Blood

Transfusion
 Introduction
An adult human has about 4–6 liters of blood circulating in the body. Among
other things, the primary function of blood is to transport oxygen to various parts
of the body. A Blood Transfusion is the infusion of whole blood or a blood
component such as plasma, red blood cells, or platelets into the patient’s venous
circulation .It is given because of red blood cell loss, such as with hemorrhage or
when the body is not adequately producing cells such as platelets. The person
receiving the blood is the Recipient. The person giving the blood is the Donor.
Why it’s done

● Restore blood volume

● Replace clotting factors
● Improve oxygen carrying capacity
● Restore blood elements that are depleted
● Prevent complications
● To raise the haemoglobin level
● To provide antibodies
 Components of Blood
Platelets
Helps in hemostasis.

Red Blood
Cells
Contains hemoglobin a protein Plasma
that binds oxygen. Contains ions and
various kinds of
proteins serving
diverse functions.
White Blood Cells
Cells primarily responsible for
immunity.
 Blood
Products
Blood is the life - maintaining fluid that
circulates through the body.

Products - Most common type of blood

product for transfusion . Used to increase the
oxygen-carrying capacity of blood. Help the
body get rid of carbon dioxide and other
waste products. 1 unit of PRBCs = raises
hematocrit by 2-3%.
 Whole Blood
It contains all the elements of blood that are
necessary for oxygen delivery and hemostasis,
in nearly physiologic ratios and concentrations.

● This type of transfusion increases a

patient’s hemoglobin and iron levels,
while improving the amount of oxygen in
the body.
● Replaces blood volume and all blood
products
 Platelets
Also known as thrombocytes

● Tiny cell structures necessary in blood

clotting process
● Replaces platelets in clients with
bleeding disorders, or platelet deficiency
1 unit = increases the average adult
client’s platelet count by about 5,000
platelets/microliter
 Fresh Frozen Plasma
Plasma is the liquid component of blood; it
has proteins called clotting factors.

● Expands blood volume and provides

clotting factors .
● Contains no RBCs 1 unit of FFP =
increases level of any clotting factor by
2-3%.
 Blood Groups

A B AB O
This blood type has a This blood type has a This blood type has This blood type has
marker known as A. marker known as B. both A and B neither A or B
markers. markers.

These markers (also called antigens) are proteins and sugars that our bodies use to identify the blood
cells as belonging in us.
General Instructions for Giving
Blood Transfusions
Donor shall be free of diseases.

No history of any diseases.

They have not donated blood within the previous 90 days. (3 months).

They should be physically healthy, and should be between 18 and 65 years.

Donor must have a normal temperature, pulse and blood pressure.

They must not have been pregnant within the last 6 months.

Their haemoglobin level must be above 12 grams per 100ml.

The donors are disqualified who have a history of recent dental surgery or major
surgery, receipt of blood or blood components, immunizations or vaccinations, use
of narcotics etc.

Before the blood transfusion, the ABO grouping and Rh typing with the recipient’s
blood should be done

Before the blood is transfused, the donor’s blood must be cross matched with the
recipient’s serum (plasma) and the recipient’s red blood cells

Explain the procedure to the donor and reassure him/her to with confidence and
cooperation.

Blood should not be collected to the empty stomach.

Before the donor is allowed to leave the hospital, his pulse rate should be
questioned as to have any giddiness.

A second withdrawal of blood should not be made until the blood volume and
constitutes have returned to normal, that is usually after 3 months.
 Collections, Storage, and
Transportation of Blood
Collection of blood from the donor is done in the laboratory by the laboratory techniques. The
donor’s blood collected into a sterile is container containing anticoagulant solution. The
anticoagulant used is ACD solution (acid citrate dextrose) or citrate phosphate dextrose.
Each donor unit must labeled in clear, readable letters, bearing the following information to be
verified at the time of administration:

● Name of the donor.

● Donor number.
● ABO grouping Rh typing
 ● Date of drawing blood
● Date of expiry
● Results of tests for hepatitis and syphilis.

The donor blood, immediately after it is withdrawn, should be placed in the refrigerator. Usually it
is stored temperature of 1 to 6 degree centigrade.

Stored blood shall be inspected daily and before use evidence of hemolysis or bacterial
contamination.

The transportation of the blood in the hospital should be done within 30 minutes after it is taken
from the place of storage.

Freezing and heating of the blood will destroy the blood cells.
 Administration of Blood
To the Recipient
When sending the recipient blood sample for grouping and cross matching, it must be
carefully labeled at the bedside of the recipient.

A request form should accompany the specimen and it should contain the following
data :
● The recipient’s name
● Hospital number
● Bed number
● Ward number
● Name of the physician
● Exact amount of blood component requested
● Diagnosis of the patient
● Any blood transfusion given earlier
It is essential that the physician writes all orders for typing, cross matching and
administration of whole blood and blood products.

When blood or blood products have to be administered, it is recommended that two

registered nurse or a physician and a registered nurse should independently verify all
identifying information on the report of the cross match, unit label and patient’s
identifications. Any error in the identification, results in the major adverse reactions.
Should there be any discrepancy, the unit should be returned to the blood bank with the
remarks.

Whole blood and the blood products should be administered through an appropriate,
sterile, pyrogen free transfusion set containing a filter which will remove clots and larger
aggregates of leukocytes and platelets.
Care is to be taken to prevent introduction of air into the apparatus.

It is recommended to use an 18 gauge needle for infusion, to prevent damage to the red cells
and provide an adequate rate of flow.

