ST.

MARY'S COLLEGE OF NURSING

Assignment work :
BLOOD TRANSFUSION

SUBJECT:CLINICAL SPECIALITY-1 (MEDICAL SURGICAL

NURSING)

SUBMITTED TO : SUBMITTED BY:

Ms.JIJI MAM Ms.DEEPIKA SINGH

 BLOOD TRANSFUSION
INDEX
TITAL PAGE NO.
1 INTRODUCTION
2 INDICATIONS
3 CONTRAINDICATIONS
4 EQUIPMENT

PREPARATION FOR BLOOD

TRANSFUSION
5

TECHNIQUE OR TREATMENT
6
7 COMPLICATIONS

ENHANCING HEALTHCARE TEAM

OUTCOMES
8
9 BIBLIOGRAPHY
 BLOOD TRANSFUSION

INTRODUCTION
Medicine has made significant progress in understanding circulation in the past few
hundred years. For millennia medicine believed in the "four humors" and used
bloodletting as a treatment. In the 1600s, William Harvey demonstrated how the
circulatory system functioned. Shortly after that, scientists became interested in
transfusion, initially transfusing animal blood into humans. Dr. Philip Syng Physick
carried out the first human blood transfusion in 1795, and the first transfusion of
human blood for treating hemorrhage happened in England in 1818 by Dr. James
Blundell.
Rapid strides have been made in understanding blood typing, blood components, and
storage since the early 1900s. This has developed into the field of transfusion medicine.
Transfusion medicine involves laboratory and clinical medicine, and physicians from
multiple specialties, such as pathology, hematology, anesthesia, and pediatrics,
contribute to the field. Charles R. Drew was an American surgeon who was one of the
pioneers in blood banking early in World War II. Transfusion of red blood cells has
become a relatively common procedure. In the United States, around 15 million units
are transfused annually, while about 85 million units are transfused worldwide
Blood is typically stored in components. Fresh whole blood has always been thought of
as the standard for transfusion; however, medical advancement has allowed the
efficient use of the different components, such as packed red blood cells (PRBCs),
individual factor concentrates, fresh frozen plasma (FFP), platelet concentrates, and
cryoprecipitate. Consequently, current indications for whole blood transfusion are
generally very few. The US military buddy transfusion system is the most widespread
system of whole blood transfusion.Additionally, whole blood transfusion in civilian pre-
hospital settings and the trauma bay is seeing a resurgence in some regions. The
hemoglobin in red blood cells binds oxygen and is the body's main source of oxygen
delivery. A single unit of packed red blood cells is roughly 350 mL and contains about
250 mg of iron.

INDICATIONS
Guidelines on red blood cell transfusion from the American Association of Blood Banks
advise a restrictive approach for stable patients with non-hemorrhaging anemia. While
there could be variations, anemia is usually defined as a hemoglobin level of less
than 13 g/dL in males and less than 12 g/dL in females. While currently, a more
restrictive threshold is used to determine the indication for transfusion,
previously, a liberal strategy, typically using a cutoff of hemoglobin less than 10
g/dL, was used, regardless of symptoms.
Currently, guidelines for the transfusion of red blood cells (RBC) generally follow a
restrictive threshold. While there is some variation in the number for the threshold, 7
g/dL is an agreed-upon value for asymptomatic healthy patients. Multiple studies have
shown this is an acceptable threshold in other patient populations, including those
with gastrointestinal (GI) bleeding and critically ill patients. The guidelines
recommend a value of 8 g/dL as the threshold in patients with coronary artery disease
or those undergoing orthopedic surgeries. However, this may be secondary to the lack
of literature on using a threshold of 7 g/dL in the evaluation studies of these
patient populations. The guidelines and clinical trials on transfusion
requirements in critical care (TRICC) also recommend a value of 7 g/dl as the
threshold for critically ill patients.
The transfusion of fresh frozen plasma (FFP) is common, but there are limited specific
indications for its use. There is insufficient evidence for its use in many clinical
scenarios, such as prophylaxis in non bleeding patients. FFP transfusion is sometimes
indicated in bleeding patients to replace lost coagulation factors. Clinical situations
fulfilling this criterion include cardiopulmonary bypass, massive transfusion,
decompensated liver disease, extracorporeal pulmonary support techniques, or acute
disseminated intravascular coagulation.
Platelet transfusion is beneficial in cases of platelet deficiency or dysfunction. In
patients with bone marrow failure, prophylactic platelet transfusion is indicated when
there are no other risk factors for bleeding and platelet counts are below 10 X
10/L. If other associated risk factors exist, the threshold to transfuse may be
raised to 20 X 10/L. A prerequisite to invasive procedures is platelet counts
greater than 50 X 10/L. In the case of active hemorrhage, platelet transfusion
should be done when thrombocytopenia contributes to the hemorrhage, and the
platelets are less than 50 X 10/L. When there is diffuse micro vascular bleeding,
the platelets should be maintained above 100 X 10/L.

