Blood Transfusion

24
 INTRODUCTION

• IV fluids can be affective in restoring intravascular

volume however they do not affect the oxygen
carrying capacity of the blood . when red or white
blood cells , platelets or blood proteins are lost
because of of hemorrhage or disease , it may be
necessary to replacethese components to restore the
bloods ability to transport oxygen and carbondioxide
clot , fight infection and keep extracellular fluid
within the intravascular compartements
 continue..

• Blood typing and cross matching

• Selection of blood donors
• Blood components ( blood and blood products for transfusion )
• Transfusion reactions
• Blood group RH factor
• Initiation of blood transfusion ( administering blood )
 Typing and cross matching

• It is important to determine from the blood of the recepient is

compatible with the blood of the donor in order to prevent
clumping and hemolysis which can be fatal for the reciepient .
• The test to determine the blood type is known the
compatibility is known cross matching
 Selection of blood donors

• The donors are selected carefully to ensure that they are free of
disease . The following factors are considered when selecting
the blood donors
• The blood is tested for infections such as Human
immunodeficiency syndrome (HIV ), HBV(hepatitis B )HCV
(hepatitis C), syphillis , west nile virus and other infections a
that can be transmitted from the donor to the receipient throgh
the blood
 continue..

• The lifestyle and health history such as previous illness , past

surgeries , sexual behaviour , drug use , travel and body
piercing or tattoos
• Vital signs and weight must be within normal range
 Blood components

• whole blood is transfused for clients with massive blood loss

while others only require contains components of the blood .
 The commonly used components
and its uses
• Components
• white blood - 450ml whole blood in 63 ml anticoagulant
• Hb will be approximately 1.2 g stored at +2 degree C to +6
degree C
• Uses - replaces blood volume as well as the blood components
(RBC , blood plasma proteins , platelets and clotting factors )
• This is used in case of acute hemorrhage
 continue..
• Packed red blood cells
• 1 unit volume = 250 ml to 300 ml
• 150 - 200 ml red blood cellsfrom which most of the plasma
has been removed
• Hb concentration will be approximately 20 g/100 ml
• storage - between +2 degree C and +6 degree C in an aproved
blood bank refrigerator
• Uses- Transfused in clients with anemia and surgeries to
improve the oxygen carrying capacity of blood without fluid
volume excess
• platelets
• 1 unit volume - 50 to 400 ml
• a single donor unit consists of 50 -60 ml plasma that should
contain less than or equal to 55 x 10 9 platelets
• platelets concentration are store for upto 5 days at +20 degree
C to + 24 degree C
• platelets require continous agitation during storage on a
platelet shaker and in an incubator to maintain the required
storage temperature clotting factors cryprecipitate
 continue.....
• uses
• used to replace clotting factor in clients with deficiency of
clotting factor
• Fresh frozen plasma - 1 unit 200 - 250 ml
• FFP in plasma prepared from whole blood , either from the
primary centrifugation of whole blood into red cells and
plasma or from a secondary centrifugation of platelets rich
plasma
• FFP is s tored at - 25 degree C or coldrr for upto 1 year
• before use , it should be thawed in the blood transfusion centre
between +30 degree C and +37 degree C
• Uses -
• used to replace clotting factor . It does not need to be cross
matched as it does not contain RBC s
• hence it can be used to blood volume expander in emergency
situations
• albumin
• uses
• used as blood volume expander and provides
plasma proteins
 Transfusion reactions

Hemolytic reaction
Febrile reaction
Allergic reactions
Sepsis
Circulatory overload
• box
 Procedure

• DEFINITION
• It is a process of transfering blood or blood components into
ones circulation intravenously
• Types of transfusion
• blood plasma, packed red blood cells , fresh frozen plasma
• Complications
• allergic reactions . febrile reactions , delayed or acute
hemolytic transfusion reaction , post transfusion purpura
• Purposes
• To restore circulating blood volume in surgery and acute blood
loss
• To correct platelet and coagulation factor deficiencies
• To correct anemia
• To treat acute sickle cell crisis
• Articles
• Blood transfusion set
• Normal saline
• Blood / blood components
• Cannula 18
• Alcohol swabs
• Sterile gloves
• Tourniquet
• Adhesive tape
• Scissors
• Roller bandage and splint
• Infusion stand
• disposable bag , kidney tray
• pressure bag
• specimen container
 Procedure

• Before procedure
Check physicians order , pts condition , and history of
transfusion reaction , reason for present transfusion etc
Identify the pt
Explain the procedure to the pt , need for transfusion ,
blood product to be given , approximate lenght of time ,
desired outcome etc..
 continue..
• Emphasize the need for pt to report unusual symptoms
immediately .
• obtain informed consent from patient.
• Obtain blood from blood bank in accordance with agency
policy. If transfusion cannot begin immediately, return product
to blood bank.
• Blood which is out of refrigerator for more than 30 minutes,
above 10°C cannot be re-issued.
 continue...

