Blood Transfusion

Blood Transfusion Opener

This module describes how to order and transfuse blood products safely to prevent potentially fatal transfusion reactions.


Although the decision to transfuse blood products should be individualised, the Clinical Guidelines for the Use of Blood Products in South Africa recommend:

  1. Red cell components:

    1. Acute blood loss > 30% of blood volume
    2. Pre-operative Hb < 8 g/dl where blood loss > 500 ml is expected
    3. Intra- or postoperative Hb < 7 g/dl
    4. Hb < 8 g/dl in acute coronary syndromes
    5. Hb < 8 g/dl with symptoms of anaemia
    6. Hb < 6 g/dl in patients with obstetric haemorrhage
  2. Whole blood

    1. Exchange transfusions in neonates
    2. Massive haemorrhage
  3. Platelets

    1. Patients with active, severe bleeding and thrombocytopenia
    2. Prophylactically in some cases of severe thrombocytopenia
    3. Given with massive infusions
  4. Fresh frozen plasma

    1. Inherited clotting factor deficiencies
    2. Acquired clotting factor deficiencies such as DIC and liver disease with active bleeding
    3. Reversal of warfarin overdose
    4. Thrombotic thrombocytopenic purpura
    5. Vitamin K deficiency with active bleeding
    6. Suxamethonium apnoea
    7. Given with massive infusions

Massive infusions (more than 10 units in 24 hours) generally involve giving packed red cells, platelets and fresh frozen plasma in a 1:1:1 ratio.


  1. Informed

    of blood product transfusion

  2. Red cell components

    • Compensated chronic anaemias such as nutritional anaemias
  3. Platelets

    • Autoimmune thrombocytopenia, thrombotic thrombocytopenic purpura, or heparin-induced thrombocytopenia


Always verify your patient’s identity and obtain written informed consent before proceeding.

How do I explain this procedure?

“I need to give you some blood, because [explain the indication]. This blood has been matched to be similar to yours, and has been checked in the laboratory to be safe for you to receive. It’s important that you understand and agree to the transfusion. The law requires that you sign a consent form.”

What can my patient expect?

“I will put up a drip and give you the blood over a few hours. It will sting when I prick your skin with the needle, but receiving the blood itself does not hurt.”

What is my patient’s role?

“Let me know if you have any allergies or medical conditions. Fearing blood or needles is normal, but tell me if you have fainted from it. It is very rare for patients to get a reaction to the blood, but let the staff know immediately if you start to feel strange or unwell.”


  1. Confirm the identity of the patient and draw a blood sample for group and

    .

  2. Complete the blood bank requisition forms in duplicate and take them with the blood sample to the blood bank.

  3. Fetch the blood from the blood bank when it is ready. Take a patient label with you to confirm the patient’s identity with the blood bank staff.

  4. Bring the

    to the patient’s bedside.


Follow medical asepsis with non-sterile gloves.

  1. Identify the patient. Two healthcare professionals should confirm that the same patient information is present on the blood unit, the papers from the blood bank, and the patient’s folder.

  2. Check that the blood unit has no leaks or clots, is not expired, and is the correct product.

  3. Insert an IV cannula,

    Be particularly meticulous about aseptic technique. Blood infusions are particularly vulnerable to bacterial colonisation, and blood is an excellent culture medium.

  4. Take baseline observations before starting the infusion.

  5. an intravenous administration set with a blood filter using normal saline. Use a platelet giving set when administering platelets, but a blood giving set can also be used if a platelet giving set is not available. Close the roller clamp and detach the bag.

  6. Tear off the port protector and attach the unit of blood to the administration set.

  7. Start the infusion. Set the

    of the infusion.

  8. Dispose of medical waste safely.

  9. Write

    for the nurses on the orders/prescription chart, specifically the name, volume and duration of the infusion. Vital signs should be recorded every 15 minutes for half an hour, then every 30 minutes for the duration of the transfusion. In cases of acute haemorrhage, observations should be continued every 15 minutes for the duration of the transfusion. Additionally, observe patients with cardiac or renal disease, who are at risk of circulatory overload, for 12-24 hours after the transfusion.

  10. Record the completion of the procedure in patient notes.


I’m unsure whether I should warm the blood.

It is not important to warm blood given slowly and in small volumes, but blood given to infants and in massive transfusions should be warmed in a blood warmer. Do not use a warm water bath or microwave to warm blood, because of the risk of haemolysing the outer layer of blood.

I’m unsure whether I can add antibiotics or other IV medications to the blood bag.

Do not add anything to a blood bag. If there is no other IV access available, you can add a Y-piece to the section of the administration set closest to the patient and infuse medication or fluids in this way.

I’m unsure how to recognise a transfusion reaction.

The patient may complain of chills, pain, shortness of breath, dizziness, a rash, or pruritis. The vital signs may be deranged, with tachycardia, pyrexia, tachypnoea, and hypotension. The patient may develop jaundice, anuria or haemoglobinuria. Severe reactions may present as anaphylaxis.

I’m unsure how to treat a transfusion reaction.

Stop the infusion and keep the IV access patent by using a new administration set with normal saline. Keep the blood and the old administration set. Contact the blood bank for advice.


  1. See Peripheral Venous Access
  2. Transfusion reactions
  3. Circulatory overload

  1. National Institute for Health and Care Excellence. Blood Transfusion (NG24). 2015. Available from: https://www.nice.org.uk/guidance/ng24
  2. Western Cape Blood Service & South African National Blood Service. Clinical Guidelines for the Use of Blood Products in South Africa. 5th edition. 2014. Available from: https://www.wcbs.org.za/wp-content/uploads/2020/06/clinical_guidelines_5th-Edition_2014.pdf
  3. Engelbrecht D. How To Give a Blood Transfusion. In: Mash B, Blitz-Lindeque J, eds. South African Family Practice Manual. 2nd ed. Pretoria: Van Schaik Publishers; 2010: 333-335.