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Blood Transfusion A clinician’s reference First Edition Hospital Transfusion Committee Centro Hospitalar de Conde São Januário (CHCSJ) SS, Macao September 2005 Hospital Transfusion Committee Centro Hospitalar de Conde São Januário (CHCSJ) SS, Macao 1 BLOOD TRANSFUSION A clinician’s reference S Hospital Tranfsusion Committee CHCSJ Heath Bureau, Macau 2 Index Introduction ------------------------------------------------------------------------------------------- 4 Useful Contacts --------------------------------------------------------------------------------------- 4 Administration of Blood and Blood Components -------------------------------------------------5 Informed Consent--------------------------------------------------------------------------------------7 Guidelines of the Blood Component Transfusion ------------------------------------------------ 8 Massive Blood Transfusion ------------------------------------------------------------------------ 12 Obstetric Haemorrhage ----------------------------------------------------------------------------- 13 Neonatal Transfusion -------------------------------------------------------------------------------- 14 Leukodepleted Blood -------------------------------------------------------------------------------- 17 Irradiated Blood Components ---------------------------------------------------------------------- 18 Autologous Donation-------------------------------------------------------------------------------- 19 Flowchart for applying PABD --------------------------------------------------------------------- 20 Standard Surgical Blood Order Schedule (SSBOS) --------------------------------------------- 21 Standard Blood Ordering Schedules General and Vascular Surgery ----------------------------------------------------------------- 22 Cardiac and Thoracic Surgery ----------------------------------------------------------------- 23 Plastic Surgery ----------------------------------------------------------------------------------- 24 Neurosurgery ------------------------------------------------------------------------------------ 25 Otorhinolaryingology --------------------------------------------------------------------------- 26 Orthopedic Surgery ----------------------------------------------------------------------------- 26 Urology ------------------------------------------------------------------------------------------- 27 Obstetrics-Gynecology ------------------------------------------------------------------------- 27 Transfusion Reactions ------------------------------------------------------------------------------- 28 References -------------------------------------------------------------------------------------------- 31 3 FOREWORD The Hospital Transfusion Committee of Centro Hospitalar de Conde São Januário (CHCSJ) was formed in 2004 to promote the concept of safe transfusion. The chairman of the committee is the Director of CHCSJ. Other members of the committee come from various departments in the hospital and include members from the Macao Blood Transfusion Centre. With the sole purpose in mind the Hospital Transfusion Committee has formulated and approved these Transfusion Guidelines as a reference to clinicians in the CHCSJ. This is the first edition. We envisioned that future editions will incorporate suggestions and recommendations from the users of the guidelines. The committee would like to acknowledge the effort of Dr. David T Lopes and Dr. Hui Ping in formulating the guidelines since 1999. Hospital Transfusion Committee , CHCSJ July 2005 4 INTRODUCTION Blood transfusion is an essential part of modern health care. Used correctly, it can save life and improve health. However, as with any therapeutic intervention, it may result in acute or delayed complications. In addition, it carries the risk of transmission of infectious agents, such as HIV, hepatitis viruses, syphilis, etc. It is also expensive and uses a scarce human resource. The risks associated with transfusion can only be decreased by close collaboration between the blood transfusion service and clinicians in managing the components of the transfusion process for which they are each responsible: 1. an adequate supply of safe blood and blood products 2. the effective clinical use of blood and blood products Considering the lack of transfusion medicine in the medical school and the rapid advance of this field since the last decade, we provide this booklet for serving as a convenient reference for issues relating to the clinical use of blood. USEFUL CONTACTS Hospital Blood Bank: 3903226, 3903219 Dr. David Lopes: 6807838 Blood Transfusion Centre: 752522 Dr. HUI Ping: Office: 7914307 Emergency: 6892637 Laboratory Supervisor: Mr. Hoo Chai Office: 752522/7914386 Hospital service Supervisor: Mr. Choi Sio Cheok Office: 752522/7914361 5 ADMINISTRATION OF BLOOD AND BLOOD COMPONENTS I. Request Form Transfusion request form must be completely fulfilled and clinical details must be provided. II. Filter · All blood components must be administered through a transfusion standard filter (170- micron) to remove blood clots and other debris. · Changing of blood filter every 4 hours. III. Timing All blood components which have been kept outside the blood bank should be transfused to the patient as soon as possible. IV. Blood Warming Never warm the blood and blood products outside the blood bank. Warming blood only restricted to: · Adult patients receiving rapid and multiple transfusions (rate >2000ml/hour). · Children receiving large volumes (>15ml/kg/hour). · Exchange transfusions in infants. · Rapid infusion through central venous catheters. V. Concomitant Use of Intravenous Solutions Only normal saline (0.9 % saline) may be administered with blood components. VI. Monitors during and after transfusion In first 5 minutes of beginning transfusion and every 30 minutes during transfusion, CHECK: S Blood pressure S Pulse S Temperature Suspect the major acute transfusion reactions, when: S A sudden rise in temperature > 10 C S Shortness of breath/chest pain S Back pain/loin tenderness S Profound hypotension 6 VII. Ordering and issuing Red Cells/Whole Blood · Routine transfusions should be requested at least 24 hours in advance during the working hours. · ±60 mins must be allowed for the grouping and crossmatch testing for emergency order. · Uncross-matched blood – can only be issued in an emergency. The blood bank staff will only release uncross-matched blood after he/she has received a request from a medical doctor, who has agreed to take responsibility for any ensuing complications. Fresh
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