Blood Transfusion
- NURS 13A RLE - Care Of Clients With Problem In Oxygenation Fluids And Electrolytes, Infectious, Inflammatory And
Immunologic Response, Cellular Aberrations, Acute And Chronic
Blood Blood Transfusion:
- Accounts for 7% of the human body weight
- The average adult has a blood volume of roughly - Acute massive blood loss;
5L (1.3 gal), composed of plasma and several kinds - Anemia and hypoalbuminemia;
of cells (occasionally called corpuscles). - Overwhelming infection;
- Erythrocytes (red blood cells) 45% of whole blood - Dysfunction of Coagulation
- Leukocytes (white blood cells) 0.7% - It involves transfusing whole blood or blood
- Thrombocytes (platelets) 54.3% components (specific portion of blood lacking in
patient)
Composition of Blood - Cross matching
1. Red Blood Cells - Blood typing
- Majority of the cells
- Chiefly responsible for transport oxygen,
perfusion
- IV Life expectancy = 115-130 days
- Approximately 5 ml per cubic millimeter
2. White Blood Cells
- Chiefly responsible for body’s defense
- 5000-10000 cubic millimeter
3. Platelets
- Prime function is to control bleeding
- 150,000 - 450 000 per cubic millimeter ❖ Whole blood - replaces blood volume and all blood
4. Plasma components: RBCs, plasma, plasma proteins, fresh
- Liquid portion of blood platelets, and other clotting factors.
- 91% water, 7% protein, 2% carbs ❖ Whole Blood Transfusion - indicated only for
patients who need both increased oxygen-carrying
Blood Transfusion Options capacity and restoration of blood volume when
1. Homologous (Allogeneic) Transmission - random there is no time to prepare or obtain the specific
donors blood components needed.
2. Autologous Transfusion - patient’s blood for his ❖ Packed Red Blood Cells - 100% of erythrocyte,
own use 100% of leukocytes, and 20% of plasma originally
3. Directed Transfusion - blood donated for specific present in one unit of whole blood.
individual - Shelf life: up to 45 days
- Color: red
Autologous Red Blood Cells - used for blood replacement - Storage conditions: refrigerated
following planned surgery - Key uses: trauma, surgery, anemia, any
- Client donates blood for autologous transfusion blood loss, blood disorders such as sickle
4-5 weeks prior to surgery. cells
- Should be transfused over 2 to 3 hours; if
Rhesus (Rh) Factor - present in the RBC’s of approximately a patient cannot tolerate volume over a
85% of the people in the US. maximum of 4 hours; it may be necessary
- Rh positive - when blood contains Rh factor for the blood bank to divide a unit into
- Rh negative - when the blood do not contain Rh smaller volumes, providing proper
factor refrigeration of remaining blood until
needed. One unit of packed red blood
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Blood Transfusion
cells should raise hemoglobin - Pass the physical and health history assessments.
approximately 1%, hematocrit 3%. - In the screening process, the donor has to fill out a
❖ Platelets - replaces platelets in clients with blood donation questionnaire form that includes
bleeding disorders or platelets deficiency. direct questions about behaviors known to carry a
- Fresh platelets most effective higher risk of blood-borne infections that are
- Shelf life: 5 days transmitted through the blood.
- Color: colorless - These behaviors include prostitution, intravenous
- Storage conditions: room temperature drug use and others.
with constant agitation to prevent - A trained physician will be asking the donor about
clumping medical / health history, and a physical
- Key uses: cancer treatments, organ examination will be conducted - which includes
transplant, surgery checking blood pressure, pulse and temperature.
- 1 pack (count by 5-8,000) - about 50 ml - All of the information from this evaluation is kept
❖ Fresh frozen Plasma - expands blood volume and strictly confidential.
provides clotting factors. - During a blood donation screening procedure, a
- Does not need to be typed and small sample of blood taken from a finger prick is
crossmatched (contains no RBCs) used to check your hemoglobin level, the
- Should be administered as rapidly as oxygen-carrying component of your blood.
tolerated because coagulation factors - If the hemoglobin concentration is normal, and the
become unstable after thawing. donor meets all the other screening requirements,
- Shelf life: 1 year the client is safe to donate blood.
