Blood Groups There are more than 20 blood group systems, including 600 different antigens. It is advisable that patients be transfused with blood that is ABO and RhD compatible and, if possible, compatible for the full Rh type, Kell, Kidd and Duffy. As many blood group systems as possible should be aimed for and, where possible, identified before initiation of transfusion since, these proteins can stimulate antibody production. Following the first transfusion, patients should ideally be tested for the presence of new antibodies to RBCs before each successive transfusion and the results carefully reported. In addition, it is important to avoid transfusion of blood from first-degree relatives (haploidentical donors), as this can increase the risk of developing a serious fatal complication known as transfusion-associated graft-versus-host disease (TA-GVHD*). This risk is higher in countries that do not have national, voluntary, non-remunerated blood donation policies, where patients must provide their own blood donor very often a family member. In this situation, the blood should be irradiated to eliminate the risk of TA-GVHD*. Filtering, Age and Storage of Blood The blood to be transferred to patients who need regular transfusions, should be filtered prior to storage to avoid white blood cell (WBC) interactions, and should be as fresh as possible, preferably not more than 10 days old. Storage temperature (4oC) and transfusion of blood temperatures should be very closely monitored and checked at all times. Pre-Transfusion Management - The nurse’s role The patient and family should be involved in the decision to initiate blood transfusions and adequate information and explanation should be provided. The patient should be given simple and clear information explaining the risks and benefits of transfusion, and what to expect. This should also include written information in the form of leaflets. Blood transfusions should be carried out in a familiar location, such as a day-care unit or thalassaemia centre, or in a designated area within the hospital, by experienced nursing staff competent in the administration and supervision of the process. Once a decision to commence transfusion has been reached, relevant protocols should be followed to ensure that the procedure is safe and effective. Where such protocols have not been established, the haemoglobinopathy unit should aim to do so as soon as possible. A wealth of information, knowledge and experience is available from relevant websites as required. * Transfusion - Associated Graft versus Host Disease
43