BLOOD TRANSFUSION

META/ GI/ ENDO RLE ROTATION

 What is blood transfusion?

➢ infusion of the whole blood or a

blood component into a patient’s
venous circulation (Evans-Smith, pp. 656)
➢A life-saving medical procedure
ordered by the doctor
Blood Transfusion Therapy

• A blood transfusion
is the introduction of
whole blood or
components of
blood, such as
plasma, serum,
erythrocytes, or
platelets, into the
venous circulation.
 BLOOD TRANSFUSION
• Blood transfusions can be
life-saving in some
situations, such as
massive blood loss due to
trauma, or can be used
to replace blood lost
during surgery.

• Blood transfusions may

also be used to treat a
severe anemia or
thrombocytopenia
caused by a blood
disease
WHAT ARE THE
RISKS OF BLOOD
TRANSFUSIONS?

•HIV virus
•Hepatitis B
•Hepatitis C
PRIOR TO BLOOD TRANSFUSIONS
• Proper cross-
matching of the
donor’s blood and
the blood of the
recipient (to assure
compatibility)
 EQUIPMENTS NEEDED
1. Blood product
✓ Fresh whole blood
✓ Packed RBC
✓ Platelet concentrates
✓ Fresh frozen plasma
✓ Cryoprecipitate
✓ Granulocyte concentrates
✓ Human Albumin
TYPES OF BLOOD AND BLOOD PRODUCTS AND
INDICATIONS FOR USE:
TYPES INDICATIONS
Whole blood To treat volume deficiencies, for example
(type A,B,AB,O, and/or Rh(+) or Rh(-) in acute hemorrhage; not indicated for
correction of chronic anemia
To expand blood volume, to restore
circulation and renal blood flow when
plasma volume is decreased but the
red cell mass is adequate, as in acute
dehydration or burns; to replace
deficient coagulation factors in
bleeding disorders.
Packed red cells (high Hematocrit, since Used when blood volume is adequate but
approximately 80% of the plasma is the red cell mass is inadequate, as in
removed). chronic anemia.
Platelets For patients with severe thrombocytopenia
(reduced platelets). Replaces platelets
for example in Dengue Hemorrhagic
Fever.
 TYPES OF BLOOD AND BLOOD PRODUCTS AND
INDICATIONS FOR USE:
TYPES INDICATIONS
Albumin To expand the blood volume rapidly when
blood volume is reduced in shock or
burns; also to increase level of
albumin in patients with
hypoalbuminemia.
Prothrombin complex (for example Used for bleeding associated with
konyne, Proplex) contains factors deficiencies of those factors.
VII,IX, and XI and prothrombin
Factors VIII fraction or (cryoprecipitate) For hemophiliacs
Caution: may transmit infection, transfuse
with a filter.
Fibrinogen preparations Used particularly for bleeding associated
with congenital hypofibrinogenemia (a
deficiency of fibrinogen, a necessary
factor for blood coagulation)
FRESH WHOLE BLOOD
PACKED RED BLOOD CELLS
PLATELET CONCENTRATE
FRESH FROZEN PLASMA
 EQUIPMENTS NEEDED
2. Blood administration
set (with an in-line
filter)
3. IVF= 0.9 NaCl (Plain
NSS)
4. IV pole
5. IV catheter (gauge 19 or
larger)
6. Disposable gloves
7. Tape
 PRE-ASSESSMENT
• Obtain baseline vital
signs, lung sounds, and
urinary output
• Review recent laboratory
values
• Ask about previous
transfusion reactions
• Inspect IV insertion site
and check the type of
solution
 DOING BLOOD TRANSFUSION
1. Determine whether patient knows reason for
transfusion
2. Explain to patient what will happen. Check for signed
consent. Advise patient to report any chills, itching,
rash, or unusual symptoms.
3. Give premedications, if ordered by the physician.
 DOING BLOOD TRANSFUSION
4. Hang container of
0.9% normal
saline with blood
administration set.
Initiate infusion
5. Start IV with gauge
18 or 19. Run
normal saline at
KVO
6. Obtain the blood
product
 DOING BLOOD TRANSFUSION
7. Complete identification and checks
Serial number
Blood component
Blood type
Rh factor
Expiration data
Screening tests (VDRL for
sexually transmitted
diseases; HBsAg for
hepatitis B; malarial smear
for malaria).
Check for clots
Identifying the blood product
Checking the blood product
8. Take baseline
Vital Signs
9. Start infusion of
blood (thaw 1st)
 DOING BLOOD TRANSFUSION
✓ Prime in-line filter
with blood
✓ Start administration
slowly (25-50 ml for
the first 15 minutes)
✓ Stay with the patient
for the first 5-15
minutes of
transfusion
✓ Check vital signs
(every 15 minutes for
1 hour)
 DOING BLOOD TRANSFUSION
• Observe patient for flushing, dyspnea, itching, hives, rash
10. Consume blood within 4 hours
11. Assess frequently for transfusion reactions.
 TRANSFUSION REACTIONS
• Definition: Reaction of the
body to a transfusion of
blood that is not compatible
with its own blood
• Signs and
Symptoms include:
– Anxiety
– Flushing
– Tachycardia
 TRANSFUSION REACTIONS

