Blood transfusion

Blood donation
To protect both the donor and the recipients, all
prospective donors are examined and interviewed
before they are allowed to donate their blood.
• Assess general health
• Identify risk factors
The American red cross (2012) requires that donors
be in good health and meet specific eligibility
criteria related to medications and vaccinations,
medical conditions and treatments, travel outside
the US, lifestyle and life events and so on.
 All donors are expected to meet the following minimal
requirements.
 Body weight should be at least 50kg for a standard 450 ml
donation, donors weighing less than 50kg donate
proportionately less blood
 The oral temperature should not exceed 37.5C
 The pulse rate should be regular and between 50- 100bpm
 The systolic arterial blood pressure should be 90 to 180
mmhg, and the diastolic pressure should be 50 to 100
mmhg
 The Hb level should be at least 12.5g/dl for female and
13.5g/dl for men
 Blood and Blood components used in
transfusion
1. Whole Blood: Cells and Indications and
plasma, hematocrit about considerations:
40%
Volume replacement and
oxygen-carrying capacity;
usually used only in
significant bleeding (> 25%
blood volume lost)
2. Packed red blood cells 3.L eukocyte-poor RBCs:
(PRBCs): RBCs with little plasma
(hematocrit about 75%); some Most WBCs removed to
platelets and WBCs remain, 250-
300ml/unit infuse over 2-4 hours reduce risk of reaction
Indications and considerations:
↑RBC mass, 4. Albumin 5%, 25%
Used to treat anemia, and reduce Indication:
risk of volume overload
Hypoproteinemia;
burns; increase volume
expansion
5. Fresh frozen plasma (FFP): separated from whole blood by
a centrifuge process, 180-270ml/unit infuse in less than 4
hours

Indications:
Used to restore plasma volume, treat some bleeding problems
Methods of use.
FFP must be thawed between 30 °C and 37 °C in a water bath
under continuous agitation or with another system able to
ensure a controlled temperature. The plasma must be
transfused as soon as possible after thawing, but in any case
within 24 hours, if stored at 4 ± 2 °C.
6. Platelets
• Maintain normal coagulation of blood, 80-
60ml/pack: usually 4-6 packs are pooled for
transfusion infuse as quickly as the pt tolerates

