SAFE BLOOD TRANSFUSION

PRACTICE

by

Dr Adegbamigbe, O.J

ABUAD 400L HAEMATOLOGY LECTURE

Sept 15TH, 2021.
Introduction
Blood transfusion can be described as the
infusion of compatible blood:
(whole blood) or
blood components (red blood cells, white blood cells,
platelets, clotting factor concentrates etc) into a recipient
(patient).

This can be patient’s own blood being collected and

transfused back to the patient in autologous
transfusion or from another person to the patient as
we have in allogeneic transfusion.
HISTORY OF BLOOD TRANSFUSION

1492 : the first recorded need for blood transfusion was

when Pope Innocent VIII, in Rome, went into a coma.
His physician advised a Blood transfusion as a
therapeutic measure for the Pope's illness. Employing
crude methods, the Pope did not benefit and died.

It was not until 1795 in Philadelphia that an American

physician, Philip Syng Physick, performed the first
known human Blood transfusion.
 HISTORY OF BLOOD TRANSFUSION
(contd)

1818 James Blundell, a British obstetrician, performed the first

successful transfusion of human blood to a patient for the
treatment of postpartum hemorrhage. Using the patient's husband
as a donor, with a syringe, he successfully transfused the wife
although he did not publish the particulars.
 From 1901, when Karl Landsteiner, an Austrian physician, and the
most important individual in the field of Blood transfusion, Born on
14th June (WHO world donor day)
 Documented the first three human blood groups (based on

substances present on the red Blood cells), A, B and O, blood

transfusion moved to a different level.
 SAFE BLOOD TRANSFUSION PRACTICE ( contd)

The transfusion of untyped blood with uncertain

outcome (usually resulting to death) has been reduced to
the barest minimum with the recent technology.

With advances in transfusion Medicine, blood can be

stored after it had been separated to various
components, in a frozen state for a year or more.

In advanced countries, automated machines are now

being used to group and cross match blood for
transfusion
 Can blood transfusion cause adverse
reactions?
Yes. Complications can occur from transfusion of blood. The
risks associated with the transfusion of any specific unit of
blood are low if appropriate steps are taken.

It thus follows that transfusions of blood and blood

components should only be prescribed:
1) When there is a definite and appropriate clinical indication.
2) When there are no feasible alternatives and
3) When the benefits of transfusion are judged by the
prescribing clinician to outweigh its short- and long term
risks.
 What is safe blood transfusion practice?
 Safe blood can be defined as blood and blood products from persons with
I. no known risks for exposure to transfusion-transmissible microorganisms (TTM; e.g.,
malaria, HIV),
II. which have been fully tested and are negative for TTM.

 Safe blood transfusion practice is the practice in which the blood supply for
TRANSFUSION is free of harmful substances or infectious agents, and
properly typed and crossmatched (GROUPED AND CROSSMATCHED) to
ensure serological compatibility between BLOOD DONORS and recipients

 Safe blood transfusion practice can be summarized as – right blood,

right patient, right time and right place
 WHO’s strategy for blood safety
The WHO strategy for blood safety and availability, endorsed by
the World Health Assembly, addresses five key areas:
1. The establishment of well-organized, nationally-coordinated blood
transfusion services to ensure the timely availability of safe blood
and blood products for all patients requiring transfusion. (NBTS in
Nigeria)
2. The collection of blood from voluntary unpaid blood donors from
low-risk populations
3. Quality-assured testing for TTIs, blood grouping and compatibility
testing
4. The safe and appropriate use of blood and a reduction in unnecessary
transfusions.
5. Quality systems covering the entire transfusion process, from donor
 Safe blood transfusion practice/
Haemovigilance
The objective of the WHO programme on blood transfusion
safety is to ensure universal access to safe, quality and
efficacious blood and blood products for transfusion.

Haemovigilance is defined as ‘the set of procedures of

surveillance organized from
 the collection of blood and its components
to the follow-up of its recipients, with the purpose of
 collecting and evaluating information on the undesirable and
unexpected effects resulting from the use of blood products
and of preventing their reoccurrence.
 Safe blood transfusion practice (contd)
Blood safety starts with selection of donors with least risk of
transmitting infective organisms (clinical screening by blood bank nurse).
 SAFE BLOD TRANSFUSION PRACTICE INCLUDES measures to protect the
recipient and the blood donor

 Blood donors : There are three types of blood donors :

 Voluntary unpaid;
 Family replacement and
 Paid.

 Voluntary unpaid blood donors are vital for ensuring a sufficient, stable blood
supply.
 A well-established voluntary unpaid blood donor programme can contribute to a
significant reduction in the risk for infections such as HIV, hepatitis B, hepatitis C
and syphilis.
A young student donating blood
 B. Measures to protect the donor.
(DONOR SELECTION CRITERIA)

1. Age 17–70 years (60 at first donation)

2. Weight above 50 kg (7 st 12 lb)
3. Haemoglobin > 13 g/dL for men, 12 g/dL for women
4. Minimum donation interval of 12 weeks (16 weeks
advised) and three donations per year maximum
5. Pregnant and lactating women excluded because of high
iron requirements
 MEASURES TO PROTECT THE DONOR (contd)

Exclusion of those with:

1. Known cardiovascular disease, including hypertension
2. Significant respiratory disorders
3. Epilepsy and other CNS disorders
4. Gastrointestinal disorders with impaired absorption
5. Insulin-dependent diabetes
6. Chronic renal disease
7. Ongoing medical investigation or clinical trials
8. Exclusion of any donor returning to occupations such as
driving bus, plane or train, heavy machine or crane
operator, mining, scaffolding, etc. because delayed faint
would be hazardous
Conditions in the donor that lead to deferral.

