Blood Transfusion

BLOOD
TRANSFUSION
DEFINITION
Blood Transfusion is a procedure in which whole blood or parts of blood are put into a patient’s
bloodstream through a vein. The blood may be donated by another person or it may have been taken from
the patient and stored until needed. Also called transfusion.
BLOOD GROUPING AND CROSS MATCHING
In administering blood, it is important for the blood of the donor and the blood of the recipient to be
compatible.
The most important system for transfusion is the ABO system, which includes A, B, O and AB blood
types. The determination of blood group is based on the presence or absence of A and B red cell antigens.
An A blood type contains A antigen and B blood type contains B antigen.
An O blood type has neither A or B antigens which makes it ‘Universal donor’ and an AB blood type has
both A and B antigens that makes it suitable for this blood type to receive blood from all other blood
types, thus making it ‘Universal recipient’.
Rh FACTOR
In addition to the kinds of protein substances found in the four blood types, some persons have an extra
protein substance called the Rhesus or Rh factor. Approximately 85% of all persons have this protein and
are called Rh positive; the remaining 15% are said to be Rh negative.
PURPOSE
1. To replace or maintain blood volume.

2. To preserve the oxygen-carrying function of the blood.
3. To increase or maintain the coagulation abilities of the blood.
INDICATIONS
1. Blood loss
1.1 Bleeding
1.2 Trauma
2. Inadequate production
2.1 Diseases like Thalassemia, Leukaemia
3. Excessive destruction of cells

3.1 Disease
3.2 Mechanical
4. Bleeding disorders
SELECTION OF DONOR
Screening of blood donors is rigorous, using criteria established to protect the donor from possible ill
effects of donation and to protect the recipient from exposure to blood-borne diseases.
According to Indian Red Cross Society, the donor must:
 be between the age group of 18-60.
 Have Hb>12.5g/dl.
 Weigh more than 45 kgs.
 Not have fever.
 Not have a history of diseases like Hepatitis, HIV infection, heart diseases, cancer, Asthma, bleeding
disorders, convulsions, Anaemia, Hypo or Hypertension, malaria, etc.
 Not have been exposed to malaria and certain drugs.
 Not be pregnant
STORAGE CONDITIONS
Blood (Product) Temperature for Storage Amount Shelf life

Whole blood 2-6 C 450 ml 35 days
PRBC 2-4 C 330 ml 120 days
Platelet Concentrate 20-24 C 15-20 ml 5 days
FFP -40 to -50 C 200-250 ml 2 years
Cryoprecipitate -30 C 15-20 ml 2 years
TRANSFUSION RATE
Blood (Product) Adults Children Duration of Transfusion

Whole blood 150-200ml/hr 2-5ml/kg/hr ~ 4 hours
PRBC 100-150ml/hr 2-5ml/kg/hr ~ 4 hours
Platelet/ Plasma 150-300 ml/hr 1-2ml/kg/hr Within 30 minutes
Transfusion Reaction
A transfusion reaction is a systemic response by the body to incompatible blood.
Transfusion reactions are either Immunologic or Non-immunologic.
Immediate reactions occur within the first 24 hours of the transfusion. These include:
 Acute Haemolytic reactions
 Anaphylactic reactions
 ARDS
 Air Embolism
 Circulatory overload
 Febrile non-haemolytic reactions
 Hypothermia
 Sepsis
 TRALI
 Urticaria
Delayed effects can occur days, months or even years after a transfusion. These include:
 Iron overload (Hemosiderosis)
 Hepatitis b or C
 HIV
 CMV infection
 Malaria
 Epstein-Barr virus infection
ARTICLES REQUIRED
 Unit(s) of desired blood product.
 Blood Transfusion (BT) set.
 Normal Saline for infusion.
 IV stand.
 A venepuncture set containing large gauge needles.
 Alcohol swabs
 Adhesive tape/ Tegaderm to secure the needle.
 Clean gloves.
NURSING RESPONSIBILITY
I) Verify client consent:

 Verify that a signed consent form was obtained.
 Assess baseline vital signs.
 Determine any known allergies or previous adverse reactions to blood.
 Note the significant clinical studies like Haemoglobin and Hematocrit.
II) Prepare the client.

