mL

Consent and Safety

Patient Identification

Always check the identity of the patient when taking sample for blood grouping or crossmatch before commencing the transfusion

Remember

• Only one patient should be bled / processed at a time
• Never pre-label the specimen tube
• Check identity by ASKING the patient to state and spell his/her name AND check the wrist band
• Check that the request form and sample match the patient and wrist band
• Remember to sign the sample and request form

Consent

Consent should be obtained and documented. Check your local institutional guidelines

Always cover the following when gaining consent -

• Explain

- Cause / likelihood of bleeding or the low blood count (including any uncertainty)?
- Nature of the proposed transfusion therapy - what is involved?
- Benefits expected?
- Risks - common & rare but serious?
- Alternatives - including the risk of doing nothing?

• Ask

- Is there anything else you would like to know?
- Is there anything you do not understand?

• Provide

- Interpreter for non-English speaking patients
- Written information

Click for more detailed information

Administration

Transfusion Set-Up

• Administer blood through a blood giving set with an administration filter (large particle filter which only removes aggregates and other large particles)
• For blood requiring bed-side leucodepletion, a "white cell filter" is required. These filters are designed to remove small particles such as white cells but allow red cells, platelets and proteins to go through. Specific set-up is required - see product inserts and talk to your local Transfusion/ Haematology Nurse Consultant or Transfusion Service provider. Do not "flush" these filters after use.
• Units labelled as leucodepleted product do not need a "white cell filter" at the bedside BUT still needs an administration filter.

Patient Monitoring

• Start transfusion within 30 minutes of removing blood from the fridge
• If you cannot start within 30 minutes then return the blood to the blood fridge unitl required
• Check patient vital signs (pulse rate, respiration rate, blood pressure and temperature) at the start of transfusion AND at least after 15 minutes, at the end of transfusion AND if there is ANY reaction. Record observations in patients notes

When to Transfuse?

• Plan ALL transfusions during business hours. Emergency transfusions should be the only transfusions given after hours
• Transfuse ONE unit at a time

How Long Should a Transfusion Take?

• Generally 2 hours.
• Each unit must be transfused within 4 hours of starting
• May be given faster in acute bleeding situations
• Use a blood warmer for massive transfusion