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ABSTRACT
OBJECTIVE: This study was conducted to determine the knowledge level of healthcare workers about blood
transfusion.
METHODS: The study was conducted between October 1, 2015 and November 2, 2015 with 100 healthcare per-
sonnel working in a training and research hospital. A survey consisting of 19 questions based on the literature was
prepared and administered. In addition to descriptive statistical methods (frequency), Fisher’s exact chi-square test
and Yates’ correction for continuity were used to compare qualitative data. Significance was assessed at p<0.05.
RESULTS: Of the total, 52% of the participants were ≤29 years of age and 94% were women. In all, 71% were
nurses and 42% had been working at the hospital for 2 to 5 years. Seventy-nine percent indicated that they had
been trained in blood and blood product transfusion, 86% stated that transfusions were performed to replace de-
ficient blood volume, and 95% responded that blood was to be requested by a physician, and 97% indicated that
informed consent of the patient should be obtained for a blood transfusion. In all, 78% of respondents identified
crossmatching as the final check for ABO compatibility. With respect to blood unit quality, 90% of the respondents
stated that they would return blood if the label could not be read and 98% would reject the product if the integrity
of the blood bag was compromised or of the blood had a cloudy or foamy appearance. In the event of a patient
experiencing fever and shock, 96% of the survey participants indicated that they would consider that it could be
a reaction to a blood transfusion. The need to confirm the patient’s identity and the type of blood products was
corroborated by 91%, and 85% agreed that no other medication should be added to the blood to be transfused.
Furthermore, 88% of the study participants approved of continuous training regarding the transfusion of blood
and blood products.
CONCLUSION: According to the results of this research, while the knowledge of the healthcare professionals
surveyed was adequate, standardization was lacking. In this respect, it may be advisable to conduct further stud-
ies on blood transfusion practices, and to provide additional in-service training to ensure patient safety and avoid
medical errors.
Keywords: Blood; education; health worker; nurse; transfusion.
Received: January 31, 2017 Accepted: June 22, 2017 Online: August 26, 2017
Correspondence: Selma DAGCI. Saglik Bilimleri Universitesi,
Umraniye Egitim ve Arastirma Hastanesi, Istanbul, Turkey.
Tel: +90 216 - 632 18 18 e-mail: selma.dagci@gmail.com
© Copyright 2017 by Istanbul Northern Anatolian Association of Public Hospitals - Available online at www.kuzeyklinikleri.com
166 North Clin Istanb
n %
most important cause of transfusion-related deaths, of any transfusion reaction. In a study performed
attention to these measures has the utmost impor- by Faukaneli et al., it was indicated that the risk of
tance [15, 18]. overlooking a transfusion reaction exists in 10% of
Early recognition of complications occurring patients due to failure to record patient vital signs
during or as a result of a blood transfusion requires and symptoms during the pre-transfusion period
the close observance of the nurse before, during, [21]. The patient should be observed directly for the
and after the transfusion. In the study conducted first 15 minutes after the initiation of a blood trans-
by Lahlimi et al., it was reported that of 42 nurses, fusion and checked thereafter at intervals (every 15
40% had incomplete information about potential minutes). In their study, Taylor et al. reported that
post-transfusion reactions [19]. Blood transfusion vital signs and symptoms of patients were observed
reactions are classified as acute or delayed reaction in 88% of cases [22]. The Hijji et al. study of 49
[15, 18]. Blood transfusions are an important cause nurses reported that 35% observed their patients at
of morbidity and mortality. Therefore, it is very im- bedside for the first 15 minutes of the transfusion.
A smaller percentage of the nurses monitored pulse
portant that nurses can recognize a blood transfu-
rate (35%) and body temperature (32%) of their pa-
sion reaction and know the measures to be taken in
tients throughout the first 15 minutes of the blood
response [15, 18].
transfusion [23].
Though each blood reaction manifests differ-
In our study, in the category of “What informa-
ently, they have some common symptoms. Most fre-
tion about transfusion is true?” a multiple choice
quently seen manifestations include a fever, chills,
question, “At what time points is the transfusion
shivering, nausea and vomiting, tachycardia, dys-
patient to be checked on?” (before beginning trans-
pnea, cyanosis, low back pain, chest pain, urticaria,
fusion, at 30 minutes, at every hour during trans-
erythema, a burning sensation along the transfused fusion, at termination of the transfusion, 4 hours
vein, headache, dizziness, hypotension, and hema- after termination of the transfusion) was responded
turia [15, 18]. to correctly by 45% of the participants. This sug-
In our survey, in response to the question, gests that there is a lack of compliance with blood
“What symptoms suggest a blood transfusion re- transfusion follow-up directions at the training and
action?” 55% of the participating healthcare work- research hospital where this investigation was con-
ers selected lower back/chest pain, 84% said rash, ducted.
