BLOOD TRANSFUSION

Objectives:
‡ Replace circulating blood volume
‡ Increase the O2 carrying capacity of blood
‡ Prevent infection: if there is a decrease in
WBC
‡ Prevent bleeding: if there is platelet
deficiency
BLOOD and BLOOD
COMPONENTS
‡ A single unit (³u´) of blood contains
450mL of blood and 50mL
anticoagulant.
‡ It is more economical, appropriate
and practical to separate blood into
its primary components:
‡ RBC, Platelet and Plasma
 BLOOD and BLOOD
COMPONENTS
Whole Blood
‡ provides all components
‡ (Hct = 40%)
‡ Complications: volume overload,
transmission of hepatitis or AIDS,
transfusion reaction, infusion of excess
potassium & sodium, infusion of
anticoagulant (citrate) used to keep
stored blood from clotting, calcium
binding & depletion (citrate) in massive
transfusion therapy
Packed Red Blood Cell (PRBC)
‡ Provide almost twice the amount of Hct than whole
blood
‡ With little plasma, some platelets and WBCs residuals
‡ Indicated in cases of blood loss, pre-op & post-op
client & those with incipient congestive failure
‡ Complication: transfusion reaction (less common than
with whole blood: due to removal of plasma protein)
Fresh Frozen Plasma
‡ Contains all coagulation factors including V & VIII
‡ Can be stored frozen for 12 months; takes 20
minutes to thaw
‡ Hang immediately upon arrival to unit (loses its
coagulation factor rapidly)
Platelets
‡ Will raise recipient¶s platelet count by 10,000/mm3
‡ Pooled from 4-8 units of whole blood
‡ Single-donor platelet transfusion may be necessary for
clients who have developed antibodies; compatibilities
testing may be necessary
Factor VIII Fractions (Cryoprecipitate)
‡ contains von Wilebrand factor, factor VIII, XIII &
fibrinogens
ßranulocytes
‡ Do not increase WBC: increase marginal pool (at
tissue level) rather than circulating pool
‡ Premedication with steroids, antihistamine &
acetaminophen
‡ Respiratory distress with shortness of breath,
cyanosis & chest pain may occur; requires
cessation of transfusion & immediate attention
‡ Shaking chills or rigors common, require brief
cessation of therapy, administration of meperdine
IV until rigors are diminished & resumption of
transfusion when symptoms relieved
BLOOD DONATION
‡ To protect both recipient and donor, all
prospective donors are screened.
‡ Donors are typically required to give consent for
the process and this requirement means that
minors cannot donate without parental consent.
‡ The donor's race or ethnic background is
sometimes important since certain blood types,
especially rare ones, are more common in
certain ethnic groups.
BLOOD DONATION
‡ Donors should not have any present or history of
the following:
‡ Viral Hepatitis
‡ Received a BT or infusion of any blood derivative within
12mos
‡ Untreated Syphilis or Malaria
‡ Drug abuse
‡ Exposure to HIV
‡ Recent asthma attack
‡ Urticaria
‡ Allergy to medications
‡ Skin infection
‡ Pregnant
‡ Tooth extraction or oral surgery 72h prior to donation
‡ Untreated exposure to infectious dse. Within the past 3
weeks
‡ Recent immunizations
‡ Recent tattoo
‡ Cancer
‡ Diagnosis of hemochromatosis
‡ Whole blood donation within the past 56 days
 DISEASES TRANSMITTED BY BT
‡ Viral Hepatitis
‡ AIDS (HIV and HTLV)
‡ Cytomegalovirus (CMV)
‡ ßraft versus Host Disease (ßVHD)
‡ Creutzfeldt-Jakob Disease (CJD)
 Cytomegalovirus (CMV)
‡ A virus that infects most people worldwide.
‡ CMV spreads from person to person by direct
contact.
‡ Although CMV infection is usually harmless, it can
cause severe disease in persons with weakened
immune systems.
‡ There is no treatment for CMV infection.
‡ Prevention centers on good personal hygiene,
especially frequent hand washing.
 ßraft versus Host Disease (ßVHD)
‡ A rare disorder that can strike persons whose immune
system is suppressed and have either received a blood
transfusion or a bone marrow transplant.
‡ Symptoms may include skin rash, intestinal problems
similar to colitis, and liver dysfunction.
‡ Clinically, graft-versus-host-disease is divided into:
‡ ÷
 or 
÷ form is normally observed within
the first 100 days post-transplant
‡
 form normally occurs after 100 days.
Creutzfeldt-Jakob Disease (CJD)
‡ CJD a dementing disease of the brain caused by an
unconventional, transmissible agent (prion).
‡ Symptoms of CJD include forgetfulness, nervousness,
jerky trembling hand movements, unsteady gait, muscle
spasms, chronic dementia, balance disorder, and loss of
facial expression.
‡ Most cases occur randomly (sporadic), but inherited
forms exist.
‡ There is neither treatment nor cure for CJD.
 POTENTIAL DONORS

