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SOPs/Transfusion/SOP-BB-002-Blood-Transfusion.md

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+# Standard Operating Procedure: Blood Transfusion Administration
+
+| Document ID | SOP-BB-002 |
+|-------------|-------------|
+| Title | Blood Transfusion Administration |
+| Revision | 1.0 |
+| Effective Date | [DATE] |
+| Author | [AUTHOR] |
+| Approved By | [APPROVER] |
+| Department | Transfusion Services |
+
+---
+
+## 1. Purpose
+
+To establish standardized procedures for the safe administration of blood and blood components to minimize transfusion errors and adverse reactions.
+
+## 2. Scope
+
+This procedure applies to the administration of:
+- Packed red blood cells (PRBCs)
+- Fresh frozen plasma (FFP)
+- Platelets (random donor and apheresis)
+- Cryoprecipitate
+- Granulocytes
+
+## 3. Responsibilities
+
+### 3.1 Ordering Physician
+- Determine transfusion indication
+- Order appropriate blood component
+- Obtain informed consent
+- Respond to transfusion reactions
+
+### 3.2 Blood Bank/Transfusion Service
+- Perform compatibility testing
+- Issue blood products
+- Maintain inventory
+- Investigate transfusion reactions
+
+### 3.3 Nursing Staff
+- Verify patient identity and blood product
+- Administer transfusion
+- Monitor for reactions
+- Document transfusion
+
+## 4. Definitions
+
+| Term | Definition |
+|------|------------|
+| Crossmatch | Compatibility test between donor RBCs and recipient serum |
+| Type and Screen | ABO/Rh typing and antibody screen |
+| Transfusion Reaction | Adverse response to blood transfusion |
+| Emergency Release | Issue of uncrossmatched blood in emergencies |
+
+## 5. Procedure
+
+### 5.1 Pre-Transfusion
+
+1. **Physician Order Review**
+   - Verify order includes:
+     - Patient identification
+     - Blood product type
+     - Number of units
+     - Rate/duration
+     - Special requirements (irradiated, CMV-negative, etc.)
+   - Confirm indication appropriate
+
+2. **Type and Screen/Crossmatch**
+   - Collect sample per specimen requirements
+   - Label at bedside with two identifiers
+   - Complete blood bank request form
+   - Allow time for testing (45 min - 1 hour typical)
+
+3. **Informed Consent**
+   - Explain benefits and risks
+   - Discuss alternatives
+   - Answer patient questions
+   - Obtain written consent (FRM-BB-003)
+   - Document in medical record
+
+4. **Pre-Transfusion Assessment**
+   - Baseline vital signs:
+     - Temperature
+     - Pulse
+     - Respiratory rate
+     - Blood pressure
+   - Assess IV access (18-20 gauge preferred)
+   - Review history of previous reactions
+
+### 5.2 Blood Product Issue
+
+1. **Request Blood from Blood Bank**
+   - Verify order and patient identification
+   - Note any special requirements
+   - Confirm expected time of transfusion
+
+2. **Blood Bank Verification (Issue)**
+   - Match unit to patient (ABO, Rh, crossmatch)
+   - Check expiration date
+   - Inspect unit for abnormalities:
+     - Hemolysis
+     - Clots
+     - Discoloration
+     - Bag integrity
+
+3. **Transport**
+   - Transport promptly (within 30 minutes)
+   - Do not store in nursing unit refrigerators
+   - Return to blood bank if transfusion delayed >30 min
+
+### 5.3 Bedside Verification (CRITICAL)
+
+**Two qualified staff must verify at bedside:**
+
+| Item to Verify | Check |
+|----------------|-------|
+| Patient wristband name matches blood bag | ☐ |
+| Patient wristband MRN matches blood bag | ☐ |
+| Patient wristband DOB matches blood bag | ☐ |
+| ABO/Rh on blood bag matches compatibility label | ☐ |
+| Unit number on blood bag matches compatibility label | ☐ |
