From the Guidelines
When giving a blood transfusion, healthcare providers should prioritize patient identification, blood product verification, vital sign monitoring, and observation for adverse reactions to minimize the risk of transfusion-related complications and ensure the best possible outcome for the patient. The most critical aspect of blood transfusion is ensuring that the right patient receives the right blood product, which can be achieved by verifying patient identity using two identifiers and cross-checking blood product labels with patient information before starting the transfusion 1.
Key Considerations
- Patient identification is paramount, and all patients receiving a blood transfusion must wear a patient identification band with their surname, forename, date of birth, and hospital unique identification number 1.
- Blood samples must be collected and labeled at the patient's side by trained personnel, and two samples are not always needed if a suitable 'historical' sample is available 1.
- Vital sign monitoring, including respiratory rate, pulse, blood pressure, and temperature, is essential before, during, and after the transfusion to identify and manage adverse reactions 1.
- Transfusion-associated circulatory overload (TACO) is a significant risk, particularly in older, non-bleeding patients, and healthcare providers should be aware of the risk factors and symptoms, including acute or worsening respiratory compromise, cardiovascular changes, and evidence of fluid overload 1.
Best Practices
- Infuse red blood cells at a rate that completes the transfusion within 4 hours per unit, and monitor the patient's response closely 1.
- Use appropriate equipment, including a 170-200 micron filter and dedicated IV line, and avoid co-administering medications except for normal saline 1.
- Document all aspects of the transfusion, including pre/post vital signs, blood product information, and patient response, to ensure accurate records and facilitate further management if necessary 1.
From the Research
Key Considerations for Blood Transfusion
When giving a transfusion of blood, there are several key factors to pay attention to in order to minimize the risk of adverse reactions. These include:
- Patient identification and blood product compatibility: Ensuring that the right blood product is given to the right patient is crucial [ 2 ]. This can be achieved through the use of electronic bedside transfusion systems that verify patient identity and blood product compatibility.
- Monitoring for transfusion reactions: Symptoms of transfusion reactions can be overlapping and nonspecific, and it is critical to stop the transfusion immediately if a reaction is suspected [ 3 ].
- Leukoreduction: The presence of leukocytes in blood products has been associated with febrile nonhemolytic transfusion reactions (FNHTRs) and allergic transfusion reactions (ATRs), and leukoreduction has been shown to minimize FNHTRs [ 4 ].
- Premedication: The use of premedication with acetaminophen and diphenhydramine to prevent transfusion reactions is not universally supported by research, and its effectiveness has been questioned [ 4 , 5 , 6 ].
Transfusion Reaction Prevention and Management
To prevent and manage transfusion reactions, the following strategies can be employed:
- Electronic verification systems: These systems can help to ensure that the right blood product is given to the right patient [ 2 ].
- Newer blood screening methods: These methods can help to reduce the risk of transfusion reactions [ 3 ].
- Hemovigilance: Improved hemovigilance can help to detect and respond to transfusion reactions [ 3 ].
- Patient monitoring: Close monitoring of patients during and after transfusion can help to quickly identify and respond to any adverse reactions [ 3 ].