Blood Safety: The Right Blood Product to the Right Patient at the Right Time
By Dr Rita Govender, Haematologist
Decision to Transfuse
The clinician must evaluate the risk-benefit ratio for each patient and obtain documented informed consent.
Despite rigorous testing, bedside practices remain a major contributor to adverse events.
- Incorrect patient identification is a leading cause of morbidity in transfusion medicine.
Three Pillars of Blood Safety
1️. Donor Selection
Voluntary, non-remunerated donors complete a detailed questionnaire to screen for:
- Medical conditions
- Behavioral risks (e.g. HIV, other infections)
Donors can self-exclude if needed.
2️.Testing of Donor & Blood Unit
Routine tests include:
- Serology: Hepatitis B surface antigen, Hepatitis C antibody, HIV 1 & 2 antibodies, Syphilis
- PCR: HIV, HBV, HCV
Blood is quarantined until all tests are negative.
Window period donations still pose a risk.
If a test is positive:
- Donor is notified, counselled, and deferred.
- SANBS initiates a look-back programme to trace previous recipients.
-Since October 2005, no documented HIV transmission due to nucleic acid testing.
3️. Clinician Responsibilities
Before transfusion (if patient is stable):
-Perform clinical & lab evaluations
-Consult a haematologist
-Consider alternatives: haematinics, prohaemostatic agents (e.g. Cyclokapron, DDAVP)
-Explore blood-conserving methods:
- Acute normovolaemic haemodilution
- Cell salvage
- Pre-op autologous donation
If transfusion is necessary:
-Choose correct product
-Obtain informed consent
-Correctly identify patient and label sample at bedside
Bedside Transfusion Protocol
At least two medical professionals must:
- Identify the patient
- Verify unit details (patient info, blood group, expiry)
- Recheck doctor’s order and previous blood group
- Inspect unit for leaks, aggregates, discoloration
Transfusion Setup & Monitoring
- Use strict aseptic technique
- Regularly inspect cannulation site
- Monitor vitals: pulse, BP, respiratory rate, temperature
- Every 15 minutes during transfusion
- Start slow: 2 ml/min for first 30 mins
- Red cells: complete within 6 hours
- Platelets: 15–20 minutes
Adverse Reactions
If symptoms arise (e.g. BP changes, fever, pain, rash):
-Stop transfusion immediately
-Change drip set, maintain vein with saline
-Record vitals, manage symptoms
-Repeat bedside checks
-Contact transfusion service
-Complete legal documentation
-Submit samples: crossmatch, LFTs, cultures, urine, blood unit & set
Key Reminders
- Use standard recipient set for red cells
- Use platelet-giving set for platelets
- Avoid bedside leucodepletion filters on pre-leucodepleted units
- Microaggregate filters not needed
- For paediatric cases, request Limited Donor Exposure Programme (LDEP)
- Use approved blood warmers only when indicated
- Never add meds/fluids to blood products
- Only compatible fluids: saline, 4% albumin, plasma protein fractions, ABO-compatible plasma
- Do not refrigerate platelet products before transfusion
- Retain empty bags for 48 hours in fridge
References
- South African standards for blood transfusion
- Clinical guidelines for blood products in South Africa (4th ed.)
- Leucocyte depletion guidelines – Blood Transfusion Services of SA
- SAMJ, May 2006, 96:5
- The Specialist Forum, April 2002
- Transfusion, 2004, 44:1S–3S
Useful Websites
🔗 SANBS Official Site
🔗 BCSH Guidelines