Prior to administer of blood, the patient’s vital signs should be recorded correctly on the nurse’s
record to provide a baseline for further observation.

Adjust the rate of flow to 5 to 10 ml per minute during the first 30 minutes of transfusion, to
detect any complication as early as possible. Give the blood at a slower rate if the patient is
elderly, suffering from heart disease and lung disease, anemia, debilitating diseases etc.
Whole blood and packed cells administered cold. No attempt is made to heat the blood.
However, blood may be allowed to stand at the room temperature for 30 to 45 minutes before it
is administered to the patient.

Once the blood is exposed to the atmosphere ( the unit is opened), it should be discarded.

The procedure involved in administration of the blood is the same as that of administration of
I.V. infusions. Watch the patient carefully for the onset of any complications. Any reaction
developed in the patient should be reported to the charge nurse and physician immediately.
The following observation are made throughout the procedure :

● Rate of flow .
● Signs of circulatory overload.
● Urinary output.
● The needle site of signs of infiltration, hematoma, and dislodgement of needle etc.
● Blood level in the container. Never allow the blood bottle to be completely empty to prevent
the entry of air.
● Reaction to the blood transfusion .
● Patency of the infusion set.
When leaving the ward, the charge nurse should report the following to the relieving nurse.

● The name and the bed number of the patient receiving the blood transfusions.
● The time at which the drip has started
● The type of blood that is given
● Amount of blood that is administered and the quantity to be given more
● Any specific precautions to be followed
● The specific rate of flow
● Any reactions observed
● Any medications administered
● General condition of the patient
 Blood Transfusion
A tray containing:
Equipments
● Blood Bag
● Cotton swab in container
● Splint and bandage
● Tourniquet Mackintosh with treatment towel
● Sterile blood transfusion set with filter
● Large needle
● Kidney tray and paper bag
● Elastoplasts or adhesive plaster and scissors
● Gloves
● Normal saline bottle
● I.V. Pump and Stand
PROCEDU
RE
● Assemble all the supplies before entering patient room
● Verify the physician’s order for the specific blood or blood product
● Ensure appropriate patient identification band is available and legible
● Two nurses must verify blood product before the start of the procedure
● Assure patency of IV line
● Hang normal saline flush bag
● Spike normal saline (500cc) bag and prime tubing, filling blood tubing filter
● Caution close normal saline roller clamp
● Spike blood bag
● Open blood roller clamp and prime tubing
● Connect IV tubing to patient‘s IV access
● Set pump to deliver blood at no more than 2ml per minutes for 15 minutes
● Monitor the patient for adverse reaction
● Measure vital sign s after 15 minutes
● Increase infusion rate after 15 minutes per MD or facility policy
● Measure vital signs when infusion is complete
● Disconnect blood tubing
● Flush IV line
● Discard tubing and blood bag
● Dispose of all soiled supplies
● Ensure safe environment
● Wash hands
 NURSING
INTERVENTI
ONS
1. If blood transfusion reaction occurs: STOP THE TRANSFUSION.
2. Start IV line.
3. Place the client in Fowler’s position if with Shortness of Breath and administer
O2 therapy.
4. The nurse remains with the client, observing signs and symptoms and monitoring
vital signs as often as every 15 minutes for the first hour and every 30 minutes
for the second hour.
5. Notify the physician immediately.
6. The nurse prepares to administer emergency drugs such as antihistamines,
vasopressor, fluids, and steroids as per physician’s order or protocol.
7. Obtain a urine specimen and send to the laboratory to determine presence of
hemoglobin as a result of RBC hemolysis.
8. Blood container, tubing, attached label, and transfusion record are saved and
returned to the laboratory for analysis.
COMPLICATIONS
HEMOLYTIC REACTION
: Due to incompatibility - hemolysis - microclots - dislodged nephron -
decrease GFR - increase waste products - leads to renal failure.

Signs and Symptoms:

● Flank Pain/ CVA Tenderness/ Lower Back Pain
● Hemoglobinuria
● Vomiting
● Hypotension
● Tachycardia
● Tachypnea

Management:
● Stop infusion
● Flush NSS
● Assess Vital Signs
● Administer O2
● Report to the physician
● Drug of Choice: Epinephrine - Cardiotonic Drug
CIRCULATORY OVERLOAD

IRON OVERLOAD
: Due to multiple Blood Transfusion - Thalassemia Major - RBC
lifespan 12 days.

Signs and Symptoms:

● Bloody Vomitus
● Hypotension
● Tachycardia
● Tachypnea
● DOB

Management:
● Stop infusion
● Flush NSS
● Assess Vital Signs
● Administer O2
● Report to the physician
● Drug of Choice: Desferal/Deferoxamine
ANAPHYLACTIC REACTION
: Due severe allergic reaction.

Signs and Symptoms:

● Bronchospasm (Wheezes,Stridor)
● Hypotension
● Tachycardia
● Tachypnea
● DOB

Management:
● Stop infusion
● Flush NSS
● Assess Vital Signs
● Administer O2
● Report to the physician
● Drug of Choice: Epinephrine, Bronchodilators, Steroids
ALLERGIC REACTION
: Mild reaction.

Signs and Symptoms:

● Urticaria
● Rashes

Management:
● Stop infusion
● Flush NSS
● Assess Vital Signs
● Administer O2
● Report to the physician
● Drug of Choice: Anti-Histamines (Cetirizine, Diphenhydramine)
 THANK YOU
Presented By:
GROUP 2

Florita
Gabiana
Gabisay
Gargar
Lagahit
Lozano
Melencion
Molino