• Never store blood in unauthorized area-like ward refrigerator.

Blood must be stored refrigerated unit at carefully controlled
temperature (4°C) 6.
• Encourage patient to empty bowel and bladder, and assist to a
comfortable position. Collect urine specimen
• After procedure
• Ensure privacy.
• Wash and dry hands.
• Check vital signs and record.
• Don disposable gloves
• Insert IV cannula (18 G/19 G), If not already present in large
peripheral vein and Initiate Infusion of normal saline solution
using blood transfusion set.
• Inspect the blood product ( By 2 nurses) for
1. Identification number
2. Blood group and type
3. Expiry date
4. Compatibility
5. Patient's name
6. Abnormal color, clots, excess air, etc
• Warm blood, if needed, using special blood warmer or
immerse partially in tepid water.
• If blood product is found to be correct, stop the saline solution
by closing roller clamp.
• Remove insertion spike from saline container and insert spike
into blood container Start infusion of blood product slowly, at
the rate of 25-50 ml/hour for the first 15 minutes.
• Stay with patient for first 15 minutes.
• Check vital signs every 15 minutes for first 30minutes or as
per agency policy
• Increase infusion rate if no adverse reactions are noticed. The
flow rate should be within safe limits
• Assess the condition of patient every 30 minutes and if any
adverse effect is observed stop transfusion and start saline.
• Send urine sample, blood sample and remaining blood product
in container with transfusion set, back to the blood bank.
• Complete transfusion and administer saline (as per physician's
order), if no adverse reaction is observed. Dispose blood
product container and set in appropriate receptacle
 continue...

• Wash hands.
• Record the following: Product and volume transfused
identification number and blood group:
• Time of administration started and completed.
• Name and signature of nursing staff carrying out procedure,
and patient's condition.
• If agency policy requires, remove label from blood bag and
paste it on patient's record,
• Assist patient to comfortable position.
 Special considerations

• Obtain baseline vital signs.

• Always check the patient/componentcompatibility/ identity (check that it is
the right unit for the right patient).
• ALWAYS take a completed patient documentation label to the blood bank
when collecting the first unit of blood.
• MATCH the details on the blood request fu against the blood compatibility
label (tag), the bag unit number and the patient documentation label.
• If everything matches, sign the unit with the date and time.
• Cover the blood bag with a towel when it hangs on the IV
pole.
• . Gently rotate the blood bag periodically to prevent clumping
of cells.
• When rewarming the blood by immersing in tap water, do not
immerse the blood bag fully into the water as it may cause
hemolysis.
• Rewarming of blood may be done by covering the blood bag
with a blanket.
• Premedications such as avil may be prescribed.
 Special considerations

• Do not administer medication through the same line, where

blood product is transfused
• Start another IV line if medications are to be infused, because
of possible incompatibility and bacterial contamination
• Blood transfusion should be completed over a period of 4
hours from the time of initiation.
• If there is any discrepancy, DO NOT sign the unit or form;
contact the staff member of the blood transfusion department
immediately.
• Inspect pack and contents for signs of deterioration or damage.
• Transfuse at prescribed rate during prescribed time, as
tolerated by the patient.
• for acute reactions "allergic, febrile, septic, haemolytic, air embolism, and
circulatory overload by assessing vital signs, breath sounds, edema,
flushing, urticaria, vomiting, headache and back pain.

• Do Not Use The Unit If

• Discoloration or signs of any leakage may be the only warning that the
blood has been contaminated by the bacteria and could cause a severe or
aled reaction if transfused. Therefore, such unit of blood component shall
not be transfused.
• There is any sign of haemolysis, clotting or contamination.
 continue...

• Any sign of contamination, such as a change of color in the red cells, which
often looks darker/purple/ black when contaminated.
• Any clot, which may mean that the blood was not mixed properly with the
anticoagulant when it was collected or might also indicate bacterial
contamination due to the utilization of citrate by proliferating bacteria.
• Any sign that there is a leak in the bag or that it has already been opened.
• The blood unit must be discarded if:
• It has been out of the refrigerator for longer than 30 minutes, or
• The seal is broken, or
• there is any sign of hemolysis , clotting , or contamination
ANY QUESTIONS ?