Policy for Blood Transfusion PROV 06 October 2007
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Document Management Title of document
Policy for Blood Transfusion
Type of document
PROV 06
Description
Guidance for clinicians and staff who undertake blood transfusions
Target audience
Clinicians
Author
Siân Roberts
Department
Professional Practice and Development
Directorate
Provider Services
Approved by
Governance Committee
Date of approval
10 October 2007
Version Number
1.0
Next review date
October 2008
Related documents
Policy for Consent toExamination or Treatment Policy for the Identification of Patients Care and Control of Medicines Policy
Superseded documents
Policy for Blood Transfusion - Daventry and South Northants PCT
Internal distribution
All staff
External distribution
None
Availability
All ratified policies, strategies, procedures and protocols are published on the Trust Intranet and Public Website.
Contact details (of main contact for this document)
Name:
Siân Roberts
Address: York House, Isebrook Hospital, Wellingborough Tel:
07880857915
E-mail:
[email protected]
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Policy for Blood Transfusion Contents 1 2 3 4 5 6
7 8
9 10 11
Introduction Objectives Scope Of Policy Equality And Diversity Supporting Data Responsibilities
5 5 5 5 6 6
6.1 6.2
6 6
Modern Matrons Nurses/Practitioners/Doctors
Decision To Transfuse Preparing The Patient/Consent To Transfuse
6 7
8.2 8.3
7 7
Reasons for transfusion Patients who refuse to consent to blood transfusion
Prescribing Blood Use Of O Rh D Negative Blood In An Emergency Taking Blood For Cross Matching
8 8 8
11.1 11.2
8 9
Procedure Collecting the blood sample
12
Transporting Blood
9
13
Practical Aspects Of Transfusion Process
9
13.1 13.2 13.3 13.4
10 10 10 10
14
Cannulation for blood transfusion Blood warming Infusion pumps Drugs must not be added to blood
Receiving Blood On Ward Or Dept.
10
14.1 14.2
10 10
Delivery to ward/dept Care of blood prior to transfusion
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15
Patient Identity And Blood Unit Check
10
15.1 15.2 15.3
10 10 11
Patient wristband Checking unit of blood to be transfused Checking patients identity against blood unit details
16
The Transfusion Process 16.1 General considerations 16.2 Preparing the giving set for transfusion 16.3 Care and monitoring of transfused patients 16.4 Observations
13 13 13 13 14
17
Management And Reporting Of Adverse Effects
15
17.1 17.2
Severe reaction Mild reaction
15 15
Reporting Adverse Events Post Transfusion Procedures
15 16
19.1 19.2
16 16
18 19
20 21 22 23
Documentation Disposal of Used Blood Pack
Returning Unused Blood Training Review And Monitoring References Appendix 1 Audit Tool Appendix 2 Patient Information Leaflet (National Blood Service) Appendix 3 Policy Impact Assessment Tool
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16 16 17 17 18 19 22
1
INTRODUCTION The administration of blood is associated with medical and legal risks. It is everyone’s duty to take care and exercise professional skills so the recipients are not harmed as a result of the administration of blood and blood products. The Health Circular HCS 2002/009 Better Blood Transfusion sets out a programme of action for the NHS to: • • • •
Ensure that better blood transfusion is an integral part of the NHS. Make blood transfusions safer. Avoid unnecessary use of blood in clinical practice. Provide better information to patient and the public about blood.
The purpose of this policy is to establish safe and consistent practice in the administration of blood in the Northamptonshire Teaching Primary Care Trust (NtPCT), reduce risk, minimise errors and maintain patient safety. This policy ensures that the NtPCT is adhering to the Blood Safety and Quality Regulations (No 50) 2005. 2
OBJECTIVES The objective of this policy is to inform all healthcare staff involved in the administration of blood transfusions of the principles of safe and secure handling and administration of blood.
3
SCOPE OF POLICY This policy is applicable to all health care practitioners who are involved at every stage of collection, preparation and administration of a blood or blood components transfusion. Within NPCT blood transfusions are carried out within the Inpatient Unit and Day Unit at Danetre Hospital, Cynthia Spencer Hospice and Cransley Hospice.
