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Blood Transfusion

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What is Blood transfusion?

Introduction of whole blood or components into the venous circulation

Blood Transfusions can save LIVES !A mainstay in the treatment of patients

whose low blood count can compromised their lives

Carries risk in various degrees of transfusion reactions as well as transmission of blood-borne pathogens

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Purposes of Blood Transfusion

To restore blood volume after severe hemorrhage

To restore the capacity of the blood to carry oxygen

To provide plasma factors (antihemophilic factor , factor VIII) or platelet concentrates which prevent bleeding

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Blood groups

Human blood is classified into 4 groupsBlood type A,B , AB and O,The presence of a specific antigen in the

erythrocytes’ surface determines the blood type of the person

Antigens can cause antibody reactions when in contact with mismatched blood

Mismatched blood can cause a hemolytic reaction

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Rh Factor

Rh or Rhesus factor was discovered in 1940Rh antigens are also present in the surface

of erythrocytesPresent in about 85% of the populationCan cause hemolytic reactions in persons

with antibody to that antigenReferred to as Rh positive or Rh negative

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BLOOD COMPONENTSBlood Products for Transfusions

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Whole blood

Includes all the blood cells ( RBCs, WBCs,) and plasma

One unit of whole blood is 500 mlReplaces blood volume and blood products:

( RBCs, plasma, plasma protein, fresh platelets and other clotting factors

Primarily used for cardiac surgery or acute hemorrhage

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Packed Red blood cells

PRBCs are left after the plasma is separated out of whole blood

Used for routine blood replacement during surgery

Used to increase the oxygen- carrying capacity of blood in anemias and disorders with slow bleeding

1 unit raises hematocrit by approx 4 %

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Platelets

May come as a single unit from multiple donors or multiple units from a single donor

Used in patients with bleeding disorders from illness, medications, trauma or organ dysfunction or with platelet deficiency

Fresh platelets are most effective

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Plasma

Expands blood volume and provide clotting factors

No need to be typed and crossmatch

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Albumin

A protein manufactured by the liver Blood volume expander and provides plasma

proteins Maintains osmotic pressure that causes fluid to

remain within the bloodstream instead of leaking out into the tissues

Needs to be transfuse if albumin gets low Is not a component that must be cross-matched

but is considered as a blood product

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Clotting factors and cryoprecipitate

Obtained by slowly thawing a unit of FFP or fresh frozen plasma

“Cryo” is the recovered cold precipitate which is rich in certain clotting factors

Used for clients with clotting factor deficiencies ( factor VIII and XIII) and those with DIC syndrome

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Transfusion Reactions

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Transfusion Reactions

Blood from the donor and from the recipient are tested for compatibility

Referred to as typing and crossmatchingUsed to assess a client closely for

transfusion reactions2 types of transfusion reaction:

Hemolytic

Nonhemolytic

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I. Hemolytic Reaction

Incompatibility between client’s blood and donor’s Clinical signs: Chills, fever, headache, backache, dyspnea, cyanosis,

chest pain, tachycardia , hypotension Nursing intervention 1.Discontinue the transfusion immediately 2. Keep the vein open with normal saline or accdg to agency protocol 3. Send the remaining blood, a sample of the client’s blood , and a

urine sample to the laboratory 4. Notify the physician immediately 5. Monitor vital signs 6. Monitor intake and output

 

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II. Nonhemolytic reactions

Febrile reactionsAllergic reactionsFluid overloadSepsis

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Febrile reactions

Febrile reactions Sensitivity of the client’s blood to white blood cells,

platelets, or plasma proteins Clinical signs: chills, warm, flushed skin. headache;

anxiety, muscle pain Nursing intervention 1. Discontinue the transfusion immediately 2. Give antipyretics as ordered 3. Notify the physician

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Allergic reactions (mild)

Sensitivity to infused plasma proteins Clinical signs: flushing, itching, urticaria, bronchial

wheezing Nursing intervention 1. stop or slow the transfusion, depending on

agency protocol 2. notify the physician 3. administer medication (antihistamine) as

ordered

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Allergic reactions (severe)

Antibody-antigen reactions Clinical signs: dyspnea, chest pain, circulatory collapse ,

cardiac arrest Nursing intervention: 1. stop the infusion 2. Keep the vein open with PNSS 3. Notify the physician immediately 4. Monitor vital signs. Administer CPR if needed 5. Administer medications and/or oxygen as ordered

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Circulatory Overload

When blood is administered faster than the circulation can accommodate

Clinical signs: cough, dyspnea,crackles (rales),distended neck veins, tachycardia, hypertension