‡ Donors should be asked if he/she

has taken any ASA or ASA
containing medications within the
past 3 days.

‡ He/she may pass the requisites for

donation
‡ Requisites:
‡ Body wt. is > 50kg (110lbs.) for a
450mL donation
‡ Age 17 above
‡ Oral temperature should not exceed
37.5oC
‡ PR should be regular and between 50-
100 bpm.
‡ BP is within 90/50 to 180/100 mmHg.
‡ Hgb level is at least 12.5g/dL (F);
13.5g/dL (M)
 TYPES OF BLOOD DONATION
‡ ë

‡ friends or family members of the patient donates the
blood
‡ considered not safe than random donations
‡  

‡ Phlebotomy is done
‡ Standard precautions are observed
‡ Donor is on semi-recumbent position
‡ Skin prep is done
‡ Tourniquet is applied
 TYPES OF BLOOD DONATION
‡  

‡ Venipuncture is performed
‡ Withdrawal of 450mL of blood (takes lees than 15 mins)
‡ After removal of needle, donors are asked to hold arm
straight up and firm pressure is applied with sterile gauze
for 2-3 mins until bleeding stops.
‡ Firm bandage is applied.
‡ Donor stays recumbent until he/she feels able to sit up.
‡ Health teachings are given.
Ú 

  
„ Before leaving, relax for 10±15 minutes and
enjoy some snacks and beverages.
„ Keep arm pressure wrap in place for about an
hour.
„ Avoid smoking for 30 minutes after donating.
„ Avoid strenuous activity or heavy lifting for about
4 hours, as it may cause bruising.
„ Double fluid intake for the next 24 hours. Water
and fruit juices are best and avoid caffeine.
„ Avoid alcoholic beverages for 12±24 hours or
until after you have eaten a full meal.
Ú 
   
 
„ Bruising (hematoma): Apply cold, wet
compresses for the first 12±24 hours; then use
warm, wet compresses thereafter. Discoloration
(blue, black or green) will be visible on arm for 7±
10 days and experience discomfort/tenderness.
„ Bleeding: Elevate arm above your head and
reapply direct pressure over the donation site.
Apply a clean bandage when bleeding has
stopped.
„ Light-headed & dizziness: Sit down and place
head between knees or lie down and elevate feet
about 12 inches. Do not drive or operate heavy
machinery.
 TYPES OF BLOOD DONATION
‡ Ú


‡ process of donating one's own blood
‡ indicated for an elective surgical or medical procedure in
which the likelihood of a blood transfusion is high. Such
procedures include surgery on the heart, blood vessels,
bones, and chest.
‡ Advantages:
‡ Blood is an exact match to his or her blood
type, thereby avoiding transfusion reaction.
‡ No risk of inadvertently transmitting infectious
agents.
‡ Supplement the community blood supply.
‡ Promotes blood cell production by bone
marrow.
‡ The patient is often reassured by the
knowledge that his or her own blood will be
used if a blood transfusion becomes necessary.
‡ Disadvantages:
‡ Contamination of autologous blood with
infectious agents is possible.
‡ possibility that a patient's blood will be
mislabeled or that allogeneic blood will be
inadvertently transfused.
‡ Costs more to process and store.
‡ Unused units are usually disposed of;
approximately 44% of autologous donations
remain unused after surgery.
 TYPES OF BLOOD DONATION
‡ ‘ 