4
EQUALITY AND DIVERSITY NtPCT recognised the diversity of the local community and those in its employment; and aims to provide a safe environment free from discrimination and a place where all individuals are treated fairly, with dignity and appropriately to their need. NtPCT recognises that equality impacts on all aspect of its day to day operations and has produced an Impact Assessment Framework for all its policies. This policy has been assessed against this framework and the results present in Appendix 3
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5
SUPPORTING DATA A blood transfusion is a potentially hazardous procedure, which should only be carried out when the clinical benefits outweigh the potential risks. The overwhelming majority of transfusion deaths are associated with clerical errors when either, • •
the sample is taken from a patient, or when a blood product is being administered
The Health Service Circular (HSC) “Better Blood Transfusion” states that clinical governance within Trusts should: • • 6
comply with British Committee Standards for Haematology (BCSH) Guidelines react to recommendations from Serious Hazards of Transfusion (SHOT)
RESPONSIBILITIES 6.1
Modern Matron
The Modern Matron at each Community Hospital is responsible for ensuring the policy is followed. 6.2
Nurses/Practitioners/ Doctors
Nurses /Practitioners/ Doctors are accountable and responsible for: • • •
• •
7
Ensuring that they follow the policy related to blood transfusions. Report any incident relating to blood products on the NtPCT incident reporting system according to the Trust’s Incident and Near Miss Policy. Reporting any incident relating to blood products to Serious Hazards of Transfusion (SHOT) and Serious Adverse Blood Reactions and Events (SABRE) (part of the Medicines and Healthcare Products Regulatory Agency). Any concerns regarding incidents related to blood transfusions should be discussed with the provider laboratory usually Northampton General Hospital or Kettering General Hospital. Ensuring that they are up to date with their own training requirements around blood and blood product transfusions.
DECISION TO TRANSFUSE The decision to give a patient a blood transfusion is the responsibility of the doctor. It is up to the doctor to assess the patient’s clinical condition as well as the laboratory results from routine testing. The trigger has shifted in recent years from arbitrary haemoglobin and haematocrit levels to the level of haemoglobin necessary for the patient to meet their tissue oxygen requirements. PROV 06 Blood Transfusion Policy.doc
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The risks associated with allergenic blood products must be considered and alternatives such as autologous blood products, crystalloid and colloid products and the possibility of pharmaceutical treatment considered. The main points to remember about transfusion therapy are: • • • • 8
The patients clinical condition should dictate what blood component to transfuse and in what quantity. The use of pharmaceutical treatments. Risk versus benefits. Patient wishes and consent.
PREPARING THE PATIENT/CONSENT TO TRANSFUSE 8.1
Reasons for transfusion
The reasons for a transfusion, the risks involved and/or alternative treatments or options must be explained to the patients or their advocate. A leaflet is available from the National Blood Service (www.blood.co.uk/hospitals/library/) that explains the reasons and possible complications of a blood transfusion (see Appendix 2). This should be made available for patients so that the patient and their advocate can make an informed choice. Good practice suggests that written consent is obtained from the patient, and the NtPCT consent policy does state that written consent is required for a blood transfusion. The clinician seeking consent must record that they have explained the risks to the patient and that the patient and carer has understood. (For further guidance see Northamptonshire Teaching PCT’s Policy for Consent to Examination or Treatment). 8.2
Patients who refuse to consent to blood transfusion
Patients have the right to refuse treatment. Whatever the views of the clinicians involved, if a patient being of sound mind, refuses to consent to blood transfusion, their beliefs should be respected and upheld. (For further guidance see Northamptonshire Teaching PCT’s Policy for Consent to Examination or Treatment). When a patient or legal guardian declines blood product transfusion, the matter should be referred to a senior healthcare professional who should hold a full and frank discussion with the patient to ascertain their views. Once the healthcare professional is satisfied that the patient understands the outcome of such a refusal, then the discussion must be documented in the Health record. As a Primary Care Trust it is very unlikely that a child would receive a blood transfusion under our care as they would require Acute Hospital admission. In the event of any problems, advice should be sought from either the Governance Team or Consultant in charge.
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9
PRESCRIBING BLOOD As with the administration of medicines, the transfusion of blood or blood products must be prescribed by a doctor. The transfusion should be prescribed on an intravenous fluid regime and the prescription and rationale documented in the patients records, signed and dated and timed by the prescriber. The flow rate must be clearly documented, based on the individual patient’s cardiac stability, and supplementary medication should be recorded next to the unit for which it is to be given as well as on the patients prescription chart in line with the NtPCT’s Care and Control of Medicines Policy.
