How do I chart packed red blood cells (PRBCs)?

From the Guidelines

To chart packed red blood cells, document the patient's name, medical record number, date and time of transfusion, unit number of the blood product, pre-transfusion vital signs, volume transfused, post-transfusion vital signs, and any reactions observed, following a restrictive transfusion strategy to maintain an Hb of 60–100 g/l based on potential or actual ongoing bleeding, intravascular volume status, signs of organ ischemia, and adequacy of cardiopulmonary reserve 1. When charting packed red blood cells, it is essential to prioritize the patient's safety and well-being by following established guidelines and protocols. The process involves:

• Verifying the patient's identity using two identifiers and checking the blood product against the physician's order
• Recording baseline vital signs before starting the transfusion, then monitoring and documenting vital signs at 15 minutes after starting, then hourly until completion
• Noting the start and end times of the transfusion, ensuring the packed red cells are administered within 4 hours to prevent bacterial growth
• Documenting the patient's response to the transfusion, including any adverse reactions such as fever, chills, rash, or respiratory distress
• Stopping the transfusion immediately, maintaining IV access, checking vital signs, and notifying the physician if reactions occur
• Completing documentation by recording the total volume transfused and the patient's post-transfusion status, including any improvement in symptoms or laboratory values that prompted the transfusion The goal of transfusion is to treat or prevent a deficit of oxygen-carrying capacity in blood to improve oxygen delivery to body tissues, and transfusion should be administered primarily to prevent or alleviate symptoms, signs, or morbidity due to inadequate tissue oxygen delivery 1. However, the most recent and highest-quality study suggests a restrictive transfusion strategy to minimize risks and improve patient outcomes 1.

From the Research

Charting Packed Red Blood Cells (PRBCs)

There are no specific studies that provide a step-by-step guide on how to chart PRBCs. However, the following information can be useful in understanding the process of transfusing PRBCs:

• The decision to transfuse PRBCs is based on surrogate parameters such as hemoglobin (Hb) concentration, in addition to clinical criteria 2.
• The standard transfusion practice involves transfusing PRBCs without determining their Hb content 3.
• The efficacy of a transfusion episode can be assessed if the Hb content of the PRBC is known and the patient's post-transfusion Hb increment is also determined 3.
• PRBC transfusion was more efficacious in patients who were transfused with PRBCs having a Hb content ≥50 g as compared to those who received randomly selected PRBCs 3.

Key Considerations

When transfusing PRBCs, the following considerations are important:

• Patient identification and blood product compatibility must be verified using an electronic bedside transfusion system to ensure the right blood product is given to the right patient 4.
• The indication for transfusion is based on surrogate parameters such as Hb concentration, in addition to clinical criteria 2.
• The most frequent causes for transfusion errors are lack of informed consent, lack of identity checking and/or AB0 identity testing, and the drawing of blood samples in unlabelled tubes 2.

Transfusion Practices

Different studies have compared the efficacy of PRBC transfusion based on its Hb content versus the standard transfusion practice:

• A prospective study compared the efficacy of PRBC transfusion based on its Hb content versus the standard transfusion practice in thalassemia major patients 3.
• A single centre retrospective observational cohort study compared mortality for patients with suspected traumatic haemorrhage transfused with pre-hospital PRBC compared to crystalloid 5.