 

‡ also known as ÷
 ÷ ÷

‡ procedure involving recovering blood lost during

surgery and re-infusing it into the patient.
‡ used frequently in cardiothoracic, vascular and
spinal surgery, in which blood transfusions and
the use of blood products have traditionally been
high.
 TYPES OF BLOOD DONATION
‡  
 
‡ transfusion method that may be done after
induction of anesthesia.
‡ about 1-2 ³u´ of blood are removed from the
patient through a venous or arterial line and
simultaneously replaced with a colloid or
crystalloid solution.
‡ blood obtained is then re-infused after surgery.
 COMPLICATIONS OF BLOOD
DONATION
‡ Excessive bleeding at venipuncture site.
‡ Fainting
‡ Anginal chest pain
‡ Seizures
 BLOOD PROCESSINß
‡ After donation, blood is tested for antibodies to:
‡ HIV 1 and 2
‡ Hepatitis B, C
‡ Human T-call lymphotropic virus type 1
‡ Blood is also tested for Hepa B surface antigen and for
syphilis.
‡ Accurate determination of blood type is done
‡ Rh and ABO system is used to determine if the blood is safe
for transfusion.
ABO system
‡ the most important blood type system (or
blood group system) in human blood
transfusion.
‡ it identifies which sugars are present on the
membrane of a person¶s erythrocytes.
‡ There are four possible blood groups in the
ABO system: AB, A, B, O.
‡ Individuals with type A blood j ÷ ÷  

÷ 
 
÷

 ÷   ÷÷ ÷ 
÷  
  blood from donors of type A and
type O blood.

‡ Individuals with type B blood j ÷  ÷  



÷  
÷

 ÷   ÷
÷ ÷ ÷   
 blood from donors of type
B and type O blood.
‡ Individuals with type AB blood j ÷ ÷÷  


÷  
÷ 


 ÷÷
÷÷ ÷ 

÷  
 blood from
any blood group

‡ Individuals with type O blood j ÷ 


÷ 
 

÷  

 


 ÷  ÷
÷÷÷÷÷ ÷ ÷


÷  
 blood from donors of only type O.
 Rh system
‡ Rh antigens are transmembrane
proteins with loops exposed at the
surface of red blood cells.
‡ Rh antigens together are proteins of
417 amino acids. These proteins
cross the red cell membrane 12
times.
‡ 85% of the population is Rh positive
(RhD)
‡ 15% lack D antigen and termed as
Rh negative
‡ the process of transferring blood or blood-based products
from one person into the circulatory system of another
‡ INDICATIONS:
‡ massive blood loss due to trauma
‡ blood loss during surgery
‡ severe anemia or thrombocytopenia
‡ blood diseases like hemophilia or sickle-cell disease
‡ Blood transfusions can be grouped into two main types
depending on their source:
‡  

÷

‡ 
 
 
÷

‡ Donor units of blood must be kept refrigerated to prevent
bacterial growth and to slow cellular metabolism.
‡ The transfusion must begin within 30 minutes after the
unit has been taken out of controlled storage.
‡ Blood can only be administered intravenously. It therefore
requires the insertion of a cannula of suitable caliber.
‡ A unit (up to 500 ml) is typically administered over 4
hours.
‡ Acetaminophen and/or an antihistamine are sometimes
given before the transfusion to prevent other types of
transfusion reactions.
Purpose:
‡ RBC: ‘
 
 

‡ Whole Blood, Plasma, Albumin: 
  
‡ Fresh Frozen Plasma, Albumin, Plasma Protein Fraction:

    
 
