Protocol for blood transfusions

[Chirley]

Hi,

I was just wondering if people can write in and describe the protocol used in their establishment for receiving blood.


I received 4 units of blood today at approximately 240 -250 millilitres per bag. The nurse also ran in 1 litre of saline. This was done over a period of around 5 hours. I was given IV Frusemide 20mgs after the first unit of blood.

My blood pressure when I arrived was 90/48 but after the third unit had risen to 150/90. The nurse herself, made the comment about how I would probably feel like I'm full of fluid and would probably need to pass a lot of urine in the next 12 hours or so.

I could feel my heart beating heavily and it was also radiating to my neck.

The protocol for observations taken during the transfusion are :

Blood pressure, pulse and temperature at the beginning and in the middle of each unit of blood.


I know that I'm young enough (53) and fit enough to tolerate a lot of fluid at the one time but even so, I still feel that it has an effect on me. I would really be worried if they tried to give that amount of fluid to my 82 year old father with a heart condition. I don't think his body would handle it.

Does your oncology unit take age and condition into consideration when giving blood ??

Just very interested.

Chirley today Hb 60 ANC 0.7 Lymphs 0.4 Platelets 210

[squirrellypoo]

Whoa 4 units in one day?? Both my hospitals will only give a max of 2 red (plus a platelet), as each bag runs over 2-2 1/2 hours. I'm guessing it's a time thing but probably also to avoid the fluid and blood pressure problems you've just described, which I've never ever heard of happening (and I've had my share of transfusions in the past!).

The blood pressure checks are like you described, but they also do pulse and temp at the same time.

[Lbrown]

One day I asked the nurse and the most they will give is 3 units of red cells. Each unit seems to range from about 250 mls to 350 mls. I get 2 units at a time and never have high BP. They take temp, pulse and BP regularly, and the only saline used is to flush the last bit of blood out of the line.

[Chirley]

Thanks for the answers. I think that it seems to depend on which nurse is looking after me as to how fast the blood and saline are run. The policy is for each unit to run over one and a half hours but sometimes the blood is run over half to three quarters of an hour.

I have a premed of hydrocortisone before the transfusion due to a previous reaction and then they wait half an hour before starting the blood. It's during this half hour that they start the 1 litre bag of saline and just run it in fully open. They then use this bag of saline to flush between each unit of blood and to flush at the end as well. The bag of saline is almost always empty by the time the transfusion is finished.

I agree 4 units is a lot and I wasn't expecting it. I am routinely booked to have 3 units every 3 weeks but this time the Hb had dropped a lot lower than it usually does so the doctor wanted the 4th unit as an add on. My doctors policy is one unit of blood for every 10 grams of Hb below 100 and then an extra unit to increase the Hb above 100.

Personally I would prefer the blood to be run slower because it does sometimes cause blood pressure changes and also makes me feel very cold. I was told once that when all the patients have finished their treatments, the nurses can go home, they don't have to wait until a set time. I think if this is true, it encourages the treatments to be given very fast. I know that once my port wasn't working properly and the blood was running slow and the nurse had to stay back after the end of shift and she wasn't very happy. She put a note on my chart to say that the blood had to be run through a pump so that it wouldn't run overtime again.

Please don't get me wrong. I'm very grateful for the genuine care that I receive at the day care and I do believe that they do the job to the best of their ability. I'm also grateful for all the blood donors. I would have been dead years ago if it wasn't for blood donors that give their time for no reward except the knowledge that they are doing something truly charitable. I worked out that I need a minimum of one blood donor a week and if I have another problem as well then I need more than one donor a week. That is a very humbling thought.

Chirley

[Lbrown]

At my hospital they pump in the blood at a rate of 200 ml per hour. So far I've had 11 red cell transfusions and only 2 units at a time. This is a bit of a pain a few times when I started at about 60, then needed to go back again the next week. They once opened up the saline to 500 ml per hour at the end.

I am thankful for blood donors too. How do you know how many units of red cells they get from a single donor?

[Chirley]

Good question. My assumption was that 1 donor gives 1 unit, too much more than that and they might become anaemic. Ha ha.

Before I became ill, I tried to donate blood but they wouldn't take it because I was anaemic. That was the first time I knew that I had anaemia and I didn't think much about it.

