Blood transfusion is an essential medical procedure, capable of saving lives and improving patient health. It relies on a precise process, comprised of five key steps, from patient preparation to post-transfusion monitoring.

These steps aim to minimize risks while ensuring compatibility between the donor and recipient. Traceability of labile blood products (LBP) is also a priority to ensure effective and safe transfusion.

Understanding this process is essential, whether you are a patient, a family member, or a healthcare professional. This includes pre-transfusion testing, medical prescription, patient identification, and transfusion record management.

Each step is rigorously planned to optimize patient safety and well-being.

In the following sections, we will detail these steps and their importance in ensuring a successful transfusion.

Patient Preparation and Information

Creating the Transfusion Record

Before any blood transfusion, it is essential to create a complete transfusion record for each patient. This file contains all relevant information, including: The patient's blood type. Date and place of birth. Medical history that may influence the transfusion. The individual distribution sheet, which includes prescription details and blood product identification, is also included in this file. Rigorous documentation ensures the traceability of blood products and prevents compatibility errors, such as those related to the ABO system or potential transfusion reactions. Patient information and consent for transfusion are essential steps. Essential steps in preparing for a blood transfusion. The patient must receive clear and detailed information about: the benefits of the transfusion; the potential risks, including side effects and rare but serious complications. This information process allows the patient to make an informed decision regarding their treatment. Free and informed consent, mandatory except in emergencies, must be obtained before proceeding with the transfusion. The physician or authorized healthcare professional explains the risks and benefits of the transfusion and obtains the consent of the patient or their legal representative, in accordance with ethical and legal standards. Pre-transfusion tests: Blood typing and screening for irregular antibodies. Pre-transfusion tests play an important role in ensuring compatibility between the patient and the blood components to be transfused. The first step is to determine the patient's blood type, which includes the ABO and Rh blood groups, as well as the search for specific phenotypes such as Rh Kell. To reduce the risk of errors, it is essential to obtain two concordant analyses performed at different times. In addition, the search for irregular antibodies (RAI) is a crucial step. It detects antibodies present in the patient that could react with the transfused red blood cells. These antibodies are often linked to previous immunizations, such as a transfusion or pregnancy. A negative result on this test is generally valid for three days. However, this validity can be extended to 21 days if the prescribing physician confirms that there has been no history of immunization in the last six months. The different blood groups: ABO, Rh, Kell. The ABO, Rh, and Kell blood groups are the main blood systems considered during pre-transfusion testing. The ABO system is the most critical for blood transfusions, as ABO incompatibilities represent the most immediate and serious risk to the patient. The ABO blood groups (A, B, AB and O) must be determined with absolute precision to avoid serious transfusion reactions.

The Rhesus system, which includes the Rh and Kell antigens, is also of great importance. The Rhesus phenotype (positive or negative) as well as the Kell phenotype must be identified to ensure blood compatibility.

Although incompatibilities in these systems are generally less serious than those of the ABO system, they can nevertheless cause significant transfusion reactions.

In short, the accurate determination of blood groups and the screening for irregular antibodies are essential steps to ensure the safety and compatibility of blood transfusions, thus reducing the risk of potentially dangerous transfusion reactions.

Prescription and preparation of the blood product

Medical prescription

The medical prescription is a key step in the blood transfusion process. It must be carried out by a hospital physician and recorded on a specific and detailed prescription. This prescription includes several essential elements: the patient's full name, their unique identification number, the type of blood product to be transfused, the volume or quantity to be administered, the date and time of the transfusion, and the infusion rate. If several products are prescribed simultaneously, the order of transfusion must also be specified. Furthermore, the prescription must mention any associated medications, detailing the dosage, route of administration, and timing of administration. For example, medications such as diphenhydramine or acetaminophen may be prescribed before the transfusion to prevent allergic reactions. Similarly, furosemide may be used to prevent complications related to overhydration.

Ordering, preparing, and storing blood products

Once the medical prescription is established, the labile blood products (LBP) are ordered. This order must be accurate and include all the necessary details to ensure the compatibility and safety of the transfusion. Blood products, such as red blood cell concentrates (RBCs) or other blood components, are prepared and stored according to strict protocols to maintain their integrity and effectiveness. Upon receipt of the blood products, a rigorous identity and compatibility check is carried out by the nurse, in accordance with Article R.4311-9 of the Public Health Code. This preliminary check is mandatory to ensure that the blood product matches the patient and the prescription specifications.

