Transfusion Reaction Algorithm 2018 Definition of Transfusion - - PowerPoint PPT Presentation

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Transfusion Reaction Algorithm 2018 Definition of Transfusion - - PowerPoint PPT Presentation

Nov 23, 2023 327 likes •747 views

Education for the Revised Transfusion Reaction Algorithm 2018 Definition of Transfusion Reaction *Any untoward event that occurs as a result of infusion of blood components or derivatives(plasma protein products) *Immediate or delayed

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Education for the Revised Transfusion Reaction Algorithm 2018

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Definition of Transfusion Reaction

*Any untoward event that occurs as a result of infusion of blood components or derivatives(plasma protein products) *Immediate or delayed *Considered definitely, probably or possibly related to the infusion *When any unexpected or untoward sign or symptom occurs during or shortly after the transfusion of a blood component, a transfusion reaction must be considered as the precipitating event until proven otherwise.

Webert, K. McMaster University. 2015

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The 5 W’s

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Who’s involved

  • The Medical Directors at Shared Health

Diagnostic Services Manitoba and Canadian Blood Services have approved the revised Transfusion Reaction Algorithm

  • PNRGTP (Provincial Nursing Resource Group for Transfusion Practice) have

participated in content review, supported by TPC’s ( Transfusion Practice Committees)

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What does the new document look like?

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Side 2

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Where does this take effect?

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When does this take effect?

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Why the revision?

  • Alignment of algorithm and procedures
  • Reinforcement that the clinical signs and

symptoms observed are NEW onset related to the transfusion

  • When assessed several common suggestions

were made

  • Easier to follow
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Distribution

  • Designated Site Leads have been sent an

education package which include;

 A letter from DSM indicating that all old algorithms be removed and discarded  Laminated transfusion reaction algorithms

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Symptoms No Change

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Number 4 and 5 have changed. Now says “Contact MD/Designate for medical assessment/ treatment”. If the physician suspects that this is a transfusion reaction then you are to proceed with the algorithm, if they assess this is not a transfusion reaction then proceed with transfusion. If you are unable to get a hold of the prescribing physician then

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Clerical Discrepancy Check

Number 2 now reads.. Confirm patient demographics and verify all documentation matches.

  • C. Tag on product matches patient
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  • The Manilla tag must not be

removed from the Blood/ Blood Product until the transfusion is complete and a transfusion reaction is not suspected.

  • This is a part of Accreditation

Canada requirements (CSA Z902-10,

11.3.4.)

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  • More definition as to how a minor

reaction is defined.

  • Temperature tighter parameters
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  • Administer any treatment the physician

may order

  • The transfusion will be resumed

cautiously and under observation for the first 15 minutes after re- establishment

  • Complete CM105
  • No change to the IVIG
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Major Reactions

  • Symptoms have been rearranged
  • Have removed the “Consult

Transfusion Medicine MD on call… “ so that this is now at the bottom of the algorithm

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  • Major Transfusion

reactions will require specific testing dependent

  • n the symptoms.
  • Have added a chart on the

back that puts the symptoms into more specific groups with the recommended investigations/ actions

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Returning the Blood to the Blood Bank

Tubing must be attached….

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The C’s

  • Blue clip must be secure

(coming from IV pump)

  • Roll clamp must be tight
  • A cap must be placed on the

end of the IV line

  • complete the CM105

(transfusion reaction investigation form)

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Please Do Not Use These

These should not be used to clamp the bags! Rationale: If they open en-route back to the blood bank the blood can no longer be cultured

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Ac Action ion Packed!

  • Each site is encouraged to update their

transfusion reaction kit

  • This could contain:

– Algorithm on the front – Sterile Red Cap – Transfusion Reaction Investigation Form – Remove the Clip – This package should be kept somewhere easily accessible

  • 500 ml bag of Normal saline with a new IV set
  • Quick Reference Sheet
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What could Kits look like?

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What happens if I need blood and the patient has had a reaction?

If URGENT blood is needed then call the Transfusion Medicine Physician on call

If the patient will require further blood products, send another crossmatch sample and requisition ** Shared Health provides 24/7 Transfusion Medicine on call support, call your paging department, blood bank… or HSC Paging to contact

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The Back

The above actions will be required for all Major transfusion reactions.

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Suspected Bacterial Contamination

  • Cultures are to be drawn from patient using the above criteria
  • Patient should be closely monitored for signs and symptoms of shock when bacterial

contamination is suspected

  • Physician who is ordering cultures on patient must also write order for blood bag

contents to be cultured prior to sending the product back to the blood bank

  • Once blood is returned to the blood bank it is then sent to microbiology for culturing
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Possible anaphylactic reaction

  • Transfusion-associated anaphylactic shock is rare
  • Anaphylaxis accounts for approximately 5% of transfusion associated

deaths (Blood Easy 4, 2016)

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  • These signs and symptoms are common when TACO ( Transfusion associated

circulatory overload) is suspected.

  • Results from impaired cardiac function, and or excessively rapid rate of

transfusion

  • Incidence is 1:700 to 8% of transfusion recipients
  • TACO is the most common cause of death from transfusion!
  • Patients who are most susceptible:
  • Over 70 years of age, infants, patients with severe euvolemic anemia

(hemoglobin<50g/L), renal impairment, fluid overload, and cardiac dysfunction (Bloody Easy 4, 2016)

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  • Could be TRALI (transfusion related lung

injury)

  • Bacterial Contamination
  • Acute hemolytic transfusion

reaction- can be associated with ABO- incompatibility

  • Anaphylaxis
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Transfusion Transmitted Injury Surveillance System (TTISS) Transfusion Transmission Information Surveillance System

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Quick Reference Guide *Optional Resource

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*Optional Resource

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Contacts

Blood Management Service office 1-204-926-8006 Darcy Heron Shared Health 1-204-237-2707 Email to bmsclinical@wrha.mb.ca

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Acknowledgements

  • Dr. Charles Musuka
  • Dr. Debra Lane
  • Dr. Arjuna Ponnampalam
  • Darcy Heron
  • Lee Grabner
  • Shana Chiborak
  • Provincial Nurses Resource Working Group

Transfusion Reaction Algorithm

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Questions?

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References

  • Dr. Kerry Gunn – Aukland District Health Board Blood transfusion Committee Chair- April 2013
  • Kirkey, S. (2013). Health experts confront the hidden hazards of blood transfusions. Retrieved from

http://o.canada.com/news/blood-hazards

  • Daw, Z., Padmore, R., Neurath, D., Cober, N., Tokessy, M., Desjardins, D., Olberg, B., Tinmouth, A., & Giulivi A. (2008).

Hemolytic transfusion reactions after administration of intravenous immune (gamma) globulin: a case series analysis. Transfusion, 48(8), 1598-1601. doi: 10.1111/j.1537-2995.2008.01721.x

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For the complete PDF education package please go to www.bestbloodmanitoba.ca

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Thank you!