Maybe 1 unit of blood is made up from different donors, but I think they wouldn't like to do that in case they find a disease in the blood and then they have more trouble tracking down the donor. Just a thought.

I have to go to a work meeting now. They want me to retire on my income protection insurance. They are afraid that I might faint and hurt myself at work and then they would be liable. I want to keep working for as long as I can and I resent my employer for putting me through this stress simply to protect themselves "on the off chance" that I faint. I have worked for the same employer for over 22 years and have never made a claim on work insurance. They want loyalty from their employees but lack any form of loyalty TO their employees.


wish me luck.

Chirley

[Neil Cuadra]

Originally Posted by cme01

My assumption was that 1 donor gives 1 unit.

That's my understanding too, for whole blood donations. At our hospital they don't take less than 1 unit or more than 1 unit. With platelets, on the other hand, it's possible to donate more than 1 unit at once since the donor doesn't lose the volume of fluid that he/she does with a blood donation.

Blood donors have to wait a couple of months between donations but exceptions are made for directed donations, such as to a relative. That means that, in theory, they could combine the whole blood from 2 donations made by the same person, but I've never heard of that happening. I think it's safe to assume that if you get 1 unit of whole blood it's from 1 person and if you get 2 units of whole blood it's from 2 people.

Let us know how the meeting goes, Chirley. Maybe you'll still have a choice in the matter.

[Birgitta-A]

Hi Chirley,
Hope the result of your meeting was OK for you! Of cause you should work as long as you feel work doesn't have a negative impact on your health.
Kind regards
Birgitta-A

[Chirley]

Thanks for your best wishes. The meeting was stressful and had good and bad outcomes.

I met with the Chairperson and deputy Chairperson and the head of Occupational Health and Safety along with my Union representative. It was acknowledged that I was the most proficient, experienced and reliable staff member in my unit. That was nice, however, I was also told that I was a worry to the organisation because IF I were to faint, hit my head and lay unconcsious it would be their responsibility.

Consequently, as they had no reason to fire me, they altered my work hours. Now they want me to only work during the week because there are more people around if I faint. Unfortunately, it means I have to increase my work hours because I will be missing out on my weekend penalty rates. I already get very tired and increasing my work hours is going to be a burden on my health. It also means that I have to take sick leave to have my transfusions instead of having them on my days off.

When does political correctness end and logic take over? I am afraid we are going to politically correct ourselves into a bottomless abyss filled with people who are afraid to open their mouths.

Obviously I'm getting older and have an older persons view on where the world is heading. GOD HELP US. I empathise with the men and women who are in the show called "Grumpy Old Women/Men". They are me to a tee.(sp)

By the way, it's 2 days since my 4 units and I'm feeling very well. Just very frustrated.

I hope what I'm experiencing at work is just an Australian idiocy and not a worldwide trend.

I've now aired my frustrations and apologise to everyone for my whinge.

Chirley

[Neil Cuadra]

Chirley,

I'll bet that by "it would be their responsibility" they mean "they would be legally liable." But that's true for any on-the-job injury and they must be insured for such things. There's a tradeoff between risks in limiting the days you can work to ensure that more people are around but giving you longer hours that could make it harder for you to maintain your stamina. By common sense the decision should be up to you. If you really want to pursue it, you might consider getting a written recommendation from your doctor about an appropriate work schedule. Your employer might be more comfortable (or feel more legally protected) following a medical recommendation.

The ideal solution is for your endurance to return to normal so it won't be an issue at all!

[triumphe64]

There are programs where you can donate two units of red cells. The rest of the blood is returned to you. They wanted me to volunteer for that a few months before I couldn't donate at all. How ironic!

[Neil Cuadra]

Originally Posted by triumphe64

There are programs where you can donate two units of red cells. The rest of the blood is returned to you.

You are right! It's not offered at my donor center but it is at others:

There's information about the "MCS+ Mobile Collection System," which separates red cells from blood, in the FAQ at donate-blood.com.

Blood is collected via a single-use disposable kit and separated while a person is donating. It is spun until the blood components separated by weight-denser blood products, such as red blood cells, are pushed to the outside of the disposable centrifuge bowl and lighter products, such as plasma, remain near the middle. This separation process is more accurate than traditional whole blood collection, for which operators must manually separate blood components. It also allows for the collection of one or two complete units of blood components immediately ready for transfusion to a patient.