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

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

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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

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Revision History

Rev	Date	Description	Author
1.0	[DATE]	Initial release	[AUTHOR]