10
USE OF O RH D NEGATIVE BLOOD IN AN EMERGENCY O Rh D negative blood should be used in a life threatening emergency when there is insufficient time for the blood bank to issue “same group” blood. A supply of O Rh D negative blood is available in the blood fridge and the emergency blood transfusion protocol must be followed.
11
TAKING BLOOD FOR CROSS MATCHING Blood and blood components must be requested by clinical staff from the blood transfusion laboratory on an individual named patient basis. 11.1
Procedure
11.1.1
Identify the patient (only staff qualified in venepuncture may take blood)
11.1.2
Before blood is taken, the patient’s identification wristband must be in place and must contain the following minimum essential information for patient identification (as outlined in NtPCT’s Identification of Patients Policy): • Patient’s last name and full first name • Date of birth • NHS number
11.1.3
Check
11.1.4
The patient must be correctly identified as follows; •
•
patient’s
identity
against
the
request
from
the
details.
Positively identify the patient through questioning; ask for the last name, first name and date of birth, in patients who are capable of giving a reliable response. In cases where the individual is unable to respond, the patient’s identity must be checked by examining the identification wristband against the medical notes. Check the following details on the patients identification wristband match those on the blood transfusion request form:
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o Last name and full first name o Date of Birth o NHS number These details must be found to be identical on the wristband and the request form. If the details do not match, the blood sample must not be taken, the ward manager must be contacted and an incident report completed as outlined in the NtPCT’s Incident Reporting Policy.
12
11.1.5
The details on the request card must contain the patient’s full name, date of birth, address, gender, blood group if known, previous transfusions (if known), pregnancies, reported red cell antibodies, reason for the request, what blood products are required, how much, when and where it is needed.
11.2
Collecting the blood sample
11.2.1
Only one patient should have blood taken at any one time.
11.2.2
Ensure the patient has given their consent for the blood to be taken.
11.2.3
Ensure that correct tube is used.
11.2.4
Sample tubes must not be pre labelled.
11.2.4
The sample tube will be labelled immediately (after the blood has been obtained) by hand, by the person who takes the sample in the presence of the patient.
11.2.5
All entries must be clearly printed.
11.2.6
The sample tube will be labelled with all the essential patient identification ie: • Last name and first name • Date of birth • NHS number • Date the sample was taken and the location of the patient
11.2.7
Addressograph labels will not be used for sample labeling.
TRANSPORTING BLOOD The NtPCT has a Service Level Agreement (SLA) with the acute Trusts for supplying blood. The appropriate hospital standard operating procedure for the ordering and transporting of blood should be followed.
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13
PRACTICAL ASPECTS OF THE TRANSFUSION PROCESS 13.1
Cannulation for blood transfusion
13.1.1
The procedure must be explained to the patient and consent obtained.
13.1.2
Only appropriately trained staff should insert intravenous cannulae.
13.1.3
The cannula chosen will depend on the size of the vein and the speed the blood is to be transfused.
13.1.4
The cannula will be inserted in line with the local areas protocol for insertion of cannulae.
13.2
Blood Warming
13.2.1
Blood warmers must not be used, and the blood must not be put into hot water or on a radiator as this damages the cells.
13.3
Infusion Pumps
13.3.1
Electronic infusion pumps may damage blood cells and should not be used for the administration of red cells unless the manufacturer has verified them to be safe for this purpose. Appropriate pumps ensure timely transfusion and can be used. The Baxter Colleague pump used in the PCT is approved for blood transfusion.
13.3.2
13.4 14
Drugs must not be added to blood under any circumstances.
RECEIVING BLOOD ON THE WARD OR DEPARTMENT 14.1
Delivery to ward/department
14.1.1
When blood is delivered to a ward or department, a member of staff who is trained to use the blood tracking system will check that the correct blood has been delivered.
14.2
Care of blood prior to transfusion
14.1.1
Blood must not be transferred out of the box into a ward fridge, unless it is a dedicated blood fridge.
14.1.2
If a blood fridge is available the blood must be recorded in line with the blood fridge protocol.
14.1.3
If the blood is being kept in a box with cold packs it has a life of 4 hours and therefore can be transfused at any point during the 4 hours from the time the blood left the blood bank.
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15
14.1.4
If more than 4 hours elapses the blood must be returned to the laboratory as wastage and an incident form completed that gives the reasons for the wastage.
