Blood Transfusion Filters,Blood Warming : Don'ts for Blood Transfusion

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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ADMINISTRATION OF BLOOD

Related Topics

Introduction

Adverse Reactions To Blood Transfusion

Dr. Mukesh Desai
Consultant Pediatric Hematologist-H.N. Hospital,
Consultant Pediatric Hematologist-Nanavati Hospital.

BLOOD TRANSFUSION FILTERS :

All blood component must be infused using filters.
Filters remove microscopic clots, cellular debris & undesirable particles.
Blood components like cryoprecipitate, platelets, FFP should also be infused using blood transfusion sets with filters.
Purified factor VIII, IX are provided by needles with inline filters
Standard blood transfusion filter size is 170-260 micron.
Microaggregate filter pore size is 20 -40 micron.
For routine transfusion, microaggregate filter is not necessary.
Microaggregate filter removes decomposed platelets, WBC and fibrin generated after 5 days of storage of blood with sizes of 20-160 micron which are pathologically implicated in ARDS, TRALI ( Transfusion related acute lung injury ) and pulmonary dysfunction.
Microaggregate filters are routinely used for transfusion in cardiovascular surgery e.g. CABG
Microaggregate filters are inappropriate to use in massive transfusion because it slows the rate of transfusion.
Microaggregate filters in pediatric cases can result in Hemolysis.

NEEDLES :

21 OR 20 NO. SCALP VEIN OR VENFLOW
For Pediatric transfusion, use 23 no scalp vein.

If BLOOD FLOW RATE IS SLOW :

Elevate blood container.
Check patency of needle and size.
Examine filter for excess debris.
Examine blood bag for presence of clot.
Add normal saline 50 to 100 cc.

BLOOD WARMING :

For routine blood transfusion blood warming is NOT necessary.
As blood flows drop by drop, it attains body temperature quickly.
Infusion of blood without warming is NOT responsible for febrile reactions or any other transfusion reaction.
Blood warming results in increased metabolism, reduced 2,3 DPG and increased risk of bacterial overgrowth.

INDICATIONS for Blood warming :

Massive transfusion 100 ml/minute or 1 blood bag every 3 minute as the recipient may develop hypothermia and arrhythmias.
Exchange transfusion in a neonate.
Cold agglutinin disease

BLOOD WARMING :

The whole blood bag should not be warmed.
Microwave should not be used for blood warming.
Blood warmers are available which warm the blood as it is flowing through the tubing.
While thawing FFP or warming blood the outlet port of the bag should be protected.

BLOOD WARMING occurs in clinical practice because of :

Delay in initiation of transfusion
Blood warming before initiation
Transfusion over prolonged duration.
Storage in unmonitored refrigerator.
Delay in completion.

*ADDITION OF DRUGS AND MEDICATIONS TO BLOOD BAGS IS PROHIBITED :

Exception : Normal saline, 5% albumin.
Addition of drugs may cause a change in the blood e.g. Ringer's lactate results in clotting of blood and is contraindicated along with blood; 5% dextrose results in hemolysis.
Changes in drug can occur because of pH and ionic molecular constituent.
In case a reaction occurs it would be impossible to ascertain who was responsible for the reaction.

DON'TS FOR BLOOD TRANSFUSION :