Blood Transfusion

introduction of whole blood or blood components into the venous circulation.Purposes Of Blood Transfusions

To restore blood volumeTo restore the oxygen-carrying capacity of the blood.To administer required blood component by the patient.

Blood Types1. Whole Blood

Most commonly used in instances of acute massive blood loss or extreme cases of acute hemorrhage. Replaces blood volume and all blood products such as RBCs, Plasma, plasma proteins, fresh platelets,

and other clotting factor.2. Packed Red Blood Cells

Make up the blood product remaining after up to 80% of the plasma is removed from the whole blood.Used to increase the oxygen-carrying capacity of blood in anemias, surgery, and disorders with slow bleeding.One unit of PRBCs has the same amount of oxygen carrying capacity as a unit of whole blood.

3. Packed Red Blood Cells May be used when the patient is at risk for circulatory overload but needs hemoglobin level for its oxygen carrying capacity.Usually infused over 2-3 hrs w/ NSS.Necessitates typing and crossmatching.

4. Autologous Red Blood CellsAre those in which the patient is infused with his or her own blood, which was donated in advance.Used for blood replacement following planned elective surgery.Client donates blood for autologous transfusion 4-5 weeks prior to surgery.Self-donation.

5. PlateletsReplaces platelets in clients with bleeding disorders or platelet deficiency.Indicted for treatment of potential life-threatening hemorrhage.Each unit should increase the average adult client’s platelet count by about 5,000 platelets/ microliter.

6. Fresh Frozen PlasmaPlasma is the fluid portion of the blood remaining after the RBC, platelets, and leukocytes has been removed.Fresh frozen plasma can be stored for 12 mos but must be used w/in 24 hrs of defrosting.

7. Fresh Frozen Plasma Provides blood volume, protein and clotting factors.Does not need to be typed and crossmatched (contains no RBCs).Each unit will increase the level of any clotting factor by 2% to 3% in the average adult.

8. AlbuminBlood volume expander.Provides plasma proteins.Does not need to be typed and crossmatched (contains no RBCs).Administered for shock, burns, and hypoproteinemia.

9. CryoprecipitateContains large amount of the clotting factor VII – the factor lacking in hemophiliacs.Contains a small number of RBC, w/c makes crossmatching unnecessary.Cryoprecipitate also contains fibrinogen.

10. Plasma Protein FactorPortion of the plasma remaining after fibrinogen, a protein important in blood clotting, and globulin, a simple protein found in blood serum, have been removed.This component is used when the replacement of intravascular volume is necessary.

Procedure for Blood Transfusion1. Verify doctor’s order. Inform client and explain the purpose of the procedure.2. Check for Cross-matching and blood typing. To ensure compatibility.3. Obtain and record baseline VS.4. Practice strict Asepsis.5. At least 2 nurses check the label of the blood transfusion.

Check the following: Serial Number Blood Component Blood Type Rh factor Expiration date Screening tests

This is to ensure that the blood is free from blood –carried diseases and therefore, safe for transfusion.6. Warm blood at room temparature before transfusion. To prevent chills.7. Identify the client properly. 2 NURSES check the client’s identification.8. Use needle gauge 18 or 19. This allows easy flow of blood.9. Use Blood Transfusion set with filter. To prevent administration of blood clots and other particulates.10. Start infusion slowly at 10 gtts/min. Remain at bedside for 15 – 30 minutes. Adverse reaction usually occurs

during the first 15 – 20 minutes.11. Monitor VS. Altered VS indicates adverse reaction.12. Do not mix medications with blood transfusions. To prevent adverse effects.

Do not incorporate medication into the blood transfusion.Do not use the blood transfusion line for IV push of medications.

13. Administer 0.9% NaCl before, during, and after BT. Never administer IV fluids with dextrose. Dextrose causes Hemolysis.

14. Administer Blood Transfusion for 4 hours (whole blood, Packed RBC). For plasma, platelets, cryoprecipitate, transfuse quickly (20 min) clotting factors can easily be destroyed.

15. Observe potential complications. Notify Physician.

Complications of Blood Transfusions1. Allergic Reaction.

It is caused by sensitivity to plasma protein or donor antibody, which reacts with recipient antigen.2. Febrile reaction.

Caused by hypersensitivity of the client’s blood to WBC, platelets or plasma proteins.Most symptomatic complication of BT.

3. Septic ReactionIt is caused by the transfusion of blood or components contaminated by bacteria.

4. Circulatory OverloadCaused by administration of blood volume at a rate greater than the circulatory system can accommodate.

5. Hemolytic ReactionCaused by infusion of incompatible blood products.Clinical Signs:

1. Low back pain (first sign)2. Chills, Feeling of fullness3. Tachycardia, Tachypnea4. Hypotension5. Bleeding6. Vascular collapse

Management when Complication Occurs in Blood Transfusion1. Stop the blood transfusion immediately.

2. Start an IV line (0.9% NaCl).3. Collect urine specimen. To detect presence of bacteria, which may be causing the adverse reaction to blood

transfusion.4. Monitor VS.

Nursing Intervention when Complication Occurs in Blood Transfusion5. Send unused blood and BT set to the blood bank for laboratory examination.6. Administer antihistamine, diuretics and bronchodilators as ordered.7. Make relevant documentation.

1. Record starting the blood, VS2. Type of blood, Blood unit #3. Sequence #, Site of venipuncture 4. Size of needle 5. Sample Documentation

1/21/08 12:30 pm 1 unit of PRBC (#65234) hung to be infused over 3 hours. IV site in L forearm with 19 g angiocath. VS taken and recorded. Informed to contact nurse if begins to experience any discomfort during transfusion. Stated he would use the call lights.

C. Jones, R.N.