+| Expiration date is valid | ☐ |
+| Blood product type matches order | ☐ |
+| Blood bag appears normal (no clots, hemolysis) | ☐ |
+| Patient confirms identity (if possible) | ☐ |
+
+**DO NOT TRANSFUSE IF ANY DISCREPANCY EXISTS**
+
+### 5.4 Transfusion Administration
+
+1. **Blood Administration Set**
+   - Use blood administration set with 170-260 micron filter
+   - Prime set with normal saline only
+   - Never add medications to blood products
+   - Maximum hang time: 4 hours
+
+2. **Compatible IV Fluids**
+   | Compatible | NOT Compatible |
+   |------------|----------------|
+   | 0.9% Normal Saline | Lactated Ringer's |
+   | | Dextrose solutions |
+   | | Medications |
+
+3. **Infusion Rates**
+   | Product | Initial Rate (first 15 min) | Routine Rate | Maximum Time |
+   |---------|---------------------------|--------------|--------------|
+   | PRBCs | 2 mL/min (50 mL) | Per order/tolerance | 4 hours |
+   | FFP | 2 mL/min | 10 mL/min or per order | 4 hours |
+   | Platelets | 2 mL/min | Per tolerance | 4 hours |
+   | Cryoprecipitate | 2 mL/min | Per tolerance | 4 hours |
+
+4. **Monitoring Schedule**
+   | Time | Action |
+   |------|--------|
+   | Pre-transfusion | Baseline vital signs |
+   | 15 minutes | Vital signs + assessment |
+   | 30 minutes | Vital signs |
+   | Hourly | Vital signs |
+   | Post-transfusion | Final vital signs + assessment |
+
+### 5.5 Transfusion Reaction Management
+
+**Signs/Symptoms Requiring Immediate Action:**
+- Fever (≥1°C rise)
+- Chills/rigors
+- Hypotension or hypertension
+- Tachycardia
+- Dyspnea/respiratory distress
+- Chest or back pain
+- Hives/urticaria/rash
+- Nausea/vomiting
+- Hemoglobinuria (dark urine)
+- Anxiety/sense of doom
+
+**Immediate Response:**
+1. STOP the transfusion immediately
+2. Keep IV line open with normal saline
+3. Notify physician immediately
+4. Check vital signs
+5. Verify patient/blood product identities
+6. Notify blood bank
+7. Complete FRM-BB-004 Transfusion Reaction Report
+8. Return blood bag and tubing to blood bank
+9. Collect post-reaction blood and urine samples
+
+**Reaction Workup**
+| Sample | Purpose |
+|--------|---------|
+| EDTA tube (lavender) | DAT, visual hemolysis check |
+| Clot tube (red/gold) | Repeat crossmatch, visual hemolysis |
+| First voided urine | Hemoglobinuria |
+| Blood cultures | If bacterial contamination suspected |
+
+### 5.6 Post-Transfusion
+
+1. **Documentation**
+   - Product type and unit number
+   - Start and end times
+   - Volume transfused
+   - Vital signs (all)
+   - Adverse reactions (or "none")
+   - Patient response
+
+2. **Disposition of Blood Bag**
+   - Per facility policy (typically to blood bank)
+   - Retain for minimum time specified
+
+## 6. Special Situations
+
+### 6.1 Emergency/Massive Transfusion
+- O-negative PRBCs for females of childbearing potential
+- O-positive PRBCs for others acceptable in emergencies
+- Type-specific blood as soon as available
+- Activate massive transfusion protocol if indicated
+
+### 6.2 Pediatric Transfusion
+- Adjusted volumes (10-15 mL/kg)
+- Smaller filter volumes
+- Consider irradiated products
+
+## 7. Documentation
+
+- FRM-BB-003 Transfusion Consent Form
+- FRM-BB-004 Transfusion Reaction Report
+- Transfusion Record (in EMR or paper)
+- Blood bank compatibility record
+
+## 8. References
+
+- AABB Standards for Blood Banks and Transfusion Services
+- AABB Technical Manual
+- FDA regulations 21 CFR 606
+- Circular of Information for Blood and Blood Components
+
+---
+
+## Revision History
+
+| Rev | Date | Description | Author |
+|-----|------|-------------|--------|
+| 1.0 | [DATE] | Initial release | [AUTHOR] |