14.1.5
If blood is being stored in a blood fridge it should not be removed until the patient has consented to having the blood transfusion.
14.1.6
There is a risk of bacterial proliferation when blood components are kept at ambient temperatures. For this reason a blood component transfusion must be started within 30 minutes of removing the pack from refrigeration.
14.1.7
Base line observations must be taken prior to commencing the infusion.
PATIENT IDENTITY AND BLOOD UNIT CHECK 15.1
Patient wristband
15.1.1
Patients undergoing blood transfusion, in any setting, will have an identification wristband in place. If the wristband needs to be removed, it is the responsibility of the person removing it to ensure that it is replaced.
15.1.1
15.2
Checking unit of blood to be transfused
15.2.1
The unit of blood must be inspected, with special attention to: • The integrity of the pack, check for leaks at the port or seams • Evidence of haemolysis in the plasma and at the interface between red cells and plasma • Evidence of unusual discolouration or turbidity • The presence of large clots
15.2.2
If there is evidence of the above the unit must not be transfused, the laboratory must be informed immediately and the blood returned to them.
15.2.3
If the blood unit pack is accidentally punctured during the setting up procedure or not transfused for any other reason, the laboratory must be informed as soon as practicable.
15.3
Checking the patients identity against the blood unit details
15.3.1
The patient identity and blood unit check must be carried out by a suitably qualified person (registered medical practitioner, registered nurse or registered midwife) with a second appropriately trained person acting as a checker (ideally a registered practitioner but may be a health care assistant with NVQ III or a student nurse who has been in training for at least 30 months).
15.3.2
The check must also be done in the presence of the patient who is to receive the transfusion.
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15.3.3
The procedure for the patient check is as follows: •
15.3.4
Positively identify the patient through questioning. The last name, first name and date of birth should be verified in all patients who are judged capable of giving a reliable response. In cases where the individual is unable to respond, the patient’s identity must be checked by examining the identification wristband against the medical notes. • Check that the following details on the patient’s identification wrist band (as outlined in NtPCT’s Identification of Patients Policy) match those on the request form: • Last name and first name • Date of birth • NHS number • If the details do not match, the blood transfusion must not be commenced, the ward manager must be informed and an incident report completed as outlined in the NtPCT’s Incident Reporting Policy. The patient identification details listed above must be found to be identical on: • The patient’s identification wristband • Blood bank slip • The label on the blood bag • The intravenous fluid prescription If the details do not match, the blood transfusion must not be commenced, the ward manager must be informed and an incident report completed as outlined in the NtPCT’s Incident Reporting Policy.
15.3.5
The blood bag and the blood supply slip should then be checked to match the patient identification number, ABO compatibility, Rhesus D group, unique donation number and the expiry date of the blood provided. If there is any discrepancy then the infusion must not be commenced and the laboratory contacted immediately. The blood should be kept to return to the laboratory. A clinical incident form must be completed.
15.3.6
All documentation including the blood supply slip and the blood prescription chart must be signed and dated by both staff involved in the checking procedure along with the start and finish time of any unit and unit number.
15.3.7
If the patient refuses to go ahead with the transfusion then the laboratory must be informed immediately to prevent any further units of blood being sent and to arrange the return of the unit to them.
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16
THE TRANSFUSION PROCESS 16.1
General considerations
16.1.1
The blood supply slip should be readily available close to the patient throughout the transfusion, for example by being clipped to the observations chart.
16.1.2
Transfusion of red cells should be commenced within 30 minutes of removal from the blood bank refrigerator and for, each unit, transfusion should be completed within 4 hours, unless there are exceptional circumstances where there is a valid reason for a longer transfusion eg age of patient or history of heart failure.
16.1.3
Only one unit of blood will be removed from the blood bank refrigerator at a time, unless extremely rapid transfusions of large quantities of blood is anticipated
16.1.4
Blood and blood components are viewed as medicines for administration purposes (British Committee for Standards in Haematology 1999)
16.1.5
Drugs must not be added to blood under any circumstances.
16.1.6
Drugs that are required for the treatment of anaphylactic shock must be available
16.2
Preparing the giving set for transfusion
16.2.1
Blood will be transfused through a sterile giving set which has a built in screen filter.
16.2.2
The giving set must be compatible with the pump that is being used.
16.2.3
The line should be primed with the blood or blood product itself or the fluid prescribed by the doctor.