‡ Cryoprecipitate, Fresh Frozen Plasma, Fresh Whole Blood:

    
   

‡ Platelet Concentration, Fresh Whole Blood: 
    

PRINCIPLES OF BLOOD
TRANSFUSION

ý Proper refrigeration
a. Expiration of packed RBC is 3-6 days
b. Expiration of platelet is 3-5 days

ý Proper typing and cross matching

a. Type O: universal donor
b. Type AB: universal recipient
c. 85% of population is RH positive
 PRINCIPLES OF BLOOD
TRANSFUSION
ý Aseptically assemble all materials needed for BT
a. Filter set
b. ßauge 18-19 needle
c. Isotonic solution (0.9 NaCl / plain NSS): to prevent
hemolysis
ý Ask another RN to re check the following
a. Client name
b. Blood typing & cross matching
c. Expiration date
d. Serial number
 PRINCIPLES OF BLOOD
TRANSFUSION
ý Check the blood unit for bubbles cloudiness,
sediments and darkness in color
a. Never warm blood: it may destroy vital factors in blood.
b. Warming is only done: during emergency situation & if
you have the warming device
c. Emergency rapid BT is given after 30 minutes & let
natural room temperature warm the blood.
ý BT should be completed less than 4 hours
 PRINCIPLES OF BLOOD
TRANSFUSION
ý Avoid mixing or administering drugs at
BT line: to prevent hemolysis
ý Regulate BT 10-15 gtts/min or KVO rate
or equivalent to 100 cc/hr: to prevent
circulatory overload
ý Monitor strictly vital signs before, during
& after BT especially every 15 minutes
for first hour because majority of
transfusion reaction occurs during this
period
BT PROCEDURE
‡ Verify doctor¶s order.
‡ Observe ten (10) Rs when preparing and
administering any blood or blood components.
‡ Explain the procedure/rationale for giving blood
transfusion to reassure patient and significant others
and secure consent.
‡ Request prescribed blood/blood components from
blood bank to include blood typing and X-matching
and blood result of transmissible disease.
‡ Using a clean lined tray, get compatible blood from
hospital blood bank.
‡ Wrap blood bag with clean towel and keep it at room
temperature.
‡ Have a doctor and a nurse assess patient¶s
condition.
‡ Countercheck the compatible blood to be transfused
against the X-matching sheet noting ABO grouping
and Rh, serial no. of each blood unit, and expiry
date with the blood bag label and other laboratory
blood exam as required before transfusion (Hgb and
Hct).
‡ ßet the baseline vital signs ± BP, RR, temperature
before transfusion. Refer to MD accordingly.
‡ ßive pre-med 30 minutes before transfusion as
prescribed.
‡ Do hand hygiene before and after the procedure.
‡ Prepare equipment needed for BT.
‡ If main IVF is with dextrose 5% initiate an IV line with
appropriate IV catheter with Plain NSS on another site,
anchor catheter properly and regulate IV drops.
‡ Open compatible blood set aseptically and close roller
clamp. Spike blood bag carefully; fill the drip chamber
at least half full; prime tubing and remove air bubbles
(if any). Use needle ß 18 or 19 for side drip (foradults)
or of 22 for pedia
‡ Disinfect the Y-injection port of IV tubing (Plain NSS)
and insert the needle from BT administration set and
secure with adhesive tape.
‡ Close roller clamp of IV fluid of Plain NSS and
regulate to KVO while transfusion is going on.
‡ Transfuse the blood via the injection port and regulate
at 10-15 gtts initially for 15minutes and then at the
prescribed rate.
‡ Observe patient for 10-15 minutes for any immediate
reaction.
‡ Observe patient on an ongoing basis for any untoward
signs and symptoms If any of these symptoms occurs
stop the transfusion, open the roller clamp of the IV line
with Plain NSS, and report to doctor immediately.
‡ When blood is consumed, close the roller clamp of BT,