 Explain the procedure and its purpose and educate the client to report any chills, nausea, itching,
rash, dyspnoea, back pain etc.
 Establish and/or check for an appropriate gauge IV line.
III) Obtain correct blood component.

 Cross-check physician’s order and patient file with the requisition slip.
 Once the unit is readied by the blood bank, send the release slip to collect the blood product.
 Check the label on blood bag with that of the patient’s file and physician’s order.
 Get the same cross-checked by another nurse, preferably more experienced, or a doctor.
 If all the details match, then thaw the blood for not more than 30 minutes.
IV) Verify client’s identity

 Ask the client’s full name.
 Match the blood bag label with client’s id band.
V) Set up the infusion equipment.

 Put on the gloves.
 Insert the BT to the blood bag using a twisting motion.
 Suspend the blood bag on the IV stand.
 Remove the air from the tubing.
 Start the transfusion.
VI) Observe the client closely for the first 5-10 minutes.
 Run the transfusion slowly for the first 15 minutes at 20 drops/min.
 Observe closely for any signs of reaction.
VII) Document relevant data.

 Baseline vital signs
 Transfusion starting time
 Blood type
 Blood unit number
 Site of venepuncture
 Size of the needle
 Drip rate
VIII) Monitor closely.

 Assess vital signs every 15 minutes for the first hour.
 After the first hour, assess the vital signs every 30 minutes.
 Do not exceed the transfusion beyond 4 hours.
IX) Terminate the transfusion.

 Don clean gloves.
 If consecutive infusion is to be started, same BT set can be used or else, discard the set according
to the Biomedical waste protocol.
 Flush the IV line with saline and then clamp.
 Remove the gloves.
 Again monitor vital signs.
X) Complete the documentation.

 Time of ending transfusion.
 Vital signs.
 Amount of blood transfused
 Record the amount in the Intake-Output chart too.
CONCLUSION:
In conclusion, although blood transfusion is a life saving measure for many patients, it should be
restricted to patients who are in real need for blood replacement. Blood transfusion is safer today than it
previously was due to the measures practiced to improve the quality of blood supply and to reduce the
risk of transfusion-transmitted diseases. These include conservation of limited resources and costs and
improved methods for blood ordering and utilization to limit wastage of blood and laboratory resources.
The T&S protocol has been proven to be safe, efficient, and beneficial to the transfusion practice of a
hospital. We suggest that all hospitals in developing countries that are currently experiencing a
high C/T ratio and having a large workload of elective surgeries should consider adopting such a policy to
allow better transfusion management.
REFERENCE
 Hood Gail.Harkness, Total Patient Care, 7 Th Edition, Mosby Publications, Page Numbers 370-371.
 Mallett Jane-Dougherty Lisa, Manual Of Clinical Nursing Procedures, 5 Th Edition, Blackwell Science
Publishers, Page Number 581-587.
 Kozier Barbara, Erb Glenora, Berman Audrey Jean, Burkekaren, Fundamentals Of Nursing, 6 Th
Edition, Pearson Education, Page Number 1352, 1354-1357.
 Lippincott, Manual Of Nursing Practice, 7 Th Edition, Lippincott William &Amp; Wilkins, Page
Number 897.
 Potter Patricia.A., Perry Anne Griffin, Fundamentals Of Nursing, 5 Th Edition, Mosby Publications,
Page Number 1243.

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BLOOD

BLOOD GROUPING AND CROSS MATCHING

1. To replace or maintain blood volume.

3. Excessive destruction of cells

Blood (Product) Temperature for Storage Amount Shelf life

Blood (Product) Adults Children Duration of Transfusion

I) Verify client consent:

II) Prepare the client.

III) Obtain correct blood component.

IV) Verify client’s identity

V) Set up the infusion equipment.

VII) Document relevant data.

VIII) Monitor closely.

IX) Terminate the transfusion.

X) Complete the documentation.

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