Education for the Revised Transfusion Reaction Algorithm 2018

Education for the Revised
Transfusion Reaction Algorithm
             2018

Definition of Transfusion
                        Reaction
*Any untoward event that occurs as a result of infusion of blood components or
   derivatives(plasma protein products)
  *Immediate or delayed
  *Considered definitely, probably or possibly related to the infusion

*When any unexpected or untoward sign or symptom occurs during or shortly after
  the transfusion of a blood component, a transfusion reaction must be considered
  as the precipitating event until proven otherwise.

Webert, K. McMaster University. 2015

The 5 W’s

Who’s involved
• The Medical Directors at Shared Health
  Diagnostic Services Manitoba and Canadian
  Blood Services have approved the revised
  Transfusion Reaction Algorithm
• PNRGTP                           have
              (Provincial Nursing Resource Group for Transfusion Practice)

  participated in content review, supported by
  TPC’s( Transfusion Practice Committees)

What does the new document look
              like?

Side 2

Where does this take effect?

When does this take effect?

Why the revision?
• Alignment of algorithm and procedures
• Reinforcement that the clinical signs and
  symptoms observed are NEW onset related to
  the transfusion
• When assessed several common suggestions
  were made
• Easier to follow

Distribution
• Designated Site Leads have been sent an
  education package which include;
 A letter from DSM indicating that all old algorithms be removed and discarded
 Laminated transfusion reaction algorithms

Symptoms
No Change

Number 4 and 5 have changed. Now says “Contact
MD/Designate for medical assessment/ treatment”. If
the physician suspects that this is a transfusion
reaction then you are to proceed with the algorithm, if
they assess this is not a transfusion reaction then
proceed with transfusion. If you are unable to get a
hold of the prescribing physician then

Clerical Discrepancy Check
Number 2 now reads.. Confirm patient demographics and verify all
documentation matches.

C. Tag on product matches patient

• The Manilla tag must not be
  removed from the Blood/ Blood
  Product until the transfusion is
  complete and a transfusion
  reaction is not suspected.

• This is a part of Accreditation
  Canada requirements (CSA Z902-10,
   11.3.4.)

• More definition as to how a minor
  reaction is defined.
• Temperature tighter parameters

• Administer any treatment the physician
  may order
• The transfusion will be resumed
  cautiously and under observation for
  the first 15 minutes after re-
  establishment
• Complete CM105
• No change to the IVIG

Major Reactions

         • Symptoms have been rearranged
         • Have removed the “Consult
           Transfusion Medicine MD on call… “
           so that this is now at the bottom of
           the algorithm

• Major Transfusion
  reactions will require
  specific testing dependent
  on the symptoms.
• Have added a chart on the
  back that puts the
  symptoms into more
  specific groups with the
  recommended
  investigations/ actions

Returning the Blood to the Blood
              Bank
      Tubing must be attached….

The C’s

   • Blue   clipmust be secure
     (coming from IV pump)
   • Roll clamp must be tight
   •   A cap must be placed on the
       end of the IV line
   • complete the CM105
       (transfusion reaction
       investigation form)

Please Do Not Use These
               These should not be
               used to clamp the
               bags!

               Rationale:
               If they open en-route
               back to the blood bank
               the blood can no
               longer be cultured

Action Packed!
• Each site is encouraged to update their
  transfusion reaction kit
• This could contain:
  –   Algorithm on the front
  –   Sterile Red Cap
  –   Transfusion Reaction Investigation Form
  –   Remove the Clip
  –   This package should be kept somewhere easily accessible
  -   500 ml bag of Normal saline with a new IV set
  -   Quick Reference Sheet

What could Kits look like?

What happens if I need blood and
   the patient has had a reaction?
                                 If URGENT blood is
                                 needed then call the
                                 Transfusion Medicine
                                 Physician on call
                                                 If the patient will require further blood
                                                 products, send another crossmatch
                                                 sample and requisition

** Shared Health provides 24/7 Transfusion Medicine on call support, call your paging
                department, blood bank… or HSC Paging to contact

The Back

The above actions will be required for all Major
transfusion reactions.

Suspected Bacterial Contamination

•   Cultures are to be drawn from patient using the above criteria
•   Patient should be closely monitored for signs and symptoms of shock when bacterial
    contamination is suspected
•   Physician who is ordering cultures on patient must also write order for blood bag
    contents to be cultured prior to sending the product back to the blood bank
•   Once blood is returned to the blood bank it is then sent to microbiology for culturing

Possible anaphylactic reaction
• Transfusion-associated anaphylactic shock is rare
• Anaphylaxis accounts for approximately 5% of transfusion associated
  deaths (Blood Easy 4, 2016)

• These signs and symptoms are common when TACO ( Transfusion associated
   circulatory overload) is suspected.
• Results from impaired cardiac function, and or excessively rapid rate of
   transfusion
• Incidence is 1:700 to 8% of transfusion recipients
• TACO is the most common cause of death from transfusion!
• Patients who are most susceptible:
     • Over 70 years of age, infants, patients with severe euvolemic anemia
        (hemoglobin

•   Could be TRALI (transfusion related lung
    injury)
•   Bacterial Contamination
•   Acute hemolytic transfusion
    reaction- can be associated with
    ABO- incompatibility
•   Anaphylaxis

Transfusion  Transmitted
   Transfusion            Injury
                Transmission     Surveillance
                             Information
               System (TTISS)
            Surveillance System

Quick Reference Guide
 *Optional Resource

*Optional Resource

Contacts
Blood Management Service office
       1-204-926-8006
          Darcy Heron
        Shared Health
       1-204-237-2707
            Email to
    bmsclinical@wrha.mb.ca

Acknowledgements
Transfusion Reaction Algorithm
  •   Dr. Charles Musuka
  •   Dr. Debra Lane
  •   Dr. Arjuna Ponnampalam
  •   Darcy Heron
  •   Lee Grabner
  •   Shana Chiborak
  •   Provincial Nurses Resource Working Group

Questions?

References
•   Dr. Kerry Gunn – Aukland District Health Board Blood transfusion Committee Chair- April 2013
•   Kirkey, S. (2013). Health experts confront the hidden hazards of blood transfusions. Retrieved from
    http://o.canada.com/news/blood-hazards
•   Daw, Z., Padmore, R., Neurath, D., Cober, N., Tokessy, M., Desjardins, D., Olberg, B., Tinmouth, A., & Giulivi A. (2008).
    Hemolytic transfusion reactions after administration of intravenous immune (gamma) globulin: a case series analysis.
    Transfusion, 48(8), 1598-1601. doi: 10.1111/j.1537-2995.2008.01721.x

For the complete PDF education
      package please go to
  www.bestbloodmanitoba.ca

Thank you!