MSF blood transfusion guidelines for nurses and doctors

by dahbaao · Published July 20, 2024 · Updated July 27, 2024

Nurses and doctors play a vital role in saving life of the patient hits by a devastating disease condition in MSF humanitarian field.

They perform different types of medical procedures to assist people and save their life.

Blood transfusion is among the medical procedure perform for the patient with anemia that their Hb level drops to abnormal level.

In this article we are going to talk all you need to know about MSF blood transfusion guidelines.

It will cover blood transfusion request by the doctor and the safe transfusion by the nurse in MSF humanitarian settings.

This article will provide nurses and doctors about the comprehensive knowledge about MSF blood transfusion guidelines. Let’s get started now.

Why do we transfuse blood?

When a patient present with anemia in the hospital we need to give blood to assist the patient survive.

But before the transfusion a nurse or a doctor should check the clinical sign of anemia and the Hb level to make that the patient need to be transfuse with a blood.

Because some patients with anemia can be treated with appropriate medication.

Understanding Anemia

Before we go deep, there is need for Us to understand the meaning of anemia. This will give us the clear picture of the condition.

Definition of Anemia

Anemia is the decrease in the amount of red blood cells. Anemia cause decrease in Hemoglobin levels to drop below the reference values, check different value of Hb level below.

Hb level for blood transfusion

When a nurse or a doctor observe clinical manifestation of anemia in a patient he should check the Hb level and decide whether to transfuse blood to the patient or not. Below are the Hb level that indicates blood transfusion in a patient.

We are going to explain them based on the age, gender and the condition of the patient.

Children
Men
Women
Pregnant women

Children 2 – 6 months:

Hb < 4 g/dl Even in the absence of signs decompensation.

6 months to 14 years children:

Hb ≥ 4 g/dl and < 6 g/dl Presence of:

Signs of decompensation
Severe Malaria
Sickle cell disease
Heart disease
Serious bacterial infection

Men and Women:

Hb < 7 g/dl Presence of:

Signs of decompensation
Severe Malaria
Sickle cell disease
Heart disease
Serious bacterial infection

Pregnant women < 36 weeks:

Hb ≤ 5 g/dl. Even in the absence of signs decompensation.

Hb > 5 g/dl and < 7 g/dl Presence of:

Signs of decompensation
Severe Malaria
Sickle cell disease
Heart disease
Serious bacterial infection

Pregnant women ≥ 36 weeks

Hb ≤ 6 g/dl Even in the absence of signs decompensation.

Hb > 6 g/dl and < 8 g/dl Presence of:

Signs of decompensation
Severe Malaria
Sickle cell disease
Heart disease
Serious bacterial infection

Anaemia may be caused by:

Decreased production of red blood cells:

Iron deficiency, nutritional deficiencies (folic acid, vitamin B12, vitamin A), depressed bone marrow function, certain infections (HIV, visceral leishmaniasis), renal failure;

Loss of red blood cells:

acute or chronic haemorrhage (ancylostomiasis, schistosomiasis, etc.);

Increased destruction of red blood cells (haemolysis):

parasitic (malaria), bacterial and viral (HIV) infections; haemoglobinopathies (sickle cell disease, thalassaemia); intolerance to certain drugs (primaquine, dapsone, co-trimoxazole, etc.) in patients with G6PD deficiency

Signs and Symptoms

Fatigue
Dizziness
Tachycardia
Pallor of the conjunctivita, palm of the hands. etc
Oedema
Respiratory distress
Angina.

MSF blood transfusion guidelines

Indications

Clinical tolerance of anaemia
Underlying conditions (cardiovascular disease, infection, etc.)
Rate at which anaemia develops.
Hb levels

Volume to be transfused

In the absence of hypovolaemia or shock:

Children < 20 kg: 15 ml/kg of red cell concentrate in 3 hours or 20 ml/kg of whole blood in 4 hours.

Children ≥ 20 kg and adults: start with an adult unit of whole blood or red cell concentrate; do not exceed a transfusion rate of 5 ml/kg/hour

Repeat if necessary, depending on clinical condition.

Before the transfusion

Before transfusion is started, consent should be obtained, and the patient’s wristband, blood unit label, and compatibility test report must be checked at the bedside to ensure that the blood component is the one intended for the recipient. Let’s see it step by step.

Explain the procedure to the patient or caregiver

Explain the patient or the caregiver about the blood transfusion, that he need to be transfuse with blood or her child need to be transfuse with blood.

Make sure they are clear with the procedure and the explanation should be in a language they understand most.

Include the benefits of the blood transfusion to their patient and the potential side effects and complications.

Sign the Consent form for transfusion

In MSF humanitarian setting there is a form containing some details about the blood transfusion procedure, that is what you explain to the patient or caregiver.

If the patient or the caregiver agree with the procedure they should sign or one of their adults relative that understands the procedure should sign the consent form.

Receiving the blood from laboratory.

A nurse should confirm with the laboratory staff that the blood is the actual one for the patient and all the materials needed from the lab are available with the blood bag.

what you should check

Patient case folder
Request forms
Blood unit number is the same with that on the request form.
Check the patient ID number on the case folder to see whether it is the same with that on the blood request form
Check ABO grouping Card
4 mixing sticks
0.9% normal saline

After you confirm with the lab staff that all the materials are available then you collect the blood and continue.

From the nurse side: Equipment

Pulse oximeter
Thermometer
Timer
Handgloves
Cotton wool
Blood transfusion Giving set (pediatric)
Wrist watch
Lancet or Fricker
Alcohol swab

Performing bed side grouping.

Bed side grouping assist a healthcare professional doing blood transfusion with an accurate and safe blood transfusion procedure to the patient. It helps to confirm the blood is actually for the patient and is compatible with the patient for transfusion.

Blood grouping card contain field to put details of the patient and the donor, make sure you put the accurate details of both usually patients’ details come first then the donor.

Both patients and the donor fields have spaces containing field with Antisera A and B.

Use your normal saline and make one small drop on the antiseras to make it wet.

Use alcohol swab and clean the patients’ finger, use your lancet and frick the finger. Make a single drop on Antisera A and B on the patient field.

Use your one mixing stick and mix the tick of blood and normal saline together with the antisera, make sure it is mixed.

Do the same for the donor, get the blood from the blood unit bag and mix.

The blood may agglutinate or not, check the interpretations below.

The blood GROUP A: Agglutination take place on antisera A only

Blood GROUP B: Agglutination take place on antisera B only

Blood GROUP AB: Agglutination take place on antisera Aand B.

GROUP O: No Agglutination take place on both antisera

Blood transfusion Monitoring

Monitor the patient’s condition and vital signs (heart rate, blood pressure, respiratory rate, temperature):
During the transfusion: 5 minutes after the start of transfusion, then every 15 minutes during the first hour, then every 30 minutes until the end of the transfusion.
After the transfusion: 4 to 6 hours after the end of the transfusion.

Blood transfusion Documentation

A healthcare provider should records everything he does to the patient.

Managing complications

If signs of circulatory overload or any transfusion reaction happens.

Stop temporarily the transfusion.
Treat allergic reaction with transfusion.
Sit the patient in an upright position.
Administer oxygen .
Administer furosemide by slow IV:
Children: 0.5 to 1 mg/kg
Adults: 20 to 40 mg
Repeat the injection (same dose) after 2 hours if necessary.
Once the patient has been stabilised,start the transfusion again after 30 minutes.

Reference: MSF Clinical guidelines

MSF blood transfusion guidelines for nurses and doctors