The patient is identified from both the hospital identification band and blood bank band . Two health care professionals (one the administering nurse) verify the patient's ABO and Rh blood type and its compatibility with the unit of blood or packed cells to be administered, as well as the unit's expiration date and time. Outdated blood is not used; it is returned to the blood bank for disposal. The blood or blood product is retrieved from the blood bank refrigerator immediately before administration because blood should not be stored in other than approved refrigerators. Blood cannot be returned to blood bank storage if the unit's temperature exceeds 50°F (10°C), a change that will occur within about 30 min of removal from storage.

Before the transfusion is started, the patient's vital signs (including temperature) are checked and recorded. The blood is inspected visually for clots or discoloration, and the transfusion is administered through an approved line containing a blood filter, preferably piggybacked through physiological saline solution on a Y-type blood administration set. No other intravenous solutions or drugs should be infused with blood (unless specifically prescribed) because of potential incompatibility. In the first 15 min, the blood flow rate is slowed to limit intake to no more than 50 mL. A health care professional remains with the patient during this time and instructs the patient to report any adverse reactions, e.g., back or chest pain, hypotension, fever, increase in temperature of more than 1.8°F (1°C), chills, pain at the infusion site, tachycardia, tachypnea, wheezing, cyanosis, urticaria, or rashes. If any of these occurs, the transfusion is stopped immediately; the vein is kept open with physiological saline solution, and the patient's physician and the blood bank are notified. If incompatibility is suspected, the blood and set are returned to the blood bank; samples of the patient's blood and urine are obtained for laboratory analysis of: hemoglobin in the urine; prothrombin time/international normalized ratio (protime/INR); blood culture; complete blood count; chemistries; and identifying data are recorded from the unit. If no symptoms occur in the first 15 min and vital signs remain stable, the transfusion rate is increased to complete the transfusion within the prescribed time, or (if necessary) the transfusion is administered as fast as the patient's overall condition permits. Once the transfusion begins, the blood is administered within a maximum of 4 hr to maintain biological effectiveness and limit the risk of bacterial growth. (If the patient's condition does not permit transfusing the prescribed amount within this time frame, arrangements are made to have the blood bank split the unit and properly store the second portion.) The patient's vital signs and response are monitored every 30 min during the transfusion and 30 min afterward; stated precautions are observed, and caregivers monitor for indications of volume overload (distended neck veins, bounding pulse, hypertension, dyspnea). Blood should not be administered through a central line unless an approved in-line warming device is used. A warmer should also be used whenever multiple transfusions place the patient at risk for hypothermia, which can lead to dysrhythmias and cardiac arrest. Patients planning elective surgery, e.g., hip, knee replacement, hysterectomy, may bank one or two units of their own blood in the weeks before surgery for use if needed. Blood-saving devices are also used in such surgeries, and this blood is returned to the patient before he or she leaves the operating theater.

cadaveric blood t.A transfusion using blood obtained from a cadaver shortly after death.

direct t.Transfusion directly from one person to another.

exchange t.The removal of all of a patient's blood volume (as in sickle cell disease, thrombotic thrombocytopenic purpura, hyperviscosity states, or hemolytic disease of the newborn) and its replacement with blood donated by others. SYN: replacement transfusion.

feto-fetal t.Twin-twin transfusion

granulocyte t.

ABBR: GTX

indirect t.A transfusion of blood from a donor to a suitable storage container and then to the patient.

intrauterine t.The infusion of blood cells into a fetus, to treat prenatal diseases such as erythroblastosis fetalis.

massive t.1The replacement of at least half of a person's blood cells in less than 24 hr.2The transfusion of ten or more units of packed red blood cells in 24 hr to a single patient.

Common complications include the dilution of coagulation proteins and platelets (increasing the probability of bleeding); a decrease in the plasma calcium concentration (transfused blood is stored in citrate, which binds calcium); metabolic alkalosis (citrate generates bicarbonate); hypothermia (blood is stored cold and must be warmed before it is infused); and alterations in the serum concentration of potassium.