BLOOD

TRANSFUSION
 BLOOD TRANSFUSION
• Infusion of blood products for the
purpose of restoring circulating
volume.
• Administration of blood and blood
components requires knowledge of
correct administration techniques
and possible complications.
• A single unit of whole blood
contains 450 mL of blood and 50 mL
of an anticoagulant
 BLOOD TRANSFUSION
• May be whole Blood or blood components
( Platelets, Plasma , PRBC, Albumin )
• The procedure usually takes 1 to 4 hours,
depending on how much blood is needed.
• A unit (bag) of red blood cells usually takes
two to three hours to give. If needed, a
unit can be given more rapidly – for
example, to treat severe bleeding.
• A unit of platelets or plasma is given in 30
to 60 minutes.
 Blood Components
BLOOD DESCRIPTION INDICATION
Leukocyte- Most WBCs removed to
free PRBC: reduce risk of reaction

Whole blood: Most common blood shock, low blood volumes, low
product given in the hematocrit and hemoglobin,
hospital hemorrhage

Packed RBCs: Separated from plasma Used to treat anemia, and

reduce risk of volume overload
 Blood Components
BLOOD DESCRIPTION INDICATION
Fresh frozen separated from whole blood by Used to restore plasma volume,
plasma (FFP): a centrifuge process treat some bleeding problems

Cryoprecipitate • thawing fresh frozen used in cases of

plasma and collecting hypofibrinogenemia, which most
the precipitate often occurs in the setting of
• contains high massive hemorrhage or
concentrations of factor consumptive coagulopathy.
VIII and fibrinogen

Platelets Maintain normal coagulability Used to treat some bleeding disorders,

of blood and to compensate when marrow can
not produce enough
 SOURCES OF BLOOD
1. Autologous transfusion - A patient’s own blood may be
collected for future transfusion; elective surgeries where
the potential need for transfusion is high (eg, orthopedic
surgery).
• Preoperative donations are ideally collected 4 to 6
weeks before surgery.
• If the blood is not required, it can be frozen until the
donor needs it in the future (for up to 10 years).
• The blood is never returned to the general donor
supply of blood products to be used by someone else.
• Patients with cancer may donate for themselves.
Advantages of Autologous Transfusion :

• Prevention of viral infections from another

person’s blood
• safe transfusion for patients with a history of
transfusion reactions
• prevention of alloimmunization
• avoidance of complications in patients with
alloantibodies.
 Contraindications for
Autologous Transfusion
• acute infection,
• severely debilitating chronic disease,
• hemoglobin level less than 11 g/dL,
• hematocrit less than 33%, unstable angina,
• Acute cardiovascular or cerebrovascular disease.
• A history of poorly controlled epilepsy may be
considered a contraindication in some centers.
 SOURCES OF BLOOD
2. allogenic or homologous transfusion. - using another's blood.
• Blood is most commonly donated as whole blood intravenously and
collecting it with an anticoagulant.
• Donors should be in good health and without any of the following:
• history of urticaria, or allergy to medications, receiving a blood transfusion
or an infusion of any blood derivative , viral hepatitis, Malaria, syphilis,
drug abuse, skin infection, asthma, possible exposure to HIV, at any time
in the past, or a history of close contact with a hepatitis or dialysis patient
within 6 months, Pregnancy within 6 months, history of tooth extraction or
oral surgery within 72 hours, A history of exposure to infectious disease
within the past 3 weeks, Recent immunizations , recent tattoo, Cancer,
history of whole blood donation within the past 56 days
 Blood Donor’s Requirement
• Body weight: more than 50 kg (110 pounds) for a standard 450-
mL donation. Donors weighing less than 50 kg donate
proportionately less blood.
• 17 years old and above
• Oral temperature not more than 37.5°C (99.6°F).
• Pulse rate: regular and between 50 - 100 beats per minute.
• Systolic arterial pressure: 90 to 180 mm Hg, Diastolic pressure :
50 to 100 mm Hg.
• The hemoglobin level : at least 12.5 g/dL for women and 13.5
g/dL for men.
 Blood Storage Life
BLOOD Storage STORAGE LIFE
PRBC 4°C With special preservatives, they can
be stored safely for up to 42 days

PLATELETS ROOM only 5 days ; platelets are gently

TEMPERATURE agitated while stored

PLASMA IMMEDIATELY lasts for 1 year if it remains frozen;

FROZEN Plasma can be further pooled and
processed into blood derivatives,
such as albumin, immune globulin,
factor VIII, and factor IX.
 Type and Crossmatch

• Blood undergoes “type and crossmatch”:

• Typing to determine ABO and Rh factor
• Crossmatching to determine compatibility between donor
and recipient blood
• Blood Types: A, B, AB, O
• The Rh factor is made up of numerous complex
antigens
• When it is present, the person is Rh positive (Rh+); if not
present, the person is Rh negative (Rh–)
 Blood Typing