Nursing intervention: 1. Place the client upright ,with feet dependent 2. Administer diuretics and oxygen as ordered 3. Notify the physician 4. Stop or slow the transfusion

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Sepsis

Contaminated blood administered Clinical signs: High fever, chills, vomiting , diarrhea, hypotension Nursing intervention 1. Stop the infusion 2. Send the remaining blood to laboratory 3. Notify the physician 4. Obtain a blood specimen from the client for culture 5. Administer IV fluids, antibiotics

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Blood Administration

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Important considerations

Gather the pertinent data; know the purpose of the transfusion Confirm the physician’s order for the number and type of units

and the desired speed of infusion Obtain blood in plastic bag from the blood bank; place the blood

in a tray covered with a towel One unit of whole blood is 500 mL; a unit f PRBC is 200-250 mL Ensure that blood is typed and cross matched properly Blood administration is not delegated to a UAP; but UAP must

know the complications or adverse effects of blood transfusion and report it to the nurse

Note any premedication ordered by the physician; schedule the administration (usually 30 minutes prior to transfusion)

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Equipment

Unit of whole blood, packed RBCs, or other component Blood administration set with 170-200 u filters Supplemental blood filters , if needed IV pump if needed 250 ml normal saline for infusion IV pole Venipuncture start kit ( including a gauge 20 needle or

catheter); g 19 in some agencies Alcohol swabs Tape Sterile gloves

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Equipment

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Preparation

Verify client consent and obtain baseline data before the transfusion

Assess vital signs for baseline date Determine any known allergies or previous

reactions to blood Note specific signs related to the client’s pathology

and the reason for the transfusion Establish the intravenous line; check whether the

needle is appropriate to administer blood

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Preparing the IV infusion

Explain to the client what you are going to do, why it is necessary and how she can cooperate.

Provide for client privacy and prepare the client. Check the client’s identification; ensure the right patient Assist the client in a comfortable position; expose the IV site but

provide for client privacy Wash hands and observe appropriate infection control procedures Prepare the infusion equipment; ensure that blood filters inside the drip

chamber is suitable for the blood component Put on gloves; close all clamps on the Y-set Insert the piercing pin (spike) into the saline solution and hang on IV

pole about 36 inches above the venipuncture site Prime the tubing; start the saline solution

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Performance

Obtain the correct blood component for the client; check the physician’s order with the requisition

Check the requisition form and the blood bag label with a lab tech or according to agency policy

Check the client’s name, ID no, blood type and Rh group, blood donor number and expiration date of the blood

Observe the blood for abnormal color, clumping, gas bubbles and extraneous material

Compare the laboratory blood bag label with client’s data If any information does not match exactly, notify the charge

nurse and the blood bank

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Important considerations

Make sure that RBC are left at room temperature for no more than 30 minutes before starting the infusion

If the start of the transfusion is unexpectedly delayed return the blood into the blood bank

Do not store blood in the unit refrigerator DO NOT ADMINISTER BLOOD UNTIL DISCREPANCIES

ARE CORRECTED OR CLARIFIED

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Prepare for transfusion

Invert the blood bag gently several times to mix the cells with the plasma

Expose the port on the blood bag by pulling back the tabs Insert the remaining Y spike into the blood bag Suspend the blood bag Establish the blood transfusion; closed the upper clamp below the IV

saline solution; open the upper clamp below the blood bag; readjust the flow rate with the main clamp

Run the blood slowly for the first 15 minutes at 20 drops/ minute Observe the client closely for the first 15 minutes Note any adverse reactions and remind the client to call a nurse

immediately if any unusual symptoms are felt during the transfusion

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Document relevant dta

Record starting the blood, including vital signs, type of blood, blood unit, sequence number, site of venipuncture, size of the needle and drip rate.

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Care of the client

Monitor the client fifteen minutes after initiating the transfusion

Establish the required flow rate if there are no signs of reaction

Do not transfuse a unit of blood for longer than 4 hours Assess the client including V/S every 30 minutes or more

often, depending on the health status Terminate the infusion if no infusion is to follow Discard the administration set according to agency policy Fill in the time the transfusion was completed on the

requisition or monitoring sheet and the amount transfused Document relevant data

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Variation: Infusing other blood components

Platelets: pooled platelets usually contain 200 – 400 mL;

Do not refrigerate platelets and keep them agitated at all times

Fresh frozen plasma: 200 to 250 mL/unit; infuse within 24 hours of thawing , at 5- 10 ml /minute

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References:

Clinical Nursing Techniques :Kozier et alContemporary Medical-Surgical Nursing:

Daniels, et alBrunner and Sudarth Medical- Surgical

Nursing : Smeltzer and Bare

Thank you…

Vina Virgo-Velasco RN

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