Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur

College of Nursing
Website: www.unp.edu.ph Mail: [email protected]

What is BLOOD TRANSFUSION THERAPY?

Blood transfusion is one of the most common interventions patients prescribed to receive,
especially in cases of severe blood loss. Transfusions usually occur when a venous access
is created to allow the patient to receive blood and blood products aimed to help restore
adequate circulating blood volume. The most commonly transfused blood components
are the red blood cells, followed by plasma and fresh whole blood. In cases where
patients exhibit bleeding problems, clotting factors may also be transfused.
ADVANTAGES
1. Avoids the risk of sensitizing the patients to other blood components.
2. Provides optimal therapeutic benefit while reducing risk of volume overload.
3. Increases availability of needed blood products to larger population.

PRINCIPLES
Whole blood transfusion

Generally indicated only for patients who need both increased oxygen-carrying capacity and
restoration of blood volume when there is no time to prepare or obtain the specific blood
components needed.

Packed RBCs

Should be transfused over 2 to 3 hours; if patient cannot tolerate volume over a maximum of 4
hours, it may be necessary for the blood bank to divide a unit into smaller volumes, providing
proper refrigeration of remaining blood until needed. One unit of packed red cells should raise
hemoglobin approximately 1%, hemactocrit 3%.

Platelets

Administer as rapidly as tolerated (usually 4 units every 30 to 60 minutes). Each unit of platelets
should raise the recipient’s platelet count by 6000 to 10,000/mm3: however, poor incremental
increases occur with alloimmunization from previous transfusions, bleeding, fever, infection,
autoimmune destruction, and hypertension.
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur

College of Nursing
Website: www.unp.edu.ph Mail: [email protected]

Granulocytes

May be beneficial in selected population of infected, severely granulocytopenic patients (less

than 500/mm3) not responding to antibiotic therapy and who are expected to experienced
prolonged suppressed granulocyte production.

Plasma

Because plasma carries a risk of hepatitis equal to that of whole blood, if only volume expansion
is required, other colloids (e.g., albumin) or electrolyte solutions (e.g., Ringer’s lactate) are
preferred. Fresh frozen plasma should be administered as rapidly as tolerated because
coagulation factors become unstable after thawing.

Albumin

Indicated to expand to blood volume of patients in hypovolemic shock and to elevate level of

circulating albumin in patients with hypoalbuminemia. The large protein molecule is a major
contributor to plasma oncotic pressure.

Cryoprecipitate

Indicated for treatment of hemophilia A, Von Willebrand’s disease, disseminated intravascular

coagulation (DIC), and uremic bleeding.

Factor IX concentrate

Indicated for treatment of hemophilia B; carries a high risk of hepatitis because it requires
pooling from many donors.

Factor VIII concentrate

Indicated for treatment of hemophilia A; heat-treated product decreases the risk of hepatitis
and HIV transmission.

Prothrombin complex

Indicated in congenital or acquired deficiencies of these factors.

 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur

College of Nursing
Website: www.unp.edu.ph Mail: [email protected]

STEPS AND NURSING RESPONSIBILITIES IN BLOOD TRANSFUSION

Before the Transfusion

1. Verify doctor’s order. Inform the client and explain the purpose of the procedure.

2. Find current type and crossmatch

 Take a blood sample, which will last up to 72 hours
 Send your sample to the blood bank
 Ensure the blood sample has the correct date/timing/labeling
 Wait for the blood bank to match and prepare needed units based on the sample
you sent them
3. Obtain informed consent and health history
 Discuss the procedure with your patient
 Confirm their health history and any allergies
 Ensure that the supervising doctor has acquired signature consent for
administration of blood products from the patient
4. Obtain large bore IV access
 This is 18G or larger IV access
 Each unit will be transfused within 2-4 hours
 Obtain a second IV access if the patient requires additional IV medication therapy
(i.e. antibiotics)
 Remember: Normal saline is the only solution that can be transfused with blood
products
5. Assemble supplies
 Special Y tubing with an in-line filter
 0.9% NaCl (Normal Saline) solution
 Blood warmer
6. Obtain baseline vital signs
 These include heart rate, blood pressure, temperature, pulse oximeter, and
respiratory rate
 Lung sounds and accurate urine output should also be documented
 Notify the doctor if their temperature is greater than 100° F
7. Obtain blood from blood bank
 Once the blood bank notifies you that the blood is ready, you must schedule its
delivery from the blood bank
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur

College of Nursing
Website: www.unp.edu.ph Mail: [email protected]

 Packed red blood cells (pRBCs) can only be hung ONE UNIT AT A TIME.
 Remember: Once the blood has been released for your patient, you have 20-30
minutes to start the transfusion and up to 4 hours to complete the transfusion

Initiating the Blood Transfusion

1. Verify Blood Product
 Two RNs at the patient’s bedside must verify the below:
 Physician’s order with patient identification compared to the blood bank’s
documentation
 Patient’s name, date of birth, and medical record number
 Patient’s blood type versus the donor’s blood type and Rh-factor
compatibility
 Blood expiration date
2. Educate the patient
 Relay the signs and symptoms of a transfusion reaction. If these occur, the patient
should notify their RN during the transfusion
 Rash, itching, elevated temperature, chest/back/headache, chills, sweats,
increased heart rate, increased respiratory rate, decreased urine output, blood
in urine, nausea, or vomiting
3. Assess and document the patient’s status
 Baseline vital signs (HR, RR, Temp, SPO2, BP), lung sounds, urine output, and
color
4. Start the blood transfusion
 Prepare the Y tubing with normal saline and have the blood ready in an infusion
pump
 Run the blood slowly for the first 15 minutes (2mL/min or 120cc/hr)
 Remain with the patient for the first 15 minutes; this is when most transfusion
reactions can occur
 Increase the rate of transfusion after this period if your patient is stable and
doesn’t display signs of a transfusion reaction
 Document vital signs after 15 minutes, then hourly, and finally, at the completion
of the transfusion
During the Transfusion
1. Look for any of these transfusion reactions
 Allergic
 Febrile
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur

College of Nursing
Website: www.unp.edu.ph Mail: [email protected]

 GVHD (Graft vs. Host Disease)

 TRALI (Transfusion Related Acute Lung Injury)
2. If you suspect a reaction, do the following
 Stop the transfusion IMMEDIATELY
 Disconnect the blood tubing from the patient
 Stay with the patient and assess their status
 Continue to check for status changes every five minutes
 Notify the doctor and blood bank
 Prepare for further doctor’s orders
 Document everything
After the Transfusion
1. Flush Y tubing with normal saline
2. Dispose of used Y tubing in a red biohazard bin
3. Obtain post-transfusion vital signs and document the patient’s status.

References:
https://www.unitekcollege.edu/blog/a-step-by-step-guide-to-blood-transfusion/
https://rnspeak.com/blood-transfusion-nursing-responsibilities/