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immunization) or for those who have rare WBC antibodies and repeated febrile transfusion reactions.
- Determine the amount of blood to administer:
a. Blood is usually replaced at a 1:1 ratio.
b. Stabilization of adequate vital signs is primary indicator of sufficient blood volume. - Order type specific or type O blood or blood component based on the type and crossmatch.
- Verify and inspect the blood pack received from the laboratory for abnormalities such as gas bubbles
or black or gray colored sediment (indicative of bacterial growth):
a. Note the time the blood pack was received and record the time.
b. Check the label for blood components, type, and expiration date.
NOTES: Two people, if possible, should independently verify the information match of type and cross
match patient to label. Infusion of a blood pack should be started within 30 minutes of being issued. - Establish baseline data:
a. Reconfirm data from the patient’s history regarding allergies or previous reactions to blood or blood
products.
b. Measure and evaluate the vital signs.
c. Record the vital signs on the chart. - Reduce the chances of reactions by applying prophylactic measures:
a. Meticulous identification and clear labeling at the bedside of casualty’s blood samples intended for
compatibility testing.
b. Ensure that blood has been screened for hepatitis, AIDS, malaria, and syphilis.
c. Carefully identify casualty and donor blood at the time of transfusion.
(1) Identify casualty by ID tags, ID bracelet, or other means.
(2) Identify the donor blood and has a second person check the blood and the casualty if possible.
d. Handle blood products with care to prevent hemolysis or destruction of RBCs by over-warming stored
blood.
(1) Warming devices applied to the blood container itself (e.g., microwave warmers) are contraindi
cated because:
(a) A high incidence of hemolysis occurs.
(b) Any interruption in transfusion may encourage bacterial growth in unused warmed blood.
(c) The blood bank will not know if unused blood has been warmed and re-chilled.
(2) Use an IV set that includes a heat exchange device, if available, to warm blood gently (but not >
37° C) during delivery.
e. Prevent contact with inappropriate IV solutions such as injections of distilled water or non-isotonic
solutions.
f. In a patient with a history of allergies or an allergic transfusion reaction, give an antihistamine
prophylactically just before or at the beginning of the transfusion (e.g., diphenhydramine 50 mg orally
or IM). It must never be mixed with the blood.
g. In cases where volume overload is possible, whole blood is contraindicated. A rise in venous pressure
can be avoided by infusing RBCs at a slow-to-moderate rate. The patient should be observed for signs
of increased venous pressure or pulmonary congestion. If possible, direct observation of venous
pressure during the infusion is a useful precaution.
h. Administer the first 10 to 30 ml over 15 min, while observing the patient for reactions.
i. Use transfusion sets that include a filter to trap the clots and fibrin shreds present in stored blood units.
j. For patients likely to receive large amounts of blood that has been stored > 5 to 6 days use
microaggregate filters to remove particles as small as 20-40μm.
k. Guard against air in tubing with any pressure infusion and when changing IV sets to prevent air
embolism.
CAUTION: Consult manufacturer's instructions. Microaggregates can be detected in the lungs after
massive transfusions and have been implicated as a cause of the syndrome of posttraumatic pulmonary
insufficiency, though direct evidence is lacking. - Prepare the blood and the blood recipient set:
NOTE: Use only tubing that is designed for the administration of blood products. It is equipped with a
filter designed for the fine filtration required for blood products. If “Y” type recipient tubing is not available,
use regular infusion tubing for the normal saline (0.9% Normal Saline only) and the available blood