96% indicated presence of a fever, and 84% noted A blood bag must be without any hole or leak,
sudden fluctuation in blood pressure. Importantly, and should not contain hemolyzed blood or coagu-
this result demonstrates that more than 50% of our lum. In a study entitled “Improving the process of
participants knew the most frequently encountered blood transfusion at a public hospital in the Turkish
complications of a blood transfusion. A study per- Republic of Northern Cyprus” by Erkoc et al., the
formed by Sazama et al. stated that a nurse’s lack of authors reported that after providing transfusion
attention to manifestations of patient reaction and nurses with pocket-sized information about the im-
continuation of administration of a blood transfu- plementation of transfusion, the majority of nurses
sion led to the death of a patient [20]. Encourag- checked for the presence of hemolysis (90.4%) and
ingly, the staff participating in our study knew of clotting (90.9%) in plasma, and holes or leaks in
nearly all (96%) of these manifestations. Bayraktar blood bags (91.8%) [24].
et al. found that fever and shivering were the most Bayraktar et al. also found that nurses did not
frequently known symptoms of blood transfusion verify the safety of blood bags. In our survey, par-
reaction among nurses [15]. This result is consis- ticipants responded to the multiple choice question
tent with that of our study. of “When should blood or a blood product be re-
Monitoring vital signs and symptoms during the jected?” as follows: when the blood has a cloudy or
pre-transfusion period facilitates the determination foamy appearance (90%), when the integrity of the
170 North Clin Istanb
blood bag is compromised (90%), when the label in- Lundy et al. determined that blood tubes had
formation on the blood bag cannot be read (98%), been sent to the laboratory without personal identi-
and when blood storage conditions are not safe fying information on the label in 17% of cases stud-
(86%). The majority of survey participants (93%) ied. Personal ID information should be written on
knew the conditions under which a blood product the label of the blood tube to be used when blood
should be returned. is drawn in order to eliminate the possibility of an
The flow rate of a unit of transfused blood empty tube being used for the sample of another pa-
should be adjusted to the duration of the transfu- tient or the ID label of another patient being mis-
sion (maximum 4 hours). If a transfusion were to takenly affixed to the tube [28, 29]. A total of 75
last more than 4 hours, bacteria can grow in blood healthcare professionals participating in our study
secondary to increased room and blood tempera- responded to the question “When do you put the
ture. Prolonged transfusion may also lead to the de- barcode for crossmatching on the tube?” with the
velopment of hemolysis [15, 18]. A question on this response “at the time blood sample is taken.” Put-
topic was answered correctly by 32% of the nurses ting a label with the patient information barcode on
in the study of Bayraktar et al. and 61.6% of the the tube at the time of blood collection will prevent
nurses in a study conducted by Benli et al. [15, 18]. cases of misidentification and help to ensure patient
In our study, 90% of the participants responded to
safety [28, 29].
the question, “For how long may a transfusion be
given?” by choosing the answer “whole blood and In various studies it has been established that
erythrocyte suspension are to be delivered within nurses did not know enough about complications
4 hours.” This was consistent with the result of the that may occur in a blood transfusion or the signs of
Benli study. potential complication [18, 30], and did not moni-
In the literature, it has been stated that the first tor patients [15, 16], yet they knew to terminate
step in the prevention of the improper implemen- blood transfusion promptly in the event complica-
tation of transfusion is to draw blood from the tions did arise [18, 30] and did so [16].
right patient and to ensure correct labeling [25]. There are studies from abroad in the literature
At least 2 identifiers are recommended for the that report mortality and serious morbidity as an
proper identification of the patient; these should outcome of improper blood transfusion [19]. Stud-
not include the patient’s room number or bed ies performed in Turkey have indicated that the
number [26]. There is no study from Turkey in attending physician was informed about the devel-
the literature reporting taking a blood sample for opment of complications related to blood transfu-
pre-transfusion testing from the wrong patient as sion [15, 16]. In the present study, it was also ob-
a result of misidentification of the patient; howev- served that the respondents knew to terminate a
er, this may be a result of inadequate reporting of transfusion when complications developed. Nearly
errors. Many relevant studies from other countries all (99%) of the participants replied to a multiple
have been shared [25]. In a study performed by choice item in our survey regarding the procedures
Chiaroni, et al., the authors indicated that in some
to be followed in cases of suspected blood transfu-
cases, patients were not correctly identified be-
sion reaction with “I immediately stop the transfu-
cause of similarities in name, surname, birth date,
sion.” This correlates with the high level of aware-
etc. In another study, inability to correctly identify
name, surname, birth date, and gender of a patient ness of transfusion reactions reflected in other
led to a blood sample being drawn from the wrong survey questions.
patient [27]. Lumadue et al. found cases of misla- Limitations of the study: Since the data of this
beling of samples as a result of the incorrect name, survey are limited to the responses given by health-
surname, or hospital ID number assigned to the care professionals working at a training and research
patient. hospital, the results cannot be generalized.
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