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Blood trasfusion reaction reporting format

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DrswatiguptaBajpai

This document outlines a transfusion reaction reporting format that collects information in 5 sections: 1) patient information, 2) transfusion product details, 3) nature of adverse reactions, 4) outcomes of adverse reactions, and 5) reporter information. It requests identifying and diagnostic information about the patient, details of transfused blood components, symptoms of any adverse reactions, outcomes like death or recovery, and contact information for the reporting individual. The goal is to systematically document transfusion reactions and their outcomes.

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Transfusion Reaction Reporting Format Blood & Blood Products A) PATIENT INFORMATION * Mandatory Field Patient initials* DOB/Age in years *: Blood Group *: _____ Diagnosis .Hospital Code No*.. Hospital Admission No. * ___________________ Sex: * F M Date & Time of Transfusion *.. Date & Time of reaction* . Date & Time of recovery. B) TRANSFUSION PRODUCT DETAILS* Components Select Unit Number Expiry Manufact urer Batch Indicati ons 1st time / Repeat Component s (transfu sed) Date Numbe r Transfusion (No. of Repeats) Whole Blood Red Blood Cells Platelets Apheresis Platelets Pooled/ RDP Solvent detergent (SD) Plasma FFP Cryoprecipitate Any other Blood Products (Please Manufact urer Batch Number Expiry Date Specify) C) NATURE OF ADVERSE REACTIONS * Reactions Please Tick () 1 Immunological Haemolysis due to ABO Incompatibility 2 Immunological Haemolysis due to other allo- antibodies 3 Non Immunological Haemolysis 4 Transfusion Transmitted Bacterial Infection 5 Anaphylaxis / Hypersensitivity 6 Transfusion Related Acute Lung Injury (TRALI) 7 Transfusion Transmitted Viral Infection (HBV) 8 Transfusion Transmitted Viral Infection (HCV) 9 Transfusion Transmitted Viral Infection (HIV-1/2) 10 Transfusion Transmitted Viral Infection, other (Specify) 11 Transfusion Transmitted Parasitic Infection ( Malaria) 12 Transfusion Transmitted Parasitic Infection, other (Specify) 13 Post Transfusion Purpura 14 Transfusion Associated Graft versus Host Disease (TAGvHD) 15 Febrile Non Haemolytic Reactions(FNHTR) 16 Transfusion Associated Dyspnea(TAD) 17 Transfusion Associated Circulatory Overload (TACO) 18 Other Reaction(s)
Transfusion Reaction Reporting Format Blood & Blood Products D) OUTCOMES OF THE ADVERSE E) REPORTER * REACTIONS* Name and professional Address: __________________ Death following the adverse reactions ______________________________________________ Recovered Pin Code : _________________ Email: _______________ Recovered with sequelae Tel No. (with STD code)__________________ Permanently disabled Unknown Any other information F) CAUSALITY Date of this report (DD/MM/YYYY) ASSESSMENT*
Transfusion Reaction Reporting Format Blood & Blood Products

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Blood trasfusion reaction reporting format

  • 1. Transfusion Reaction Reporting Format Blood & Blood Products A) PATIENT INFORMATION * Mandatory Field Patient initials* DOB/Age in years *: Blood Group *: _____ Diagnosis .Hospital Code No*.. Hospital Admission No. * ___________________ Sex: * F M Date & Time of Transfusion *.. Date & Time of reaction* . Date & Time of recovery. B) TRANSFUSION PRODUCT DETAILS* Components Select Unit Number Expiry Manufact urer Batch Indicati ons 1st time / Repeat Component s (transfu sed) Date Numbe r Transfusion (No. of Repeats) Whole Blood Red Blood Cells Platelets Apheresis Platelets Pooled/ RDP Solvent detergent (SD) Plasma FFP Cryoprecipitate Any other Blood Products (Please Manufact urer Batch Number Expiry Date Specify) C) NATURE OF ADVERSE REACTIONS * Reactions Please Tick () 1 Immunological Haemolysis due to ABO Incompatibility 2 Immunological Haemolysis due to other allo- antibodies 3 Non Immunological Haemolysis 4 Transfusion Transmitted Bacterial Infection 5 Anaphylaxis / Hypersensitivity 6 Transfusion Related Acute Lung Injury (TRALI) 7 Transfusion Transmitted Viral Infection (HBV) 8 Transfusion Transmitted Viral Infection (HCV) 9 Transfusion Transmitted Viral Infection (HIV-1/2) 10 Transfusion Transmitted Viral Infection, other (Specify) 11 Transfusion Transmitted Parasitic Infection ( Malaria) 12 Transfusion Transmitted Parasitic Infection, other (Specify) 13 Post Transfusion Purpura 14 Transfusion Associated Graft versus Host Disease (TAGvHD) 15 Febrile Non Haemolytic Reactions(FNHTR) 16 Transfusion Associated Dyspnea(TAD) 17 Transfusion Associated Circulatory Overload (TACO) 18 Other Reaction(s)
  • 2. Transfusion Reaction Reporting Format Blood & Blood Products D) OUTCOMES OF THE ADVERSE E) REPORTER * REACTIONS* Name and professional Address: __________________ Death following the adverse reactions ______________________________________________ Recovered Pin Code : _________________ Email: _______________ Recovered with sequelae Tel No. (with STD code)__________________ Permanently disabled Unknown Any other information F) CAUSALITY Date of this report (DD/MM/YYYY) ASSESSMENT*
  • 3. Transfusion Reaction Reporting Format Blood & Blood Products