BLOOD TRANSFUSION

GUMEDE O
 DEFINITION
Is the introduction of whole blood or blood
components i.e packed red cells, plasma,
platelets directly into client’s circulatory
system.
 INDICATIONS
 To restore circulating volume after severe
haemorrhage.
 To replace a deficiency of specific blood
components e.g. platelets, white blood cells e.t.c.
 To restore coagulation factor deficiences.
 To improve oxygen carrying capacity in severe or
chronic anaemia.
 To increase white blood cells to decrease chance
of infection or combat infection.
 TYPES OF BLOOD COMPONENTS
• WHOLE BLOOD
• Contains all blood components and is
transfused to clients who need both red blood
cells and volume replacement after significant
blood loss.
• A unit of whole blood is 500mls.
 PACKED RED BLOOD CELLS (RBCs)
Contains red blood cells with most plasma
removed.
Packed r.b.c provide the same oxygen carrying
capacity as whole blood but without the volume.
They are used to treat chronic anaemia.
Transfusing r.b.c prevents problems like fluid
overload and electrolyte imbalance since they
have less volume and less sodium and potassium
 WHITE BLOOD CELLS(WBCs)
 White blood cells or granulocytes can be
administered to clients with a low or abnormal
w.b.c count.
 They help in fighting infection.
 They are given to cancer patients with low
white cell count due to chemotherapy or
effects of cancer.
 PLATELETS
Platelets consist of platelet concentrates and
platelet rich plasma.
Platelets initiate blood clotting and
haemostasis.
Platelets are transfused in thrombocytopenia.
 FRESH FROZEN PLASMA (FFPs)
FFP is administered to provide clotting factors
to clients with coagulation deficiences who
are bleeding or about to undergo an invasive
procedure.
FFP is sometimes used as a volume expander.
 ALBUMIN
 Is a plasma protein contained within the
plasma.
 It is used to restore intravascular volume and
to maintain cardiac output in clients with
hypoproteinaemia and it carries no risk and
maybe given without regard to the client’s
ABO group or Rh factor.
 CRYOPRECIPITATE
Is a plasma protein rich in fibrinogen and
blood clotting factor viii.
It is administered to control bleeding in clients
with fibrinogen deficiencies e.g. in
haemophilia who genetically lack factor viii.
 BLOOD COMPATIBILITY
• Blood typing is testing the client’s blood type.
• Cross matching is the process of ensuring that
it is compatible with donor blood.
 BLOOD GROUPS
 ABO blood groups can be determined by testing
for antigens on the erythrocyte.
 Grouping is divided into 4 groups i.e A, B, AB,O
 The erythrocyte of a person in group A have the
A antigen, B have B antigen and AB have both
antigens.
 O have no antigens.
 Each blood group contains naturally occuring
antibodies ( agglutinins) in the serum.
 Blood groups cont.
 A has anti B antibodies, B has anti A
antibodies, AB has no antibodies, O has anti A
and anti B antibodies.
 Anti A antibodies destroy A antigen, anti B
destroy B antigen and this result in red cell
destruction called haemolysis.
 O is universal donor since it doesn’t have
antigens so it doesn’t fight or destroy other
blood types.
 Blood groups cont.
 AB is universal recipient as it doesn’t have
antibodies enabling accepting transfusion
from other blood types.
 RHESUS FACTOR
Rhesus factor is also important to determine
before transfusion to prevent incompatibility.
There is antigen D located on the surface of the
erythrocyte which determines that a person is
Rh positive.
The absence or lack of this antigen means the
person is Rh negative
If Rh positive blood is exposed to Rh negative
cells haemolysis occurs.
BLOOD TRANSFUSION PROCEDURE
• REQUIREMENTS
Trolley with packaged blood components from
blood bank grouped and cross matched
250mls 0,9% normal saline
Blood administration set with filter
Blood warming equipment
Spirited swabs in receiver
Strapping, paper packet, gloves
 PRETRANSFUSION PREPARATION
 Explain procedure to the client and obtain
written consent
 Review physician’s order for transfusion.
 Review laboratory form for blood group result
and rhesus factor.
 Inspect client’s current i.v for patency and
intactness.
 Assess the size of the cannula, a big size 18-19
gauge is preferred to facilitate transfusion flow.
 Prep cont.
 Put up normal saline and connect blood giving
set.
 Flush the line with normal saline and start the
flow while waiting for blood to warm to room
temperature.
 Obtain patient’s vital observations i.e BP,T,P,R as
baseline.
 Inspect patient’s body for any rashes and
exclude headache and backache.
 Prep cont.
 With another nurse(RGN) at the client’s
bedside, verify the blood product and the
client’s identity by comparing laboratory blood
record with:-
 The patient’s name, hospital number
 The blood group and Rhesus factor on blood
bag label.
 The blood unit number, expiry date
 Type of blood component
 Prep cont.
 Both nurses sign on transfusion record to
reduce chances of giving the wrong blood type
and causing a reaction which can be fatal.
 Remove normal saline after stopping the flow
and spike the blood component aseptically.
 Fill the giving set with blood.
 TRANSFUSION
Infuse blood slowly for the first 15minutes (10
drops/minute )since reaction occur within first 15-
20minutes.
Monitor and document vital signs every 5 minutes
during first 15minutes.
Assess for chilling, back pain, headache, nausea and
vomiting.
If any adverse reactions occur, close clamp, remove
blood and put up normal saline and notify physician
immediately.
 Transfusion cont.
Obtain urine and blood specimens and send to lab
with blood unit.
If no reactions after 15minutes, calculate and
regulate flow according to physician’s orders usually
4hrs for 500ml unit.
Monitor vital signs hourly until transfusion is
complete to detect any reactions or fluid overload.
When tansfusion is complete, clamp and put up
normal saline, infuse until tubing is clear.
 TRANSFUSION CONT.
If more blood is to be transfused, prepare the
unit, check and countersign as above while
normal saline is running, TKVO.
Obtain and document post transfusion vital
signs.
If transfusion orders are complete, disconnect
blood giving set and connect solution set and
put up normal saline.
Regulate to desired rate.
 Transfusion cont.
Keep the unit and tubing for 24hrs.
Wash hands and document procedure, enter
amount transfused on intake.
Frusemide i.v may be given per doctor’s
orders to prevent kidney damage.
Post transfusion haemoglobin level check is
done in 24hrs.