Transfusion Therapy and Blood Component Administration
Before the blood arrives
Confirm informed consent, verify the type and screen/crossmatch specimen, and check that the order specifies the product, volume, and any irradiation or leukoreduction requirement. Baseline vital signs are required. Use 0.9% sodium chloride as the only compatible diluent; lactated Ringer's contains calcium and is not used with blood. Blood tubing with an in-line filter is required, and no medications are added to a blood component.
At the point of administration
Two qualified individuals independently verify patient identifiers against the unit label - name, medical record number, blood type, unit number, and expiration. Begin slowly for the first 15 minutes and remain at the bedside during that window. Complete each unit within 4 hours of spiking to limit bacterial proliferation.
Recognizing and managing reactions
Febrile nonhemolytic (most common): fever, chills - stop, evaluate, treat per policy. Mild allergic: urticaria without other symptoms. Acute hemolytic (often ABO error): fever, chills, flank or back pain, hypotension, dark urine, DIC - stop immediately, maintain IV access with saline, notify the provider and blood bank, return the unit and tubing. TRALI: acute hypoxemia and bilateral infiltrates within 6 hours. TACO: dyspnea, hypertension, jugular venous distention, crackles from volume overload.
Trap: calling every reaction "stop the transfusion" without distinguishing mild urticaria (may be paused and treated, then resumed per policy) from a hemolytic reaction (stop permanently).
Worked example: Ten minutes into a unit the patient has a fever of 38.9 °C, back pain, and dark urine. Action: stop the transfusion, keep the vein open with saline through new tubing, notify the provider and blood bank, and return the bag and tubing.