• An Rh positive person may receive either – or +

blood
• An Rh negative person must receive only Rh–
blood
• If an Rh– person receives Rh+ blood, antibodies will
form
• If another transfusion of Rh+ blood is given, the
antibodies will agglutinate with the Rh antigens of the
blood being transfused
Blood compatibilities
 Blood typing for transfusion

• Universal donor= O-
• Does not contain A, B, or Rh antigens
• Universal recipients= AB+
• Blood contains A, B, and RH antigens
• Usually blood banks exactly match the pt blood
 Blood Screening

• Prior to be being released for patient use

• testing for:
• Hepatitis C
• Human immunodeficiency virus (HIV)
Y-type blood tubing
 INDICATIONS OF BLOOD
TRANSFUSION
• Severe blood loss during major surgery, childbirth
or a severe accident
• anemia that has failed to respond to other
treatments
• inherited blood disorders, such as thalassaemia or
sickle cell anaemia
• An illness that causes bleeding, such as a bleeding
ulcer.
• An illness that destroys blood cells, such as
hemolytic anemia or thrombocytopenia
 Infusion Therapy Risks

• Risk factors:
• Disease transmission
• Hepatitis B, Hepatitis C, Hepatitis A, HIV ,
Syphillis)
• Bacterial contamination
• Acute or delayed transfusion reactions
• Allergic reactions
• Mismatched ABO
• Incompatible Death
• Circulatory overload
 Infusion Therapy Hazards

• Some risks specific to massive transfusion

(replacement of > one blood volume in 24 hours):
• Hypothermia
• Hemodilution
• Platelet dysfunction
• Electrolyte problems
 ADMINISTRATION PROCESS
PRE TRANSFUSION PHYSICAL ASSESSMENT
• Systematic physical assessment and measurement of baseline vital signs
• Respiratory system: auscultation of the lungs, use of accessory muscles.
• Cardiac system: edema, other signs of cardiac failure (eg, jugular venous
distention).
• Skin: Rashes, petechiae, and ecchymoses.
• EENT: sclera should be examined for icterus.
• ASSESS Transfusion history
• Previous transfusions, allergies and reactions
• Type of transfusion reaction, manifestations, and treatment
 Interventions
• Once the blood has been taken from the blood
bank, it must be administered within 30 minutes
• Use 18 or 20 gauge IV cannula
• Check vital signs prior to administration
• Use BT Set for administration
 Interventions
• The nurse must ensure:
• Positive patient identification
• Appropriateness of blood component
• Verification of donor – recipient compatibility
• Blood product inspection (checked by 2 licensed
nurses. )
 Verify product expiration date , name,
medical record number, type of blood,
blood band id, pt age
 administration of blood
• Monitor for blood reactions, vital signs continuously
during administration
• For first 15 minutes, run the transfusion slowly—no faster
than 5 mL/min.
• If no adverse effects occur during the first 15 min,
increase the flow rate unless the patient is at high risk for
circulatory overload.
• Signs of adverse reaction: restlessness, hives, nausea,
vomiting, torso or back pain, shortness of breath,
flushing, hematuria, fever, or chills.
 Administration of blood
• Administration time does not exceed 4 hr because
of the increased risk for bacterial proliferation.
• Be alert for signs of adverse reactions (Post
Transfusion) circulatory overload, sepsis, febrile
reaction, allergic reaction, and acute hemolytic
reaction.
• Change blood tubing after every 2 units
transfused, to decrease chance of bacterial
contamination.
• A platelet count may be ordered 1 hr after
platelet transfusion to facilitate this evaluation.
NURSING MANAGEMENT FOR
TRANSFUSION REACTIONS
If a transfusion reaction is suspected,
• Stop the transfusion.
• Maintain the intravenous line with normal saline solution through
new intravenous tubing, administered at a slow rate.
• Assess the patient carefully. Compare the vital signs with those
from the baseline assessment.
• Assess the patient’s respiratory status carefully. Note the
presence of adventitious breath sounds, use of accessory muscles,
extent of dyspnea (if any), and changes in mental status, including
anxiety and confusion.
NURSING MANAGEMENT FOR
TRANSFUSION REACTIONS
• Note any chills, diaphoresis, complaints of back pain, urticaria, and
jugular vein distention.
• Notify the physician of the assessment findings, and implement any
orders obtained.
• Continue to monitor the patient’s vital signs and respiratory,
cardiovascular, and renal status.
• Notify the blood bank that a suspected transfusion reaction has
occurred.
• Send the blood container and tubing to the blood bank for repeat typing
and culture. The identifying tags and numbers are verified.
 Transfusion Complications

• Noninfectious Complications (up to 1,000 times more likely

than an infectious complication)
A. Acute complications - occur within minutes to 24
hours of the transfusion, (Acute hemolytic reaction,
Allergic reaction, Anaphylactic reaction,
TRANSFUSION-ASSOCIATED CIRCULATORY OVERLOAD
B. Delayed complications - may develop days, months,
or even years later. (Delayed hemolytic reaction , Iron
overload, Overtransfusion or undertransfusion
• Infectious Complications (Hepatitis B, C virus)