- Color: yellowish
- Storage conditions: frozen Blood Transfusion Procedure:
- Key uses: burn patients, shock, bleeding ● Pre-transfusion
disorders (thrombocytopenia) 1. Informed Consent
- 1 unit = 150-250 ml - Per policy / procedure, questions
❖ Albumin - indicated to expand the blood volume of addressed
patients in hypovolemic shock and to elevate level - Exception: emergent, life
of circulating albumin in patients with threatening bleed
hypoalbuminemia. The large protein molecule is a 2. Transfusion Order
major contributor to plasma oncotic pressure. - Indication supported: labs, signs
❖ Cryoprecipitated Antihemophilic Factor (Cry) - a and symptoms
portion of plasma rich in clotting factors, including - Complete, required information
factor VIII and Fibrinogen. This helps to slow or included
stop bleeding due to illness or injury. 3. Group and Screen Testing
- Shelf life: 1 year - Required for compatible blood
- Color: white components
- Storage conditions: frozen - ABO, Rh (D) blood groups,
- Key uses: hemophilia, Von Willebrand antibody screen (clinically
Disease, rich source of fibrinogen significant antibodies)
- 1 unit = 15-20 ml - Label tube of blood at patient;s
bedside
Who can donate blood? 4. Prepare the patient
- In good health - Educate: symptoms to WOF
- In between 16-65 years old (16-17 years old need indicative of reaction
parents’ consent) - Itchiness, urticaria
- Weigh at least 110 pounds (pamamantal), DOB/SOB,
- Have a blood pressure between: Systolic - 90-120 dizziness, HA, fever, chills
mmHg; Diastolic - 60-100 mmHg; and
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- Adverse reactions: respiratory
distress, high fever,
hypo/hypertension and red urine ● (Transfusion)
can indicate a more serious 1. Checking Blood Components/Blood
reaction. Products
- Assess for transfusion risk - Blood received matches
factors; history of previous transfusion order
transfusion reaction (ex. - At bedside, in physical presence
Pulmonary edema develops of patient:
primarily due to volume excess a. Check patient
or circulatory overload; coarse) identification: surname,
5. Prepare the equipment first name, ID number
- Dedicated, patent IV (peripheral on armband, order
or central) transfusion and chart
- Compatible IV fluid (only 0.9% label/tag
NaCl for blood components) b. Check ABO, Rh
- Blood components- tubing/filter; compatibility, Blood
change after 4 units or 4 hours Groups:
- Platelets - always new/fresh identical/compatible on
tubing/filter group and screen test,
- Prime tubing/filter: blood or label, transfusion and
compatible IV fluid chart label/tag
- Infusion devices c. Unit/s to transfuse
6. Pick up Blood from Laboratory identical on physician’s
(things to check on blood details) order
- Patient identification (surname, d. Visual inspection and
first name, unique ID number) expiry, Components: no
- Blood serial number clots, usual color, ports
- Blood product type (e.g., red intact, packaging/seal
cells) is identical on EMR order, intact, color
the blood product label and the e. Blood should be room
luggage tag on room temperature
- Volume ordered by HCP before administration
- ABO/RhD on blood product label 2. Documentation
and PDR tag are identical - File completed chart label/tag for each component
- Expiry date or product transfused on patient’s health record
- Integrity of blood product (check (include start and stop time)
for sediments) - Some hospitals require a completed “transfusion
- Scan the blood product after the record” attached to patient’s chart
above checks are completed - Record volume transfused, vital signs and patient’s
- Checking blood products against assessments
the order should be done by RN - If a transfusion reaction is suspected: report to
and Medtech, after that both of HCP, document signs and symptoms, patient care
them will sign on the patient's done
form; and in ward, blood - Once the blood is removed from the blood bank, it
products should be checked should be initiated/transfused within 30 minutes
again by using two RN and sign or returned.
that details are correct.
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- Adverse events associated with the transfusion of
whole blood or one of the components.
● (Post transfusion) - These may range in severity from minor to life
1. Completing the transfusion threatening
- Re-assess the patient and - Reactions can occur during the transfusion (acute
re-check the vital signs transfusion reactions) or days to weeks later
- Periodically post transfusion( (delayed transfusion reactions)
reactions may occur 4 hours
post-transfusion; for dyspnea 1. Hemolytic Transfusion Reaction - is a life
reactions up to 24 hours post threatening complication occurring from
transfusion) transfusion of donor blood that is incompatible
- Comply with expiry time specific with the recipient’s blood.
for blood component/blood - Low back pain
product outside the expiry time, - Flank pain
discard the remainder - Chills
- Component tubing: flush with - Fever
0.9 %NaCl - Nausea
- Products given IV: flush tubing/IV - Tachycardia
site with compatible IV fluid - Tachypnea
- Some hospitals require returning - Flushing
the empty blood bag to - Hypotension
Laboratory; otherwise, dispose - Headache
of blood tubings/bags in - Hemoglobinuria (cola-colored urine)
biohazardous waste Nursing Intervention:
2. Patient Assessment and Vital Signs (for 1. Discontinue the transfusion
each blood unit) immediately; the blood tubing
- Close monitoring / observation must be removed. Use new
required tubing for the saline infusion
- 15 minutes before starting 2. KVO with normal saline or
(baseline data), 15 minutes after according to agency protocol.
starting (checking alteration 15 3. Send the remaining blood, a
minutes), 15-30 minutes before sample of the clients’ blood and
each unit consumed, check after a urine sample to the laboratory.
each unit consumed 4. Notify the physician immediately.
- Temp, BP, pulse, respiratory rate, 5. Monitor vital signs
oxygen saturation (should be 6. Monitor fluid intake and output.
done in full minute); chest
auscultation is included after 1.
each blood unit 2. Circulatory Overload - volume greater than can be
3. Infusion rate (for each unit) accommodated by the circulatory system
- 4 to 6 hours - Clinical signs: dyspnea, tachycardia,
- 50 ml/hour for first 15 minutes; cough, crackles, distended neck veins,HPN
can be deferred if acute bleeding Nursing Interventions:
- Re-check after 15 minutes, if no - Place client upright, with feet
indication of reaction then dependent
increase the rate as ordered. - Administer diuretics and oxygen
as ordered
Complications of Blood Transfusion - Notify the physician
- Stop or slow the transfusion
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3. Delayed hemolytic transfusion reaction
- Occurs 1 to 2 weeks after the transfusion;
erythrocytes hemolyzed by antibody are
not detectable during cross-matched but
are formed rapidly after transfusion.
- It generally is not dangerous, but
subsequent transfusions may be
associated with acute hemolytic reaction.
- Clinical signs: fever, mild jaundice, gradual
fall of hemoglobin, positive Coombs’ test
Several Infectious disease can be transmitted through
blood transfusion:
- Hepatitis B
- Non-A, non-B hepatitis
- Malaria
- Syphilis
- Acquired immunodeficiency syndrome (AIDS)
4. Massive Transfusion Reactions
- Reactions associated with massive
transfusions (>10 units of packed RBCs on
1 or 6 hours) include:
★ C - coagulopathy (delusional
coagulopathy)
★ A - acidosis
★ T - temperature (hypothermia)
★ CA - hypocalcemia
★ KE- hypo/hyperkalemia
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