16.2.4
Gloves must be worn when priming the giving set line, and when connecting the giving set to the patient.
16.2.5
Each blood transfusion giving set must be used for a maximum of 12 hours and should be changed if the blood transfusion continues for longer than 12 hours.
16.2.6
A new giving set should be used post transfusion if another substance is to be infused.
16.3
Care and monitoring of transfused patients
16.3.1
The patient should be in an area that can easily be monitored by staff.
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16.3.2
Gloves must be worn when attaching the primed giving set to the patient.
16.3.3
Severe reaction to the transfusion is most likely to occur within the first 20 minutes of the start of each unit and the nurse must stay with the patient during this time.
16.3.4
The patient (or the patient’s parent or guardian) will be informed of possible adverse effects of the transfusion and the importance of reporting to clinical staff immediately any shivering, rash, flushing, shortness of breath or pain in the extremities or loins.
16.3.5
Staff should be observing the patient for the following symptoms; • • • • • • • • • •
Shortness of breath A feeling of doom (may be associated with cytokine activity) Agitation Flushing Pain at venepuncture site Pain in abdomen flank or chest Fever Hypotension General oozing from wounds and puncture site Urticaria
16.3.6
Observations relating to the transfusion will be recorded separately from other observations, clearly dated and timed.
16.3.7
The start and finish times of each unit transfused will be clearly recorded on the observations chart.
16.4
Observations
16.4.1
Temperature, pulse, respirations and blood pressure will be recorded before the start of each unit of blood or blood component and at the end of the transfusion episode (i.e. when all the planned units have been transfused).
16.4.2
Temperature, pulse, respirations and blood pressure will be measured and recorded 15 minutes after start of each unit being transfused. The cannula site must be checked frequently
16.4.3
Additional observations will be made depending on the patient’s clinical condition, and can be taken hourly unless there are indications of a reaction.
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17
MANAGEMENT AND REPORTING OF ADVERSE EFFECTS 17.1
Severe Reaction
17.1.1
A severe reaction is evidence by one or more of the following symptoms and signs: • • • • • • •
17.1.2
If a severe reaction is suspected: • • • • • • • • •
Stop the transfusion immediately Seek urgent medical assistance Take down the blood giving set and replace with saline to be run slowly to maintain venous access Keep the blood unit and blood giving set Take temperature, pulse, respirations and blood pressure immediately and continue at frequent intervals Record the volume and colour of all urine being passed Inform the blood laboratory as soon as possible Contact paramedics for transfer to Northampton/Kettering General Hospital if required. Use the Patient Group Direction for Adrenaline if necessary.
17.2
Mild Reaction
17.2.1
If the adverse reaction symptoms are mild, for example, a rise in temperature of less than 1.5 0C and/or a urticaral rash then: • • • •
18
Pain in abdomen, flank or chest or venepuncture site Flushing Fever Hypotension Haemoglobinuria Non productive cough Breathlessness
Recheck the unit of blood being given, Give anti-pyretic (not aspirin) for fever, Give antihistamine for urticaria, Slow the transfusion rate
REPORTING ADVERSE EVENTS • • • •
If a transfusion reaction is suspected, whether mild or severe, a member of the medical staff must be contacted immediately. All transfusion reactions must be recorded in the patient’s notes. The blood laboratory must be informed of all transfusion reactions. In all cases of adverse reactions to blood transfusions an incident form must be completed as outlined in the Trust’s Incident and Near Miss Policy.
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• • 19
20
SHOT and SABRE must be informed of any adverse reaction to a blood transfusion. All cases of adverse reaction will be subjected to individual case review.
POST TRANSFUSION PROCEDURES 19.1
Documentation
19.1.1
When the transfusion is complete the blood bank slip must be fixed into the patient’s medical records.
19.1.2
The sheet used for prescribing the blood or blood product must be filed in the patient’s medical records.
19.1.3
The sheet containing the nursing observations during the transfusion must be filed in the patient’s medical records.
19.1.4
A description, if relevant of any adverse reactions and the action taken should be filed in the patients medical records.
19.2
Disposal of the Used Blood Pack
19.2.1
Empty blood bags must be disposed of in the yellow clinical waste sacks.
19.2.2
Used giving sets should be disposed of in the sharps bin.
RETURNING UNUSED BLOOD Any blood that is not used in a transfusion should be returned using the standard operating procedure issued by the relevant acute Trust.
