What are the steps to follow for a planned blood transfusion in a 55‑year‑old patient?

Steps for Planned Blood Transfusion in a 55-Year-Old Patient

For a planned transfusion in a 55-year-old patient, you must obtain documented informed consent during pre-assessment, verify patient identity with four core identifiers at bedside immediately before transfusion, monitor vital signs at baseline, 15 minutes after starting, at completion, and 15 minutes post-transfusion, and maintain complete traceability documentation for 30 years. 1, 2, 3, 4

Pre-Transfusion Phase

Informed Consent (Must Be Completed Before Procedure)

• Obtain and document informed consent during pre-assessment whenever transfusion is anticipated before surgery 2, 1
• Discuss in the absence of undue influence factors 2
• Explain why transfusion is needed and specific benefits for the patient's condition 2
• Cover individualized risks including transfusion reactions, infections, TACO (the most common cause of transfusion-related mortality in older patients), and other adverse events 2, 1
• Present alternatives such as cell salvage and autologous donation where applicable 2, 1
• Document the patient's questions, responses given, and their agreement on the consent form, anaesthetic record, or patient notes 2
• Confirm the patient has capacity to provide consent and understands the information 2

Patient Assessment and Preparation

• Assess for TACO risk factors particularly relevant to this age group: patients >45 years require careful evaluation for silent myocardial ischemia and underlying ischaemic heart disease 1
• Evaluate for heart failure, renal failure, hypoalbuminaemia, and low body weight 1
• Consider body weight dosing of red blood cells and slow transfusion rate in high-risk patients 1
• Ensure two identification wristbands are in place with four core identifiers: first name, last name, date of birth, and medical record number 3, 4

Blood Product Ordering and Laboratory Work

• Order appropriate blood components based on clinical indication 1
• Ensure type-and-screen or cross-match is completed and documented 3
• Verify ABO blood group confirmation and document any irregular antibodies detected 3
• Record the 14-digit donation number, blood group, expiry date and time for each unit 3

Immediate Pre-Transfusion Phase

Bedside Identity Verification (Most Critical Safety Step)

• Perform positive patient identification at bedside immediately before transfusion—never in advance 4, 5
• Verify four core identifiers on patient's wristband match exactly with the compatibility label on blood component and the prescription 3, 4
• This is the single most critical safety step to prevent ABO incompatibility errors, which carry greater risk than aggregate viral transmission 4, 5

Equipment and Access

• Establish large-bore IV access (ideally 8-Fr central venous access for massive transfusion scenarios) 4
• Use blood administration sets with inline filters 4
• Prepare warming equipment for patient and blood products to prevent hypothermia-induced coagulopathy 4

Baseline Vital Signs

• Record heart rate, blood pressure, temperature, and respiratory rate before starting transfusion (within 60 minutes) 1, 3, 4
• Document these baseline values in the patient record 3

During Transfusion Phase

Monitoring Schedule

• Record vital signs 15 minutes after starting transfusion 1, 3, 4
• Monitor respiratory rate throughout transfusion as dyspnoea and tachypnoea are early symptoms of serious reactions 1
• Complete vital signs at completion of each unit 1
• Record vital signs 15 minutes post-transfusion 1, 3, 4

Timing Requirements

• Complete red cell transfusion within 4 hours of removal from controlled refrigerated storage 3, 4
• Record exact date and time transfusion started and completed 3

Reaction Management

• If suspected transfusion reaction occurs, stop transfusion immediately and maintain IV access with normal saline 4
• For anaphylaxis: administer epinephrine 0.3 mg IM into anterolateral mid-thigh (may repeat once) 4
• For suspected TACO: stop transfusion, administer diuretic therapy, provide oxygen support 4, 1
• For suspected TRALI: stop transfusion, provide critical care respiratory support, do not give diuretics 4
• For febrile reactions: administer intravenous paracetamol only 1
• For allergic reactions: administer antihistamine only 1
• Do not use steroids and antihistamines indiscriminately 1

Post-Transfusion Phase

Documentation (Legal Requirement)

• Document 100% traceability in patient record—this is a statutory requirement retained for 30 years 3
• Record component type, volume, donation number, blood group, expiry date/time 3
• Document pre-transfusion testing results 3
• Include signature and professional designation of prescribing clinician and those who performed bedside check 3
• Record number of units and total volume transfused in case notes 1
• If allogeneic blood given, document reasons clearly 1

Patient and Provider Notification

• Inform patient before discharge that they received blood components and this removes them from the donor pool 3, 4
• Notify the patient's general practitioner 2, 3, 4

Adverse Event Reporting

• Report serious adverse events to hospital transfusion committee and national reporting system 1
• Document type of reaction, time of onset, signs/symptoms, management actions, and notification to transfusion laboratory 3

Common Pitfalls to Avoid

• Never perform identity verification away from bedside or in advance—misidentification is the most common transfusion risk 3, 4, 5
• Never transfer blood without transfusion laboratory knowledge—coordinate cold chain maintenance and traceability 1
• Do not transfuse blood removed during haemodilution that has been at room temperature for more than 6 hours 1
• Avoid rapid transfusion in older patients with cardiac or renal comorbidities—transfuse slowly on a unit-by-unit basis 1, 6
• Do not use indiscriminate premedication with steroids in immunocompromised patients 1