and disconnect from IV lines then regulate the IVF of
plain NSS as prescribed.
‡ Continue to observe and monitor patient post
transfusion for delayed reaction could still occur.
‡ Re-check Hgb and Hct, bleeding time, serial
platelet count within specified hours as prescribed
&/or per institution¶s policy.
‡ Discard blood bag and BT set and sharps
according to hospital policy.
‡ Document the procedure, pertinent observations
and nursing intervention and endorse accordingly.
TRANSFUSION REACTIONS
TRANSFUSION REACTIONS
Nursing Management
‡ Upon identifying that there is a transfusion reaction the
nurse should:
‡ Stop BT
‡ Notify physician
‡ Flush with plain NSS
‡ Administer isotonic fluid solution: to prevent shock and
acute tubular necrosis
‡ Send the blood unit to blood bank for re-examination
‡ Obtain blood sample & send to laboratory for re-
examination
‡ Monitor vital signs & I&O
‡ Administer medications as ordered
ý Anti Histamine (Benadryl): if positive to hypotension,
anaphylactic shock: treat with Epinephrine
‡ Administer medications as ordered
ý Antipyretic
ý Antibiotic
‡ Administer medications as ordered
ý Loop diuretic (Lasix)
 NURSINß RESPONSIBILITY
‡ Assess client for history of previous blood
transfusions & any adverse reaction
‡ Ensure that the adult client has an 18-19
gauge IV catheter in place
‡ Use 0.9% sodium chloride
‡ At least two nurse should verify the ABO
group, RH type, client & blood numbers &
expiration date
‡ Take baseline V/S before initiating transfusion
‡ Start transfusion slowly (2 ml/min)
‡ Stay with the client during the first 15 min of
the transfusion & take V/S frequently
‡ Maintain the prescribed transfusion rate:
‡ Whole Blood: approximately 3-4 hr
‡ RBC: approximately 2-4 hr
‡ Fresh Frozen Plasma: as quickly as possible
‡ Platelet: as quickly as possible
‡ Cryoprecipitate: rapid infusion
‡ ßranulocytes: usually over 2 hr
‡ Volume Expander: volume-dependent rate
‡ Monitor for adverse
reaction
‡ Document the following:
‡ Blood component unit
number (apply sticker if
available)
‡ Date of infusion starts & end
‡ Type of component &
amount transfused
‡ Client reaction & vital signs
‡ Signature of transfusionist
 PHARMACOLOßIC
ALTERNATIVES TO BT
‡ ßrowth Factors
‡ Erythropoietin
‡ ßranulocyte-Colony Stimulating Factor
‡ ßranulocyte-Macrophage Stimulating Factor
‡ Thrombopoietin
 Erythropoietin
‡ a glycoprotein hormone produced by the kidney, that
controls erythropoiesis, or red blood cell production.
‡ Available forms as biomedicine
‡ Epoetin (i

 (also known as 
) or 
 )
‡ Darbepoetin (Ú
 )
‡ Epoetin delta (ë )
‡ Methoxy polyethylene glycol-epoetin beta (

) by Roche
‡ Erythropoietin is associated with an increased risk of
adverse cardiovascular complications in patients with
kidney disease if it is used to increase hemoglobin levels
above 13.0 g/dl.
ßranulocyte-Colony Stimulating Factor
‡ Used to increase the number of hematopoietic stem
cells in the blood of the donor before collection by
leukapheresis for use in hematopoietic stem cell
transplantation.

‡ It may also be given to the receiver, to compensate

for conditioning regimens.

‡ Brand Name: Neupogen

ßranulocyte-Macrophage Stimulating Factor
‡ a protein secreted by macrophages, T cells, mast cells,
endothelial cells and fibroblasts.

‡ stimulates stem cells to produce granulocytes

(neutrophils, eosinophils, and basophils) and
monocytes.

‡ Trade Name: Leukine

Thrombopoietin
‡ stimulates the production and differentiation of
megakaryocytes, the bone marrow cells that fragment
into large numbers of platelets

‡ Thrombopoietin shares its first 153 amino acids with

erythropoietin