Safety of Blood Products in Blood Transfusion - Essay Example

SAfety of blood and blood products Your name: Institution name: Introduction Blood transfusion is an important, life saving intervention in the management of patients. All patients requiring blood or blood products should have access to safe blood and blood products, including whole blood, plasma-derived medicinal blood, and labile blood components (Paul, 2011). Blood and blood components should be appropriate to the patients’ clinical needs, provided in time and correctly administered. Patient safety in blood and blood components will depend on the safety of blood and blood products and the safety of the transfusion process- this process encompasses a series of steps that including the prescription and ordering of blood and blood products (King and Bandarenko, 2008); identification of patients; collection and labeling of blood samples; pre-transfusion compatibility tests and issue of blood and blood products (Callum et el, 2009); collection and transportation of blood within the healthcare facility; monitoring of patients; and management of transfusion of complications. An appropriate and correct administered of blood and blood product process ensure that patients safety and contributes to survival and improved health (Paul, 2011). Sometimes, blood and blood products carry with it some adverse events that may include errors (Hendrickson and Hillyer, 2009), transmission of infections, and transfusion reactions (Wiley-Blackwell, 2011). The most important serious blood reactions and death is wrong blood or blood product due to clinical errors during blood transfusion process, such as incorrect identification of blood samples (Schiffer et el, 2001), patients or blood units; labeling and sampling errors; clerical errors (Pineda and Taswell, 1975), laboratory errors; improper handling and storage of blood; and lack of patient monitoring during blood transfusion (Klein et el 2007). Most of these clinical errors on blood and blood products can be prevented if there is strong hospital process and system for clinical management of blood and blood products, appropriate training of healthcare personnel and implementation of standardized procedures throughout the clinical process (Engelfriet et el, 2001). Standard protocols for blood and blood product are important to reduce the potential for errors (Poterjoy et el, 2009). These safety protocols have been put in each healthcare institution and each healthcare facility should conform to the standard practices that have been outlined in these guidelines (Schiffer et el, 2001). In most health facilities, there exist quality management system and this includes active transfusion committee, a process to correct protocols and practice when deficiencies have been identified. Donor Screening Blood and blood products safety will begin with the blood donor. In order for healthcare facilities to make sure the blood is safe, blood donor will be asked a series of questions covering his/her health history, lifestyle and travel (Paul, 2011). It is important that blood donor recognize that the questions being asked are as crucial as the sensitive tests applied within hospital laboratories in making sure the donated blood is safe. Donor screening is usually done by appropriately qualified and trained healthcare personnel. The key objectives for hospitals are to protect the health of the patient who receive the blood and donor who give the blood (Wiley-Blackwell, 2011). The detailed documentation and questioning aims to ensure that blood and blood products is not taken from any person who will suffer ill effect as a result of the donation of blood or from any donor who is of high risk in transmitting infectious diseases e.g. Hepatitis B & C or HIV (Engelfriet et el, 2001). Haemoglobin screening is usually performed on all persons donating blood through various techniques (King and Bandarenko, 2008). This is in addition to various tests that have been performed at many sessions (Callum et el, 2009). NIBTS medical personnel will take samples which will allow various tests to be performed within the laboratories using sensitive techniques, and this will provide an improved donor care. (syphilis), West Nile virus (WNV), and T. Cruzi. All the infectious diseases during screening assays must be found to be negative in blood unit in order for such blood to be released or the components be released to the hospital for blood transfusion (Klein et el 2007). blood components will be tested for bacterial contamination through culturing method that has been initiated 24 hours after collection (Poterjoy et el, 2009). The whole blood and blood components derived platelets that have been tested for bacterial testing with point of release immunoassays. Collection and Production After the blood has been screened, a person donating blood will proceed to donate approximately 470 ml of blood (Klein et el 2007). The venepucture are will be cleaned with antiseptic in order to reduce the potential of introducing new bacteria agents during the blood collection (Paul, 2011). The donate blood will then be collected into sterile blood packs which has a device that will improve blood safety, for example, a simple pouch that prevents tiny pieces of human skins from the needle prick and first few drops of donated blood from getting into the pack (Wiley-Blackwell, 2011). These collection packs are also seen to facilitate the production of numerous blood components within a “closed” system thus reducing any possibility of bacterial agents’ contamination during the blood collection (Schiffer et el, 2001). Further blood processing will include filtration of blood to remove white blood cells from the collected blood, this is done as a precautionary safety measure. It is important for early detection because such antibodies may cause serious hemolytic disease for unborn babies or hemolytic transfusion reaction, and this may complicate the compatibility blood testing and may also delay the procurement of blood that is compatible with the patient. Indirect antiglobulin testing is used to screen for unexpected anti-RBC antibodies. This type of test may be found to be positive in the presence of an unexpected blood group antibody (Paul, 2011). Reagent RBCs are will then be mixed with the recipient serum or plasma, incubated (Slichter, 2007), washed, and then tested with antihuman globulin and then observation will be made for agglutination (Wiley-Blackwell, 2011). Once the recipient antibody