CONTRAINDICATIONS
There are no absolute contraindications, but some patients or their patients
(in pediatric cases) may refuse to receive transfusions on religious grounds. Whole
blood transfusion is not indicated when component-specific treatment is available, such
as using red blood cells to treat anemia or using fresh frozen plasma to treat
coagulopathy. Whole blood transfusion could lead to many complications, for instance,
volume overload, which is why it is advisable to use component therapy whenever
possible.
EQUIPMENT
The suggested equipment required for a blood transfusion includes the following:
 Blood components or whole blood could be provided through various central
venous access devices or peripheral intravenous catheters. The following sizes
should be considered:
1. 20-22 gauge for routine transfusion in adults
2. 16-18 gauge for rapid transfusion in adults
3. 22-25 gauge for pediatrics
 The requirements for administration sets might vary
 Blood filters
  The administration of platelet-poor plasmas requires supplies that often differ by
product and brand.
 Infusion devices, such as infusion pumps, blood warmers, rapid infusers, and
pressure devices, can be used to transfuse blood components.
 A pressure infusion device may be needed for the rapid transfusion of blood
components.
 A blood warmer device is often needed to prevent hypothermia in the rapid
administration of cold-blood components, for instance, in trauma settings or operation
theatres.
PREPARATION FOR BLOOD TRANSFUSION
Preparation for blood transfusion involves running pre transfusion testing for
compatibility between recipient antibodies and donor red blood cells. This involves
obtaining a sample of the recipient’s blood to send for a type and screen. The type and
screen test verifies the recipient’s blood type and also determines if the recipient has
any “unexpected” (non-ABO) antibodies that might cause a reaction.
Find Current Type and Cross match
 Take a blood sample, which lasts up to 72 hours
 Send the sample to the blood bank
 Ensure that the blood sample has the correct labeling with the date and timing
 Wait for the blood bank to crossmatch and prepare the needed units
Obtain Informed Consent and Health History
 Discuss the procedure with the patient
 Confirm the past medical history and any allergies
 The supervising provider should have obtained signed consent from the patient
Obtain Large-bore Intravenous Access
 This is 18 gauge or larger IV access
 Each unit should be transfused within 2-4 hours
 A second IV access should be secured in case the patient needs additional IV
medications
 Normal saline is the only fluid that can be administered with blood products
Assemble Supplies
 Y tubing with an in-line filter
 0.9% NaCl solution
  Blood warmer
Obtain Baseline Vital Signs
 These include heart rate, temperature, blood pressure, pulse oximeter, and
respiratory rate
 Respiratory sounds and urine output should also be documented
 Notify the provider if the temperature is more than 100 F
Obtain Blood from the Blood Bank
 Once the blood bank notifies that the blood is ready, its delivery from the blood
bank should be ensured
 Packed red blood cells can only be given one unit at a time
 Once the blood has been released for the patient, there are 20-30 minutes to
begin the transfusion and up to four hours to complete it.

TECHNIQUE OR TREATMENT
Here are some of the general steps providers should follow when carrying out a blood
transfusion:
 Verify Blood Product
 Relay the features of a transfusion reaction to the patient. The patient should
inform the nursing staff during the transfusion if these appear.
 Baseline vital signs, lung sounds, urine output, and skin color

 Prepare the Y tubing with 0.9% NaCl and have the blood unit ready in an infusion
pump
  The blood should be run slowly for the first fifteen minutes, for instance, 2 ml/min
or 120 ml/hr
 Staff should be supervising the patient for the first fifteen minutes as this is when
most transfusion reactions happen
 The rate of transfusion can be increased after this period if the patient is stable
and does not display any signs of a transfusion reaction
 Document vital signs after fifteen minutes, then every hour, and finally, at the end
of the transfusion
 During the transfusion, look for any signs of transfusion reactions
 If a reaction is suspected, stop the transfusion immediately
 Disconnect the blood tubing from the patient
 Inform the provider, stay with the patient and assess the status
 Document everything
 After the transfusion, flush Y tubing with normal saline and dispose of used Y
tubing in the biohazard bin
 Obtain post-transfusion vital signs
 After the procedure, some patients could experience soreness at the puncture
site, but this should dissipate quickly.

COMPLICATIONS
There are multiple complications of blood transfusions, including infections, hemolytic
reactions, allergic reactions, transfusion-related lung injury (TRALI), transfusion-
associated circulatory overload, and electrolyte imbalance.
According to the American Association of Blood Banks (AABB), febrile reactions are the
most common, followed by transfusion-associated circulatory overload, allergic reaction,
TRALI, hepatitis C viral infection, hepatitis B viral infection, human immunodeficiency
virus (HIV) infection, and fatal hemolysis which is extremely rare, only occurring almost
1 in 2 million transfused units of RBC.
For comparison, the lifetime odds of dying from a lightning strike are about 1 in 161,000.
A list of approximate risk per unit transfusion of RBC (adapted from AABB clinical
guidelines published JAMA November 15, 2016) will be discussed here.
Adverse Event and Approximate Risk Per Unit Transfusion of RBC
 Febrile reaction: 1:60
 Transfusion-associated circulatory overload: 1:100
 Allergic reaction: 1:250
 TRALI: 1:12,000 (Transfusion related acute lung infection)
 Hepatitis C infection: 1:1,149,000
 Human immunodeficiency virus infection: 1:1,467,000
 Fatal hemolysis: 1:1,972,000

ENHANCING HEALTHCARE TEAM OUTCOMES

Our understanding of blood transfusion has improved dramatically over the past three
decades. Unlike before, empirical blood transfusions are no longer the norm. While
blood products do have a benefit, they can also cause harm. Healthcare workers who
look after patients needing a blood transfusion should consult with a hematologist if they
remain unsure about the indications. Inter professional team collaboration is crucial in
managing patients undergoing blood transfusions and those having adverse reactions
to transfusions. The key is to reduce the harm from unnecessary blood transfusions.
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