Makindo Medical Notes

Note: If a transfusion reaction is suspected, immediately stop the blood transfusion, assess the patient, verify that the blood unit and patient match, and consult with a specialist if unsure.

About

• Contact the laboratory immediately if the situation is urgent.
• Send a cross-match sample to the lab as soon as possible.

Introduction

• Blood is a scarce, potentially risky, and costly resource.
• Transfusions should only be given when the benefits outweigh the risks.
• Blood is typically provided as red cell concentrates (280-350 mL).
• Generally, fully cross-matched blood should be used. In emergencies, it can be made available within 40 minutes of receiving the sample.

Safe Group and Save and Transfusion

• Patient identification is crucial: Incorrect identification can be fatal. Patients must wear an ID band (or equivalent) displaying their name, date of birth, and a unique ID number.
• Verify patient identity at every stage of the transfusion process. The details on the ID band and blood pack must match exactly. If there is any discrepancy, do not transfuse.
• Monitor the patient throughout the transfusion. Safe transfusion practices are built on proper education and training.

Clinical Urgency

• Very urgent: Life-threatening haemorrhage requiring immediate blood. The lab may issue group O Rh(D)-negative blood, often stored nearby in ITU/Resus areas.
• Urgent: Blood required within 5-10 minutes. Send a cross-match sample to the lab urgently. ABO- and Rh(D)-matched blood will be issued.
• Non-urgent: Blood needed within 30-60 minutes. A full pre-transfusion compatibility test will be done, and the lab will issue fully compatible blood.

Further Transfusions

• If a new transfusion is needed more than three days after the initial one, a new sample must be sent for cross-match.
• If additional blood is required within 72 hours of the initial cross-match, a new sample is not needed.

Non-Emergency / Elective Transfusion

• For anaemic patients with no acute bleeding, transfusions should be administered slowly, typically over 2-4 hours.
• In patients with poor cardiac reserve, administer blood over 4 hours and consider oral furosemide (e.g., 40 mg with alternate bags) to manage fluid balance.
• Acute Blood Loss: Loss of more than 20% of blood volume (approximately 1000 mL) often requires transfusion. Do not delay when blood loss is acute and rapid. Follow local guidelines and consider initiating the massive transfusion protocol.
• Surgical Patients: Transfuse if haemoglobin (Hb) is <80 g/L or if pre-op Hb is <90 g/L and significant perioperative blood loss is expected. Investigate any known anaemia. Maintain Hb >80 g/L, and aim for >100 g/L in patients with significant comorbidities such as ischemic heart disease or valvular heart disease.
• Acute Myocardial Infarction (MI): Aim to maintain Hb >100 g/L but avoid excessive levels.
• General Cases with Hb <80 g/L: Investigate and address the underlying cause. Transfuse if the patient is symptomatic with severe fatigue, breathlessness, or significantly reduced exercise tolerance compared to their pre-anaemia baseline.
• General Cases with Hb 80-100 g/L: Investigate and manage the underlying cause. Transfuse if the patient shows symptoms such as severe fatigue, breathlessness, or reduced exercise tolerance compared to their pre-anaemia state.