Blood transfusion is an essential medical procedure, capable of saving lives and improving patient health. It relies on a precise process, composed of 5 key steps, from patient preparation to post-transfusion monitoring.

These steps aim to minimize risks while guaranteeing compatibility between the donor and the recipient. The 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 relative, or a healthcare professional. This includes pre-transfusion testing, medical prescription, patient identification, and the management of transfusion records. 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

Creation of the transfusion record

Before any blood transfusion, it is essential to create a complete transfusion record for each patient. This record includes all relevant information, including:

• The patient's blood type.
• The date and place of birth.
• Medical history that may influence transfusion.

The nominative distribution sheet, which includes the prescription details and the identification of the blood products, is also included in this file.

A rigorous documentation guarantees the traceability of blood products and prevents compatibility errors, such as those linked to the ABO system, or potential transfusion reactions.

Information and obtaining patient consent for transfusion

Patient information and consent are essential steps in preparing for a blood transfusion. The patient must receive clear and detailed information on:

• The benefits of transfusion.
• 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, which is 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

Determination of blood group and search for irregular agglutinins

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 ABO and Rhesus 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 matching analyses, performed at different times.

In addition, the search for irregular agglutinins (RAI) is an essential step. It detects antibodies present in the patient that could react with transfused red blood cells. These antibodies are often linked to previous immunizations, such as a transfusion or pregnancy. A negative result for this search 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 past six months.

Different blood groups: ABO, Rhesus, Kell

ABO, Rhesus, and Kell blood groups are the main blood systems taken into account 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 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 severe than those of the ABO system, they can nevertheless cause significant transfusion reactions.

In summary, the precise determination of blood groups and the search for irregular antibodies are essential steps to guarantee the safety and compatibility of blood transfusions, thereby reducing the risk of potentially dangerous transfusion reactions.

Prescription and preparation of the blood product

Medical prescription

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 order 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.

In addition, the prescription must mention the associated drug treatments with the transfusion, detailing the dosage, route of administration, and timing of administration. For example, drugs such as diphenhydramine or acetaminophen may be prescribed before the transfusion to prevent allergic reactions. Similarly, furosemide may be used to avoid complications related to hyperhydration.

Ordering, preparation, and storage of blood products

Once the medical prescription has been established, the labile blood products (LBS) are ordered. The order must be precise, and include all the details needed to guarantee compatibility and transfusion safety. 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 efficacy.

After receiving the labile blood products (LBP), a rigorous check of identity and compatibility is carried out by the nurse, in accordance with Article R.4311-9 of the Public Health Code. This prior check is mandatory to ensure that the blood product corresponds to the patient and the specifications of the prescription.

Finally, blood products are stored under specific conditions, including in temperature-controlled refrigerators, to ensure their viability and safety until 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, verifying their last name, first name and date of birth. This verification can be done by asking open 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 their questions should be taken into account and clear answers should be provided.

The final check also includes a verification of 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.

Initiation of transfusion and monitoring of the transfused individual

Blood transfusion must be performed in a dedicated location, without interruption of the steps, and by a single person to ensure optimal consistency and safety. The transfusion rate must imperatively comply with medical prescriptions, especially in patients over 70 years of age, in order to prevent Transfusion-Associated Circulatory Overload (TACO).

During transfusion, continuous and attentive monitoring is essential. Vital parameters, such as heart rate, blood pressure, respiratory rate, and oxygen saturation, should be checked regularly, especially during the first 15 minutes. This monitoring should be adapted to the clinical situation and medical prescription throughout the transfusion and until its completion.

In addition to vital parameters, it is important to monitor clinical signs, such as consciousness, sweating, pallor, warmth, and skin coloration.

The patient should be informed of the importance of reporting any unusual signs, such as chills, tingling, breathing difficulties, or a feeling of fever. It is important to convey this information without alarming them. Any anomaly observed should be immediately reported to the physician for evaluation and appropriate intervention.

Post-transfusion follow-up

Immediate monitoring and reporting of any incidents

After the end of the transfusion, patient monitoring is essential to quickly detect any potential transfusion reaction. Severe reactions usually occur within the first 15 minutes and up to 6 hours after the transfusion. However, reactions can still occur within 24 hours and up to 15 days later.

It is essential to carefully monitor the patient's vital parameters, including heart rate, blood pressure, respiratory rate, and oxygen saturation. Any unusual symptom, such as fever, dyspnea, crackles, cyanosis, or hypotension, should be immediately reported to the prescribing physician.

In the event of a transfusion reaction, the transfusion must be stopped immediately, and the IV line should be maintained with a saline solution until the physician makes a decision.

Biological samples to identify anti-leukocyte antibodies (anti-HLA, anti-granulocytes) may be necessary. Close monitoring of respiratory and cardiovascular functions is also essential. Any transfusion reaction must be reported to the French Blood Establishment (EFS) and the hospital's hemovigilance correspondent.

Letter to the attending physician and closure of the transfusion file

Once the transfusion has been completed and post-transfusion monitoring carried out, it is important to close the patient's transfusion record. This includes completing the transfusion report in full, with details of the transfusion, vital parameters monitored, and any reactions or incidents that may have occurred.

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

A letter should also be sent to the patient's attending physician, informing him or her of the transfusion, the results obtained, and any follow-up or post-transfusion treatment recommended. This communication is essential to ensure continuity of care and appropriate post-transfusion follow-up.

Finally, the used blood bag must be stored for 24 hours in an individual bag with a Luer-Lock stopper, before being disposed of in accordance with current institutional procedures. The delivery note must be kept in the patient's file to ensure traceability of labile blood products.

Conclusion

Blood transfusion is both a complex and critical process, requiring meticulous attention at each stage. This includes preparation, patient information, and post-transfusion monitoring. Understanding the importance of blood group determination, screening for irregular agglutinins, and ABO and Rh compatibility is paramount to avoid severe transfusion reactions.

Medical prescription, preparation and storage of labile blood products, and continuous monitoring of the patient during and after transfusion are essential steps to ensure the safety and effectiveness of this procedure.

By scrupulously respecting these steps and following the standards of good transfusion practices, healthcare professionals can reduce risks while optimizing the benefits of blood transfusion. It is essential to stay informed and to train regularly in order to maintain high standards in transfusion safety. In addition, traceability and accurate documentation of all blood products are essential to ensure continuity and quality of care.

FAQ

What are the main reasons for blood transfusions?

The main reasons for performing a blood transfusion include:

• Significant loss of blood or fluids.
• Profound anemia.
• Severe hemorrhage.
• Third-degree burns.
• Hemophilia.
• Bone marrow or other organ transplants.
• Surgical interventions with severe hemorrhage.

It is also indicated for treating diseases affecting blood cell production, such as some forms of cancer, as well as the effects of chemotherapeutic or radiotherapeutic treatments.

What precautions are taken to ensure blood compatibility between donor and recipient?

To ensure blood compatibility between donor and recipient, several essential precautions are taken:

• A cross-match is performed by mixing a drop of the recipient's blood with that of the donor to check for any reaction.
• Blood bag labels are carefully checked to ensure they match the correct patient.
• ABO and Rhesus compatibility is checked.
• An irregular agglutinin test is performed to detect any dangerous antibodies in the patient's plasma.

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

Possible side effects or adverse reactions include:

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

Acute or delayed hemolytic reactions, respiratory problems, and bacterial infections may 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, the period 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.
• Respiratory difficulties.
• Fever sensation.

Monitoring continues according to hospital policies and the patient's clinical condition, sometimes for several hours after the end of the transfusion, in order to detect any signs of late intolerance.