21
TRAINING All staff involved in the administration of blood will: • • • •
Be required to be competent to perform all aspects of the procedure they will be undertaking and will be accountable for their actions in accordance with the NMC code of conduct Receive annual basic life support and management and treatment of anaphylaxis Receive cannulation and venepuncture training and update to maintain competence Be required to have blood tracking training if they have access to the blood fridge.
Only staff who have undergone blood tracking training and are assessed as competent will be given bar codes that allow access to the blood fridge. A record of all staff training will be kept.
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A training needs analysis will be carried out to identify further staff training requirements. 22
REVIEW AND MONITORING This policy will be reviewed annually or sooner in light of changes to national guidance or clinical practice. An audit will be carried out every 6 months to ensure compliance with this policy. An audit tool listing the criteria that will be audited is given in appendix one.
23
REFERENCES • • • • • • • • • • • • •
The Blood Safety and Quality Regulation (No 50) 2005. Contreras M (ed)(1998) ABC of transfusion 3rd edition. BMJ Books UK Luton and Dunstable Hospital Trust 1999) Guidance document for the safe administration of blood and blood components and management of the transfused patient. DRAFT1 Luton UK McCleland D (ed) (2001) Handbook of transfusion medicine Blood Transfusion Service od the uk. UK Mercuriali F, Inghilleri G (1999) Transfusion risks and limitations. Minerva Anestesiol May;65 (5)286-92 Murphy MF, Dochety, Greenfield P (1997) Survey of the information given to patients about blood transfusion and the need for consent before transfusion. St Bartholemews Transfusion medicine 1997 Dec;7(4)287-8 Greaves C, Brogan R (2000) Blood Transfusion at Home.UK British Committee for Standards in Haematology (1999) The administration of blood and blood components and the management of transfused patients. Transfusion Medicine, 1999, 227-238 Department of Health (2002) Health Service Circular 2002/009 Better Blood Transfusion The Serious Hazards of Transfusion Steering Group (2002) SHOT Annual Report 2000/2001. South Worcestershire PCT, Policy and guidelines for blood transfusion, August 2005. Northampton General Hospital, Blood Transfusion Policy, June 2007. Daventry and South Northants PCT, Policy for blood transfusion, December 2003.
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Appendix One Audit Tool An audit consisting of the following criteria will be carried out in all areas within the NtPCT that carry out blood transfusion.
Standard
Percentage compliance 1. All patient’s (or their carers) receiving blood 100% transfusion, will be aware of the indications for transfusion, its risks and benefits and their right to refuse 2. The patients notes include the sheet used 100% for prescribing the blood, the observation sheets completed during the transfusion 3. The blood prescriptions sheet will contain minimum essential patient identification details 4. Observations of temperature, pulse and respirations relating to blood transfusion will be recorded separately from other patient observations 5. Observations of temperature, pulse, respirations and blood pressure are recorded before each unit commences and 15 minutes after the start of each unit and at the end of the transfusion 6. Blood supply slip is available in the patient’s medical records. 7. All staff have attended basic life support and anaphylaxis training in the last year 8. The blood fridge has been checked and calibrated annually
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Clinical Exceptions None
None
100%
None
100%
None
100%
None
100%
None
100%
None
100%
None
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Appendix Two Patient Information Leaflet (National Blood Service)
Will I need a blood transfusion? IMPORTANT INFORMATION FOR ALL PATIENTS WHO MAY NEED A BLOOD TRANSFUSION Like all medical treatments, a blood transfusion should only be given if it is essential. Your doctor will balance the risk of you having a blood transfusion against the risk of not having one. Ask your doctor, nurse or midwife to explain why you might need a blood transfusion.
Why might I need a blood transfusion? Most people can cope with losing a moderate amount of blood without needing a blood transfusion and this loss can easily be replaced with other fluids. Your body will make new red blood cells (essential for carrying oxygen throughout the body) over the following few weeks. However, if larger amounts of blood are lost, a blood transfusion may be the only way of replacing blood rapidly. A blood transfusion may be needed to treat severe bleeding, for example during or after an operation, childbirth or in a major accident. A blood transfusion can also be used to treat severe anaemia (a lack of red blood cells).