– Hypotension
– Chest pain
– Back pain
– Dyspnea
– Fever
– Chills
– Jaundice
 TYPES OF TRANSFUSION
REACTIONS

• Febrile non-hemolytic
transfusion reaction –
most common
– Fever and dyspnea
1-6 hours post
transfusion
• Viral Infection
• Bacterial Infection
 TYPES OF TRANSFUSION
REACTIONS
• Acute Hemolytic
Transfusion – medical
emergency
–Common cause:
clerical error
–Fever, chills,
back pain,
hemoglobinuria

• Anaphylactic Reaction
 TREATMENT OF TRANSFUSION
REACTIONS
• Stop the
transfusion
immediately
(saving the
remaining blood
and IV tubing for
testing) and to
provide
supportive care to
the patient.
 DOING BLOOD TRANSFUSION
12. If a Transfusion Reaction
is suspected, stop blood
transfusion, and run
0.9% Normal Saline.
Notify the doctor and
the Blood Bank
13. When transfusion is
complete, clamp off
blood and infuse 0.9%
Normal Saline
14. Record administration
of blood and patient’s
reaction.
 POSITIVE OUTCOME

Exhibit signs and symptoms of

➢Fluid Balance
➢Improved Cardiac Output
➢Enhanced Peripheral Tissue
Perfusion
TRANSFUSION REACTION
In medicine, a transfusion reaction is any adverse
event which occurs because of a blood transfusion.

These events can take the form of an allergic reaction,

a transfusion-related infection, hemolysis related to
an incompatible blood type, or an alteration of the
immune system related to the transfusion.

The risk of a transfusion reaction must always be

balanced against the anticipated benefit of a blood
transfusion.
TYPES OF TRANSFUSION REACTIONS
• FEBRILE NON-HEMOLYTIC TRANSFUSION
REACTION.

– This is the most common adverse reaction to a blood

transfusion.
– -Symptoms include fever and dyspnea 1 to 6 hours
after receiving the transfusion.
– Such reactions are clinically benign, causing no lasting
side effects or problems, but are unpleasant for the
patient.
• VIRAL INFECTION.
– The risk of viral infection is a common concern when receiving
a blood transfusion.

• BACTERIAL INFECTION.

– Blood products can provide an excellent medium

for bacterial growth, and can become
contaminated after collection while they are being
stored.
– The risk is highest with platelet transfusion, since
platelets must be stored near room temperature
and cannot be refrigerated.
• ACUTE HEMOLYTIC REACTION.

– This is a medical emergency resulting from rapid

destruction (hemolysis) of the donor red blood cells by
host antibodies.
– The most common cause is clerical error (i.e. the wrong
unit of blood being given to the wrong patient).
– The symptoms are fever and chills, sometimes with back
pain and pink or red urine (hemoglobinuria).
– The major complication is that hemoglobin released by the
destruction of red blood cells can cause acute renal failure.
• ANAPHYLACTIC REACTION.

– These reactions are most common in people

with selective IgA deficiency (although IgA
deficiency is often asymptomatic, and people may
not know they have it until an anaphylactic
reaction occurs).
– An anaphylactic reaction is a medical emergency,
requiring prompt treatment, and may be life-
threatening.
• TRANSFUSION-ASSOCIATED ACUTE
LUNG INJURY (TRALI).
– TRALI is a syndrome of acute respiratory
distress, often associated with fever, non-
cardiogenic pulmonary edema, and hypotension.

• VOLUME OVERLOAD.
– Patients with impaired cardiac function (eg
congestive heart failure) can become volume-
overloaded as a result of blood transfusion,
leading to edema, dyspnea (shortness of breath),
and orthopnea (shortness of breath while lying
flat).
• IRON OVERLOAD.
– Each transfused unit of red blood cells contains
approximately 250 mg of elemental iron.
– Since elimination pathways for iron are limited, a
person receiving numerous red blood cell
transfusions can develop iron overload, which
can in turn damage the liver, heart, kidneys, and
pancreas.
– The threshold at which iron overload becomes
significant is somewhat unclear, but is likely
around 12-20 units of red blood cells transfused.
• TRANSFUSION-ASSOCIATED GRAFT-VS-
HOST DISEASE (GVHD).
– GVHD refers to an immune attack by transfused cells
against the recipient.
– This is a common complication of stem cell
transplantation, but an exceedingly rare complication
of blood transfusion.
– It occurs only in severely immunosuppressed patients,
primarily those with congenital immune deficiencies
or hematologic malignancies who are receiving
intensive chemotherapy.
– When GVHD occurs in association with blood
transfusion, it is almost uniformly fatal.
– Transfusion-associated GVHD can be prevented by
irradiating the blood products prior to transfusion.
TREATMENT OF TRANSFUSION
REACTIONS
• Stop the transfusion immediately (saving
the remaining blood and IV tubing for testing)
• To provide supportive care to the patient.
• More specific treatments depend on the
nature and presumed cause of the transfusion
reaction.
• Most hospitals and medical centers have
transfusion reaction protocols, which specify
testing of the blood product and patient for
hemolysis, bacterial contamination, etc.
 SOURCES:
Evans-Smith, Pamela.,
Taylor’s Clinical
Nursing Skills: A
Nursing Process
Approach,
Lippincott Williams
and
Wilkins, 2005, pp.
656-658
THANK YOU