The safe transfusion of blood and blood products is an essential skill in everyday practice. The risk associated with this has the potential to be significant in terms of harm to the infant or child. Transfusion-transmitted infections are a potential hazard. A complex procedure, a safe transfusion practice depends on good teamwork at every stage of this multi-faceted procedure. In accordance with the Blood Safety and Quality Regulation (2005), it is a legal requirement that every unit of blood is traceable from donor to recipient.

Infants and children generally require red cell transfusion to treat anaemia and haemorrhage. Diagnosis of anaemia is confirmed by measurement of haemoglobin levels. There is no threshold level for transfusion; a complete clinical assessment will determine the need to transfuse with red cells.

Platelets and fresh frozen plasma may be administered when thrombocytopenia is diagnosed to prevent or to cease haemorrhage.

There are over 200 identified blood groups, however, it is the ABO and Rh D blood systems that are familiar to nursing practice. Blood groups are inherited. The ABO group is identified in the table. Patients with blood group A will have an A antigen on the membrane of their red cells. Its function is to stimulate the production of anti-B antibodies that circulate in the plasma and offer defence to the body against B antigens that are present on the surface of the red cell membrane of B and AB red cells. Thus, a patient who is blood group A can only receive group A or group O blood, as people who are blood group O have neither A or B antigens and they produce A and B antibodies in their plasma.

Rh D refers to its presence or absence on the surface of the red cell membrane. When present, the patient will be Rh D positive, when absent, it will be reported as Rh D negative blood group. Antibodies against the Rh factor are developed through placental sensitization or transfusion. Haemolytic disease of the newborn may occur when the mother is Rh D negative and the biological father is Rh D positive and the baby’s blood is Rh D positive. When the baby’s blood crosses into the mother’s circulation via the placenta, Rh D antibodies may be produced by her immune system, resulting in haemolysis of the baby’s red cells.

• Ensure consent is obtained and the procedure understood by the child and parents/carers with potential problems made aware to them as they will need to alert healthcare staff promptly if any such problems occur.
  
• Assist with the cannulation procedure in accordance with local guidelines, ensuring the cannula is secured correctly and is patent by flushing it using a pulsatile flushing action with 0.9% sodium chloride.
  
• Pre-transfusion medication should be administered as prescribed.
  
• Ensure the blood or blood product has been prescribed on the infant’s/child’s prescription chart with the name of the blood component/product to be administered clearly legible, the amount to be transfused and the duration of transfusion stated.
  
• Record the temperature, heart rate/pulse, respiratory rate, blood pressure and SaO₂ level as a baseline and note these as pre-transfusion observations on the infant’s/child’s chart.
  
• Arrange for the blood component to be collected giving the four points of patient identification to the person designated to collect it:
  
  
  
  1. Forename
     
  2. Surname
     
  3. Date of birth
     
  4. Hospital identification/NHS number.

The collection document must be signed, ideally by the health care professional who requested it, and it should have the four points of patient identification, the time of collection and the time of delivery. The blood component should be checked and the transfusion commenced immediately or as soon as possible on its receipt in the clinical area. If delayed, then the blood transfusion laboratory must be contacted for advice.

• Before commencing the transfusion, a final bedside check must be done. The 14-digit donation number on the National Blood Service unit label bar code should match the unit identification label on the compatibility tag attached to the bag.
  
• Check the patient information on the unit with the infant’s/child’s identification wristband: they should match.
  
• Prime the intravenous administration giving set with the blood/blood product. The type of giving set to be used will depend on the product being administered. Commence the infusion at the prescribed rate. The rate of the infusion will depend on the product being administered. When transfusing red cells, the rate of the infusion should be slower for the first 15 minutes than the prescribed rate. In an emergency situation, transfusion rates may be increased.

• All empty units must remain in the clinical area until the current transfusion is completed and then returned to the blood transfusion laboratory or disposed of in the clinical area as per local policy dictates.
  
• If the child has had an adverse reaction, then the bag must be returned to the blood transfusion laboratory.
  
• Ensure the transfusion procedure has been documented accurately in the infant’s/child’s records.

Adverse reactions range from mild to severe. They can be life-threatening and are mostly due to ABO incompatibility as a result of human error or misidentification of the infant/child at any stage in the transfusion process.

Symptoms of infective shock are:

• muscle pain;
  
• pyrexia;
  
• hypotension;
  
• tachycardia;
  
• rigors;
  
• wheeze/dyspnoea;
  
• shocked appearance.

Irrespective of the nature of the reaction, the transfusion MUST always be stopped immediately and prompt medical review must occur. If the child has collapsed, then begin basic life support.