Is a blood transfusion my only option? Blood transfusion is only needed for a small number of patients having an operation. Sometimes it is possible to recycle your own blood during or after an operation. Ask if this is appropriate for you. Certain medical conditions causing anaemia may be managed by treating the cause rather than by giving a blood transfusion. If you are told that you might need a blood transfusion, you should ask why it is necessary and whether there are any alternative treatments. You do have the right to refuse a blood transfusion, but you need to fully understand the consequences of this before doing so. Some medical treatments or operations cannot be safely carried out without a blood transfusion being given.
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What can I do to reduce the need for a blood transfusion before an operation? If you do not eat enough foods containing iron, you may have low iron levels. A varied and balanced diet should normally provide an adequate iron intake. Your blood count should be checked 6-8 weeks before your operation to see if you are anaemic. A shortage of iron can cause anaemia and correcting this in good time, before your operation, may reduce the need for a blood transfusion. Some medicines, such as warfarin, aspirin and some anti-inflammatory drugs may increase the risk of bleeding during your operation. Always check with your doctor to find out if you should stop taking these before your operation, and when you should restart them.
Are blood transfusions safe? The biggest risk from receiving a blood transfusion is being given the wrong blood. You must be correctly identified to make sure that you get the right blood transfusion. Wearing an identification band with your correct details is essential. You will be asked to state your full name and date of birth, and the details on your identification band will be checked before each bag of blood is given. If you have previously been given a card which states that you need to have blood of a specific type, please show it as soon as possible to your doctor, nurse or midwife and ask them to tell the hospital transfusion laboratory. Compared to other everyday risks the likelihood of getting an infection from a blood transfusion is very low. All blood donors are unpaid volunteers. They are very carefully selected and tested to make sure that the blood they donate is as safe as possible. The risk of getting hepatitis from a blood transfusion is currently about 1 in 500,000 for hepatitis B and 1 in 30 million for hepatitis C. The chance of getting HIV or HTLV infection is about 1 in 5 million. Although the risk of getting variant Creutzfeldt-Jakob Disease (vCJD) from a blood transfusion is probably low with a single blood transfusion, the risk of any infection will increase with additional blood transfusions. Each year, approximately 2 million units of blood are transfused in England and there have been just a handful of cases where patients are known to have become infected with vCJD from a blood transfusion.
How will my blood transfusion be given? A blood transfusion is usually given through a tiny tube directly into a vein in the arm. Each bag of blood can take up to four hours, but can be safely given more quickly if needed. You may be given more than one bag of blood during your transfusion.
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How will I feel during my blood transfusion? Most people do not feel anything whilst receiving a blood transfusion.You will be observed at regular intervals; if you begin to feel unwell during or shortly after your blood transfusion, you should inform a member of staff immediately. Some people may develop a temperature, chills or a rash. These reactions are usually mild and are easily treated with paracetamol, or by slowing down the blood transfusion. Fortunately, severe reactions to blood are extremely rare. If they do occur, staff are trained to recognise and treat these.
What if I have worries about receiving a blood transfusion? If you have any concerns you should discuss these with your doctor, nurse or midwife. Most hospitals have specialist staff working in blood transfusion and, if appropriate, they may be able to come and talk to you.
Other Information If you are interested in finding out more about blood transfusion and have access to the Internet, you may find the following websites useful: • National Blood Service: www.blood.co.uk • National Patient Safety Agency: www.npsa.nhs.uk/pleaseask • The National Blood Service (NBS) is part of NHS Blood and Transplant, a Special Health Authority within the NHS, and provides the blood that patients receive. In order to plan for future blood demands, information about which patients receive blood needs to be gathered we may ask a Trust or GP to provide limited medical information on a sample of patients who have received blood transfusions. Any information that is passed on to the NBS is held securely, with the rights of these individuals protected under the Data Protection Act. Additional copies of this leaflet can be obtained from the NBS Hospital Liaison Office. Call 01865 440042. INF/PCS/HL/001/05 03/07 LC378P
PROV 06 Blood Transfusion Policy.doc
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Appendix Three Policy Impact Assessment – Screening Tool
Name of Directorate:_Provider Services
Date of Assessment: 20/09/07
Policy being assessed: Policy for Blood Transfusion
Assessment Carried out by: Siân Roberts
Policy Title
Policy for Blood Transfusion
Who is affected
PCT staff and patients undergoing blood transfusion
PROV 06 Blood Transfusion Policy.doc
Statutory requirements
Blood Safety and Quality Regulations 2005
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Full Assessment Needed Yes / No No
Priority High / Medium / Low Medium
