Guidelines for Safe Planned Blood Transfusion in Adults

Pre‑Transfusion Phase

Obtain documented informed consent before the procedure – the patient must be informed of the indication, benefits, risks (including transfusion reactions, infections, and TACO) and alternatives such as cell salvage; consent is recorded in the anaesthetic record. 1
Assess patients > 45 years for TACO risk factors – evaluate for silent myocardial ischemia, underlying ischaemic heart disease, heart failure, renal failure, hypo‑albuminaemia and low body weight. 1
Dose red‑cell units according to body weight and use a slower transfusion rate in high‑risk patients to reduce circulatory overload. 1
Order blood components based on a clear clinical indication (e.g., anaemia, massive hemorrhage) as recommended by the American Society of Anesthesiologists. 7
Record baseline vital signs (heart rate, blood pressure, temperature, respiratory rate) within 60 minutes before starting the transfusion and document them in the patient record. 1

Perform positive patient identification at the bedside immediately before transfusion; verification must occur at the bedside, not in advance. 1
Establish large‑bore intravenous access (ideally ≥8 Fr) for massive transfusion scenarios to ensure adequate flow. 1
Use blood‑administration sets equipped with inline filters to trap micro‑aggregates and debris. 1
Prepare warming devices for both the patient and blood products to prevent hypothermia‑induced coagulopathy. 1

Monitor vital signs 15 minutes after the start of transfusion and record them. 1
Continuously observe respiratory rate; new dyspnoea or tachypnoea are early indicators of serious reactions. 1
Obtain a full set of vital signs at the completion of each unit of blood. 1
Record vital signs again 15 minutes after the transfusion ends. 1
If a transfusion reaction is suspected, stop the transfusion immediately and keep the IV line open with normal saline. 1
For suspected TACO, discontinue the transfusion, administer diuretics and provide supplemental oxygen. 1
For febrile reactions, give intravenous paracetamol; for allergic reactions, give an antihistamine. 1
Avoid routine use of steroids or antihistamines as pre‑medication unless specifically indicated. 1

Document 100 % traceability of the transfused component (type, volume, donation number, blood group, expiry date/time) in the patient record; records must be retained for 30 years. 5
Record the total number of units and cumulative volume transfused in the operative notes. 5
If allogeneic blood was given, clearly state the clinical justification in the documentation. 5
Inform the patient before discharge that they have received blood components and that they are no longer eligible as a donor. 5
Notify the patient’s general practitioner of the transfusion. 5
Report any serious adverse events to the hospital transfusion committee and the national reporting system, including details of the reaction, timing, management and laboratory notification. 5

Never perform identity verification away from the bedside or in advance – bedside verification is the single most effective safeguard against ABO incompatibility errors. 1
Do not transfer blood without the transfusion laboratory’s knowledge; maintain the cold chain and traceability throughout the process. 1
Do not transfuse blood that has been at room temperature for > 6 hours after haemodilution. 5
Avoid rapid transfusion in older patients with cardiac or renal comorbidities; administer units slowly, one at a time. 1
Do not use indiscriminate steroid pre‑medication in immunocompromised patients. 1