# 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] |