• Blood must be given immediately at the time that it is needed. Re-evaluate the patient immediately prior to transfusion to ensure that blood is still required to save life

• Only use blood which is free of HIV, has been properly grouped and cross matched and is in the correct bag labelled for the patient

• Remove the bag of blood from the Blood Bank refrigerator just before transfusion

• Never transfuse blood which has been out of the refrigerator for more than one hour or out of the donor for more than 21 days

• Give frusemide (1 mg/kg STAT) IV at the beginning of the transfusion (but only if the patient is NOT actively bleeding). If patient has heart failure, give frusemide immediately; do not wait until blood is available [see annex b paediatrics dosage]

• Give antimalarial drugs (full course) to all patients having blood transfusion

• For children, the volume of blood to be transfused [V] may be determined by use of the formula:

V = 6WD if whole blood is used

OR

V = 3WD if packed red cells are used

where W is the weight of the child in kilograms and D is the Hb deficit, ie. the difference between the initial Hb before transfusion and the desired Hb for age after transfusion

• Neonates less than one week old who may require exchange transfusion should be referred

• Transfusion of adults requires a minimum of 2 units of blood. Transfusion of only 1 unit in an adult is probably not needed.

Transfusion Reactions

If the patient develops fever, skin rash or becomes ill, then:

• Stop blood transfusion immediately

• Give chlorpheniramine 5 mg IV STAT OR 5 mg 1M STAT (children 0.4 mg/kg STAT)

• Return blood to the bank with a fresh sample of patient's blood

• Monitor urine output

• Monitor cardiovascular & renal function

• If hypotension develops start IV fluids.