is detected, it specificity will then be determined. It is important to know the specificity of the antibody because it will help physicians to select compatible blood, assess its clinical significance, and also help the clinicians to manage hemolytic diseases incase for newborn babies. Antibody titration will only be carried out when unexpected anti-RBC antibody has been identified in the plasma an expectant woman or in a recipient that has cold autoimmune hemolytic anemia (Slichter, 2007). The maternal antibody titer will correlates with the severity of hemolytic disease in the incompatible fetus and can be used to treat hemolytic disease of the babies along with amniotic fluid and utrasonography. Storage of blood The ‘Blood cold Chain’ is a system that is used to store and transport blood and blood components so that the blood is stored at the correct temperature from collection to administration to the affected patient (Wiley-Blackwell, 2011). Any break in the ‘blood cold chain’ will increase the risk for the recipient of the blood or blood product. Plasma freezers (Holland and Brooks, 2006), blood bank refrigerators, blood transport boxes, platelet agitator cum incubators are part of equipments that are used to store blood and blood components. Whole blood and red cells must be stored at a temperature that is between +2oC to +6oC in a blood bank refrigerator (Wiley-Blackwell, 2011). These refrigerators have in-built monitors that monitor the blood temperature and cooling fan that ensure there is even distribution of cold air in the refrigerator. Maintenance of above storage temperature is important to maintain the oxygen carrying ability of blood product. The upper limit of six degree Centigrade is important to minimize the growth of any bacterial contamination in the blood (Slichter, 2007). Below two degree Centigrade, red cells become haemolysed. So they should not be allowed to freeze (Holland and Brooks, 2006). Haemolysed cells if transfused can cause renal failure & fatal bleeding problems. Fresh frozen plasma is stored in colder or Blood Transfusion centre at -40 degree C and has a shelf life of approximately one year (Paul, 2011). If the blood is not stored at this temperature the coagulation factors as Factor V deteriorate and Factor VIII and the amount of blood will be greatly be reduced and this will defeat the purpose for which the blood is to be administered (Wiley-Blackwell, 2011). Fresh frozen plasma will be twaned before being transfused to a patient and Fresh frozen plasma should be transported in a blood transport box in which the blood temperature is maintained between two degrees centigrade to six degrees centigrade (Wiley-Blackwell, 2011). Platelet blood is prepared by automated method as well as manual methods and then the blood component will be stored at 22 degree Centigrade to 24 degree Centigrade in platelet agitator cum incubator in order to maintain platelet function of stoping bleeding or preventing spontaneous bleeding in patients with hypo plastic anemia or thrombocytopenia or bone marrow failure (Paul, 2011). The whole blood that will be used for separation of platelets components should be kept at twenty degrees centigrade to twenty four degrees centigrade before the blood is processed as lower temperature will affect the platelet separation and function (Wiley-Blackwell, 2011). Blood platelets must be prepared within eight hours of phlebotomy and stored at 20-24 degree C with continuous agitation.to prevent aggregation which can result in loss of viability (Holland and Brooks, 2006). Since platelets blood is stored at room temperature there may be a risk of bacterial contamination therefore the storage area should be maintained at ambient temperature that is below twenty four degrees centigrades and should be transported in a blood transport box that keeps the temperature in the correct range of about 20 degree C – 24 degree C. Inspection of Blood bags The blood bags that are used to transport blood should be inspected for damage and deterioration during storage before the blood and blood components are issued from the blood centre and before being transfused to patients (Paul, 2011). Any sign of leakage or discoloration is a warning sign of bacterial contamination and this can cause serious reaction if given to patients (Wiley-Blackwell, 2011). Therefore it is important for hospitals to check each blood bag for sign mentioned above. Blood Transport Boxes Blood transport Boxes should be used for whenever blood is moved from the blood centre to patient bed side or operation theatre (Paul, 2011). It is important to use clean and sturdy transport boxes that maintain optimum temperature required for blood during transport. References Callum JL, Karkouti K, Lin Y. Cryoprecipitate: the current state of knowledge. Transfus Med Rev. 2009;23(3):177–188. Engelfriet CP, Reesink HW, Brand A, et al. Transfusion-related acute lung injury (TRALI). Vox Sang. 2001;81(4):269–283. Hendrickson JE, Hillyer CD. Noninfectious serious hazards of transfusion. Anesth Analg. 2009;108(3):759–769. Paul M. Ness (2011). Does transfusion of stored red blood cells cause clinically important Adverse effects? A critical question in search of an answer and a plan. Transfusion; 51 (4): 666 King KE, Bandarenko N. Blood Transfusion Therapy: A Physician's Handbook. 9th ed. Bethesda, Md.: American Association of Blood Banks; 2008:236. Klein HG, Spahn DR, Carson JL. Red blood cell transfusion in clinical practice. Lancet. 2007;370(9585):415–426. Holland LL, Brooks JP. Toward rational fresh frozen plasma transfusion: the effect of plasma transfusion on coagulation test results. Am J Clin Pathol. 2006;126(1):133–139. Schiffer CA, Anderson KC, Bennett CL, et al. Platelet transfusion for patients with cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001;19(5):1519–1538. Poterjoy BS, Josephson CD. Platelets, frozen plasma, and cryoprecipitate: what is the clinical evidence for their use in the neonatal intensive care unit? Semin Perinatol. 2009;33(1):66–74. Slichter SJ. Platelet transfusion therapy. Hematol Oncol Clin North Am. 2007;21(4):697–729, vii. Pineda AA, Taswell HF. Transfusion reactions associated with anti-IgA antibodies: report of four cases and review of the literature. Transfusion. 1975;15(1):10–15. Wiley-Blackwell. (2011, April 18). Safety of stored blood among chief concerns for transfusion medicine community. ScienceDaily. Retrieved December 17, 2014 from www.sciencedaily.com/releases/2011/04/110415083140.htm Read More