Finally, blood products are stored under specific conditions, including temperature-controlled refrigerators, to guarantee their viability and safety until the time of transfusion.

Performing the Transfusion Procedure

Final Check Before Transfusion

Before starting the transfusion, a rigorous check is carried out to guarantee the safety and compatibility of the process. This includes confirming the patient's identity by verifying their last name, first name, and date of birth. This verification can be done by asking open-ended questions or by using the identification bracelet, especially if the patient is unconscious. It is equally essential to ensure that the patient fully understands the transfusion procedure and its potential effects. All of their questions must be addressed and clear answers provided.

The final check also includes verifying the patient's baseline vital signs, such as heart rate, blood pressure, respiratory rate (if necessary), temperature, and oxygen saturation. These parameters establish a baseline before starting the transfusion.

Administering the Transfusion and Monitoring the Transfused Person

The administration of the blood transfusion must be carried out in a dedicated area, without interruption of the procedures, and by a single person to ensure optimal consistency and safety. The transfusion rate must strictly adhere to medical prescriptions, particularly in patients over 70 years of age, to prevent Transfusion-Associated Circulatory Overload (TACO). During the transfusion, continuous and attentive monitoring is essential. Vital signs, such as heart rate, blood pressure, respiratory rate, and oxygen saturation, must be checked regularly, especially during the first 15 minutes. This monitoring must be adapted to the clinical presentation and the medical prescription throughout the transfusion and until its completion. In addition to vital signs, it is important to monitor clinical signs such as level of consciousness, sweating, pallor, warmth, and skin color. The patient should be informed of the importance of reporting any unusual signs, such as chills, tingling, difficulty breathing, or a feeling of fever. It is important to convey this information without alarming the patient. Any observed anomaly must be immediately reported to the physician for evaluation and appropriate intervention.

Post-transfusion follow-up

Immediate monitoring and reporting of any incidents

This report must be returned to the hematology laboratory (LIHT) along with any associated pre-transfusion tests.

A letter must also be sent to the patient's primary care physician to inform them that the transfusion was performed, the results obtained, and any recommended post-transfusion follow-up or treatment. This communication is essential to ensure continuity of care and appropriate follow-up of the patient after the transfusion.

Finally, the used blood bag must be stored for 24 hours in an individual bag with a Luer-Lock cap before being disposed of according to current institutional procedures. The delivery slip must be kept in the patient's file to ensure the traceability of labile blood products (LBP). Conclusion: Blood transfusion is a complex and critical process that requires careful attention at every stage. This includes preparation, patient education, and post-transfusion monitoring. Understanding the importance of blood typing, irregular antibody screening, and ABO and Rh compatibility is essential to prevent serious transfusion reactions. Medical prescription, preparation and storage of labile blood products, and continuous patient monitoring during and after transfusion are critical steps to ensure the safety and efficacy of this procedure. By strictly adhering to these steps and following transfusion best practice guidelines, healthcare professionals can minimize risks while maximizing the benefits of blood transfusion. Staying informed and undergoing regular training is essential to maintaining high standards of transfusion safety. Furthermore, traceability and accurate documentation of all blood products are essential to ensure continuity and quality of care.

FAQ

What are the main reasons for a blood transfusion?

The main reasons for a blood transfusion include:

• Significant loss of blood or fluids.
• Severe anemia.
• Severe bleeding.
• Third-degree burns.
• Hemophilia.
• Bone marrow or other organ transplants.
• Surgery with severe bleeding.

What are the possible side effects or adverse reactions during a blood transfusion?

Possible side effects or adverse reactions include:

• Fever and chills.
• Allergic reactions such as hives or anaphylaxis.
• Volume overload.
• Lung damage.
• Destruction of red blood cells.
• Graft-versus-host disease (GVHD).
• Infections.

Acute or delayed hemolytic reactions, problems Respiratory and bacterial infections can also occur.

How are patients monitored during and after a blood transfusion?

Patient monitoring during a blood transfusion is rigorous, especially during the first 5 to 15 minutes, when adverse reactions are most likely. Vital signs such as:

• Heart rate.
• Blood pressure.
• Respiratory rate.
• Oxygen saturation.

are monitored. Patients are also instructed to report any unusual symptoms, such as:

• Chills.
• Tingling.
• Difficulty breathing.
• Feeling feverish.

Monitoring continues according to facility policies and the patient's clinical condition, sometimes for several hours after the transfusion is complete, to detect any signs of delayed intolerance.