Post Transfusion Review and Interrupted Transfusions

After the unit is complete, the clinician checks whether the transfusion worked, whether any reaction occurred and what is needed next. Interruptions and delays also need clear rules, because partially used units and units that wait too long are unsafe.

Safety preparation.

• Ensure the transfusion is finished or stopped, and the line is flushed.

• Have access to the observation chart, the prescription and the latest laboratory results.

• Know the hospital time limit for units out of storage.

Special groups.

• Children and neonates: weight based assessment and caution with repeated doses.

• Patients with sickle cell disease: avoid raising haemoglobin over 10 g/dL.

• Patients at risk of delayed haemolysis: previous alloimmunisation, multiply transfused, sickle cell disease.

At completion. Observations, volume given and symptoms. Flush the line. Dispose of the empty bag and giving set as the hospital directs, except after a reaction, when they are retained and returned to the blood bank.

Review of effect.

• Haemoglobin about 1 hour after completion in a non-bleeding patient (the expected rise is about 1 g/dL for one adult unit).

• Platelet count 10 minutes to 1 hour after platelets.

• Coagulation and fibrinogen 15 to 60 minutes after plasma and cryoprecipitate.

• Clinical response: symptoms, vital signs, bleeding.

Documentation. Date, volume, outcome, reaction, and the plan.

After a completed transfusion.

1. Record final observations and any symptoms.

2. Check the laboratory response at the right time.

3. Decide whether further transfusion is needed, using the same thresholds and reassessing symptoms, not only the number.

4. Treat the cause of the anaemia, bleeding or coagulopathy.

5. Before discharge, tell the patient to report jaundice, dark urine, fever, fatigue or breathlessness in the next 3 to 14 days, which can indicate delayed haemolysis.

Interrupted transfusions.

• Non-reaction causes (cannula failure, equipment problem, procedure): clamp the line, keep the unit as the hospital allows, and restart only if the unit remains within 4 hours of leaving controlled storage and has been kept at the right conditions. Otherwise discard it and prescribe a new unit if needed.

• Never return a partly used unit to the blood bank for reissue.

• Reaction: stop, assess, keep access, recheck identity, inform the blood bank, and do not restart without authorised clinical evaluation.

Delayed transfusions.

• If a unit is not started within 30 minutes of leaving controlled storage, return it to the blood bank at once if it is unopened and has been kept as validated. If not, it is discarded.

• Do not store blood in a ward refrigerator.

• If the delay is due to a patient problem, re-plan with the blood bank before collecting another unit.

• For urgent indications, tell the blood bank about the delay so they can prepare another unit.

Wrong unit or error. Stop, treat the patient, retain the unit and report the event.

Complications. Delayed haemolytic reaction, delayed serological reaction, iron overload with repeated transfusion, unrecognised overload, and transmission of infection (rare, with lookback).

Documentation. Reason for interruption, amount transfused, discarded product and the plan for any replacement.

Quality assurance. Audit post transfusion haemoglobin checks, discarded units, units out of storage too long, and reaction reports. Include these in the transfusion committee's review.

Referral and escalation. Haematology for unexpected response, suspected delayed haemolysis or new antibodies, and the blood bank for any incident.