Blood: Guidelines for Appropriate Use

Clinical Description

Refer to the Ministry of Health Guidelines for Safe Blood Transfusion for further details on:

• Donor recruitment and selection
• Blood collection
• Storage procedures and records
• Laboratory testing of donorand recipient's blood
• Refer to Guidelines for the Clinical Use of Blood and Blood Products in Malawi for Clinical aspects of blood transfusions and administration Transfusion reactions
• Blood transfusion, although having undoubted benefits, also carries serious risks including:
• Possible transmission of infections e.g., HIV and viral hepatitis)
• Intravascular haemolysis
• Fluid overload

Blood is an expensive and scarce resource, therefore only prescribe bloodif the benefits outweigh the risks. It is expensive and uses a scarce human resource, therefore only prescribe bloodif:

• less hazardous therapy has been or will be ineffective,
• the benefits outweigh the risks involved
• the decision to transfuse blood has been based on careful assessment of the patient which must indicate that it is necessary to save life or prevent major morbidity.
• Except in the most exceptional life-threatening situations, always transfuse blood which has been obtained from appropriately screened blood donors and/or appropriately screened for infectious agents.
• Ensure that compatibility testing is carried out on all blood to be transfused. In absolute emergencies, where there is no time for emergency cross-matching, emergency blood (O- negative blood) can be issued but a cross-match should still be done while the transfusion is in progress.
• Observations of the patient's vital signs should be done at the time of starting the transfusion, at 15 minutes, 1 hour, 4 hours and at 24 hours.
• It is encouraged to use blood components when available than whole blood in hospitals where blood components are made available by the national blood transfusion service. Transfuse whole blood if blood components not available.

Precautions:

• Identical ABO group or ABO compatible blood should be used. Rh negative patients should get Rh negative blood especially women in childbearing age group.

Selection ofABO compatible packed red cells

Donor ABO group

Recipient's ABO group 1st choice 2nd choice 3rd choice 4th choice

O O none none none

A A O none none

B B O none none

AB AB A B O

Selection of Rh compatible donor red cells:

• Rh positive patients can be transfused with Rh positive and Rh-negative blood.
• Rh negative males or elderly females with no potential for childbearing can safely receive Rh positive blood in circumstances where Rh negative blood is not available.
• Rh negative female patient in the childbearing age must receive Rh negative blood.

In circumstances where a surgery is planned or forthcoming childbirth, the blood bank should be informed at the earliest to make Rh negative blood available as Rh- negative blood may not be routinely stocked at the blood banks.

• In case of emergency when Rh negative blood is not available, it may be necessary to use Rh D positive blood. Following transfusion of >15ml up to 1 unit of blood, it is advisable to give IV anti-D IgG at dose of 50-75 IU/ml of blood. All efforts should be made to make Rh negative blood available at the earliest once urgency is managed.
• Ensure that compatibility testing is carried out on all blood to be transfused. In absolute emergencies, where there is no time for emergency cross-matching, uncross- matched blood can be issued but a cross- match should still be done while the transfusion is in progress.