Blood transfusion is one of the important procedures administered in healthcare centers to meet surgical and trauma needs. This procedure is categorized under transfusion medicine section. Blood transfusion is a high-risk procedure as it involves multiple protocols and guidelines for safe and effective transfusion.
Guidelines and Procedure
Transfusion medicine has high significance as it involves the transfusion of blood and blood products depending upon the patient needs. Blood required for the transfusion is obtained from blood banks, which are established either by the government or privately following NCCLS standards for the blood banks. The standards are evaluated by organizations such as WHO to set a uniform and global protocol for safe transfusion. Blood transfusion is predominantly done to increase the percentage of hemoglobin in anemic patients and also to replace vital components such as platelets and serum proteins in some medical conditions. Other reasons for blood transfusion is to replace the amount of blood lost during surgery or trauma. Patients suffering thrombocytopenia (any disorder in which there is an abnormally low amount of platelets) might be in need of platelet transfusion.
Blood banks are authorized by the government to collect blood of different groups. Some of the rare groups include B negative, O negative and Bombay blood group. In these situations, the names and the address of these respective rare blood types are noted to ensure timely availability in case of a transfusion request. Cancer patients also require transfusion in case of conditions such as leukemia and malignant carcinomas associated with spleen or bone marrow. Leukocyte reduction procedure is followed in some transfusion centers in order to minimize the incidence of transfusion-associated allergic reactions. All donors are checked for a three-month gap before the subsequent transfusion to facilitate fresh blood collection from the donors containing viable red blood cells.
Different types of Blood transfusions:
Fresh Whole Blood: This is mostly needed during cardiac surgery or massive hemorrhage. Fresh Whole blood has RBC, plasma and fresh platelets.
Packed RBC: This is mostly needed to raise the hematocrit (the proportion of total blood volume that is composed of red blood cells).
Frozen packed RBC: Stored for nearly 3 years, frozen packed RBC is sparingly used. It is often used for rare blood groups. Patients suffering severe leukoagglutinin reactions or anaphylactic reactions might need this.
Leukocyte-Poor Blood: Patients who suffer severe leukoagglutinin reactions might need this. It is an expensive process as WBC are removed by centrifugation.
Precautions and risks
Transfusion is a very important procedure and hence primary analysis of the donor blood is done in order to avoid blood borne sepsis, transfusion allergies and organ damage. The donor blood is always cross-matched with the recipient's in order to check the compatibility of the blood. All procedures are documented to ensure safety and tracking of a transfusion procedure, as it is associated with medico-legal protocols. The A and B antigens are the first check before transfusion. In emergencies, type O/Rh-negative blood can be given to any recipient and usually packed cells are given. The Rh factor has also to be tested. Blood from the donor is also investigated for infections such as HIV 1&2, HBV, HCV, and VDRL to ensure safe transfusion.
Blood is collected from the healthy donor in a blood bank by administering venipuncture procedure from the brachial region. The obtained blood is transported for immediate need in surgeries or stored for few days in case of a scheduled surgery having the requirement for the particular blood group. The transfusion requirement is clearly stated in the surgical form and the blood bank technicians provide number of units required on the given date. Some of the common side effects associated with blood transfusions are infections of both viral and bacterial origin obtained from an infected donor. Receipt of blood contaminated with gram-negative bacteria often causes septic shock, Disseminated intravascular coagulation or DIA (a large amount of procoagulant enters the blood stream over a short period of time, overwhelming the body’s ability to replenish coagulation factors and causing bleeding) and acute kidney injury. Receipt of blood with gram-positive bacteria causes fever and Bacteremia (presence of bacteria in blood) but rarely causes sepsis.
Intravenous therapy or IV therapy involves using a vein to administer medicines or fluids to a person. IV is used for blood transfusion, electrolyte administration, medications or treating dehydration. Intravenous therapy allows instantaneous access to the blood supply. Using IV is suitable for patients who need continuous medication and when drugs are not well absorbed by the gastrointestinal tract. Using IV therapy might lead to swelling and pain around the area. Care must be taken to avoid infection of IV site.
Cesarean section or C-section is a surgical method of delivering a baby. A cut is made across the belly just above the pubic area. A horizontal incision is made in the lower uterine portion. LSCS - Lower segment Cesarean section is the preferred type of Cesarean surgery today as it allows the uterus to remain strong for future childbirth. The uterus is opened along with the amniotic sac and the baby is delivered. This is resorted to when a vaginal delivery is not possible; either because of risk to the mother or baby. Typical cases where Cesarean section is opted for are fetal distress, breech baby, uterine rupture, prolonged labor, hypertension in mother, tachycardia in mother or child or contracted pelvis. In cases of twin pregnancy or triplets, Cesarean section is opted. When the baby's heart rate is abnormally high or the baby has developmental problems, the obstetrician might suggest a c-section. But being a surgical procedure, Cesarean section carries some amount of risk. There can be chances of hemorrhage leading to anemia or need for blood transfusion. There is risk of infection at incision site or injury to other organs. The recovery time is longer than a normal vaginal delivery.
Bibliography / Reference
Collection of Pages - Last revised Date: May 24, 2018