1. Those at risk of HIV through lifestyle will refrain from

donation (sexual practices, piercing, tattooing)
2. Donors with history of hepatitis deferred until 12 months
after recovery
3. Exclusion of all potential donors who have themselves
received a blood transfusion (due to risk of third party vCJD
transmission)
4. Exclusion of those who have received pituitary-derived
hormones or cadaveric dura mater or corneal grafts, and
those with family history of CJD
CONDITIONS IN THE DONOR THAT LEAD TO
DEFERRAL(Contd).

5. Exclusion of those whose travel history places them at risk of

infections such as Chagas’ disease , SARS
6. Permanent exclusion of any donor who has had filariasis, bilharzia,
yaws or Q fever
7. Exclusion for varying time following vaccinations
8. Exclusion after known exposure to infectious illnesses such as
varicella or anyone with a malignant condition
9. Exclusion of those with diseases of unknown origin, e.g. Crohn’s
disease or other illness, e.g. cardiovascular, diabetes, malignancy.
10. Exclusion of those taking teratogenic drugs or those that accumulate
in the tissues
 Hazards of blood donation
Fainting : the most common hazard of blood donation is
reported in between 2% and 5% of all donors, but being
especially common in young people and in those donating for
the first time.

Delayed faints occurring after a donor has left the clinic are
potentially hazardous and a contraindication to further
donation.
For this reason, those donors who are drivers, machine
operators, scaffolders and so on should not return to work on
the day of donation
 Hazards of blood donation(contd)
Infection of the venepuncture site should be avoided by
meticulous attention to skin cleansing and aseptic techniques.

Bruising of the arm may occur, particularly when venous

access has been difficult; firm pressure over the site for 2–3
min and an explanation to the donor are usually sufficient.

Trauma to the nerves: Attempted venepuncture may result in

trauma to nerves in the arm, resulting in pain, paraesthesiae
and numbness.
Such symptoms generally resolve in a few days, but very
rarely may take several months of recovery
1. To identify need for transfusion which is to save life and
STEPS IN SAFE BLOOD TRANSFUSION PRACTICE

prevent complications of anaemia.

2. In blood loss, plasma expanders are used to treat

hypovolaemic shock, and the appropriate blood product is
given if needed. (NO unnecessary transfusions!)

3. Appropriate donors are selected (voluntary non-remunerated

blood donors)

4. Screening for transfusion transmissible infections is done

before a donor is bled
 STEPS IN SAFE BLOOD
TRANSFUSION(contd
5. The blood is then separated into various components for
maximum use of blood.

6. The separated blood components are then stored in

appropriate anticoagulants and in conducive environment to
maintain the safety and viability of the blood.

7. Patients are to sign a consent form (or be signed on patient’s

behalf, if a minor or is not able to make the decision) agreeing
to blood transfusion or otherwise.
Blood components: (a) plasma‐depleted red cells;
(b) platelets; and (c) fresh frozen plasma.

a c

b
 STEPS IN BLOOD
TRANSFUSION(contd)
8. Blood issued out from the blood bank is received by ward
nurse who then checks that the names on the bag and other
demographic features, tally with the patient before the blood
is accepted for transfusion to the patient.

9. In the presence of blood transfusion reaction, the blood is

stopped and the doctor is called, who then assess the cause
and manage appropriately. In many cases (e.g. in allergic
reaction) the blood transfusion may be continued.
 STEPS IN SAFE BLOOD
TRANSFUSION(contd)
Choosing the appropriate blood for the recipient:

1. ABO group compatible blood is given

2. Blood group A for A, B for B and O for O. O may be given

to either A or B. They MUST be crossmatched!

3. Must be crossmatched to detect presence of antibodies that

may cause haemolytic transfusion reaction
 Issuing out the blood

Ensure prompt delivery of the blood component to the

clinical area
 Pre-administration Procedure
Step 1: Ensure the blood component has been prescribed
Step 2: Undertake baseline observations

Step 3: Undertake visual inspection

LEAKS
DISCOLOURATION
CLUMPING

EXPIRY DATE

If there is ANY discrepancy - DO NOT transfuse

25
Putting up a safe blood
Indications for blood transfusion

Includes, but not limited to:

1. Severe aneamia e.g in massive bleeding or with cardiac
decompensation.

2. Bone marrow failure (low red cell, white cell and platelet)

3. Exchange blood transfusion in neonates with jaundice

4. Blood transfusion in preparation for cancer therapy

SUMMARY

TO QUARANTEE SAFE BLOOD TRANSFUSION PRACTICE

THE FOLLOWING ARE IMPORTANT;
1. Blood transfusion when absolutely indicated (i.e. No feasible
alternative).
2. Right donor (voluntary unpaid) selected, with clinical and
laboratory screening thoroughly done.
3. Blood collected and well preserved under strict aseptic
condition.
4. Appropriately cross matched and given to the right patient.
5. Haemovigilance to monitor any adverse reactions in order to
take necessary steps in treatment and prevention of
reoccurrence.
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