Indications:
• Used to treat some bleeding disorders, and to
compensate when marrow can not produce
enough.
7. Granulocytes: granulocyte 9. Cryoprecipitate:
transfusions have been
broadly used to prevent Fibrinogen, von Willebrand
and/or treat life- threatening factor, factor VIII, factor XIII
infections in patients with and fibronectin
severe febrile neutropenia.
Indications: von
Indications: severe
neutropenia in selected Willebrand’s disease
patients. Hypofibrinoginemia
8. Anti- hemophilic factor: Hemophilia A
factor VIII (8) 10. Factor IX concentrate:
Indication: hemophilia A Indication: Hemophilia B
 Standard donation
Phlebotomy consists of venipuncture and blood
withdrawal.
• Standard precautions are used.
• Donors are placed in a semi- recumbent
position.
• The skin is carefully cleansed with an
antiseptic preparation, a tourniquet is applied,
and venipuncture is performed.
• Withdrawal of 450 mL of blood usually takes less than
15 minutes. After the needle is removed, donors are
asked to hold the involved arm straight up, and firm
pressure is applied with sterile gauze for 2 or 3 minutes
or until bleeding stops.
• A firm bandage is then applied.
• Donors remain recumbent until they feel able to sit up,
usually within a few minutes.
• Donors who experience weakness or faintness should
rest for a longer period.
• Donors then receive food and fluids and are asked to
remain another 15 minutes.
• Donors are instructed to leave the dressing on
and to avoid heavy lifting for several hours, to
avoid smoking for 1 hour, to avoid drinking
alcoholic beverages for 3 hours, to increase
fluid intake for 2 days, and to eat a healthy
meals for 2 weeks.
• Specimens from this donated blood are tested
to detect infections and to identify the
specific blood type.
 Autologous donation
• A patient ’s own blood may be collected for
future transfusion; this method is useful for
many elective surgeries where the potential
need for transfusion is high (e.g, orthopedic
surgery).
• Preoperative donations are ideally collected 4
to 6 weeks before surgery. Iron supplements
are prescribed during this period to prevent
depletion of iron stores.
• Typically, 1 unit of blood is drawn each week;
• The primary advantage of autologous
transfusions is the prevention of viral
infections from another person’s blood. Other
advantages include safe transfusion for
patients with a history of transfusion
reactions, prevention of alloimmunization,
and avoidance of complications in patients
with alloantibodies.
• Contraindications to donation of blood for
autologous transfusion are:
- Acute infection,
- Severely debilitating chronic disease,
- Hemoglobin level less than 11 g /dL, hematocrit
less than 33%,
- Unstable angina,
- Acute cardiovascular or cerebrovascular disease
- A history of poorly controlled epilepsy.
 Complication of blood donation
Excessive bleeding at the donor’s venipuncture site is
sometimes caused by a bleeding disorder in the donor
but more often results from a technique error:
• laceration of the vein,
• excessive tourniquet pressure,
• failure to apply enough pressure after the needle is
withdrawn.
• Fainting is common after blood donation and may be
related to emotional factors, a vasovagal reaction, or
prolonged fasting before donation
• loss of blood volume, hypotension and syncope may
occur when the donor assumes a standing position.
 CONT
• A donor who appears pale or complains of
faintness should immediately lie down or sit
with head lowered below the knees; he or she
should be observed for another 30 minutes.
• Anginal chest pain may be precipitated in
patients with unsuspected coronary artery
disease.
• Seizures can occur in donors with epilepsy,
although the incidence is very low
 Blood processing
Samples of the unit of blood are always taken
immediately after donation so that the blood can be
typed and tested. Each donation is tested for:
• Antibodies to HIV 1 and 2,
• Hepatitis B core antibody (anti-HBc),
• Hepatitis C virus (HCV)
• human T-cell lymphotropic virus, type I (anti-HTLV-I/II).
• The blood is also tested for hepatitis B surface antigen
(HbsAG) and for syphilis.
• Blood is also screened for cytomegalovirus (CMV)
• Blood is also screened for cytomegalovirus (CMV), if it tests
positive for CMV, it can still be used, except in recipients who are
negative for CMV and who are immunocompromised.
• Equally important to viral testing is accurate determination of the
blood type, To prevent a significant reaction, the same type of RBCs
should be transfused.
• Previously, it was thought that in an emergency situation in which
the patient’s blood type was not known, type O blood could be
safely transfused. This practice is no longer advised by the American
Red Cross.
• The Rh antigen (also called D) is present on the surface of RBCs in
85% of the population (Rh-positive). Those who lack the D antigen
are called Rh-negative. RBCs are routinely tested for the D antigen
as well as ABO. Patients should receive PRBCs with a compatible Rh
type.
 Intraoperative blood salvage
• This transfusion method provides replacement for
patients who are unable to donate before surgery and
for those undergoing vascular, orthopedic, or thoracic
surgery.
• During a surgical procedure, blood lost into a sterile
cavity (eg, hip joint) is suctioned into a cell-saver
machine.
• The RBCs are washed, often with saline solution, and
then returned to the patient as an intravenous
infusion.
• Salvaged blood cannot be stored, because bacteria
cannot be completely removed from the blood.
• Transfusion of packed red blood cells
• Transfusion of platelets or fresh frozen plasma

(check printed paper, page 942, medical surgical

nursing brunner and suddarth)
 Patient teaching
• Review of signs and symptoms of potential
transfusion reactions especially for patients
who didn’t receive any blood transfusion
• Signs and symptoms of a possible reaction
include fever, chills, respiratory distress, low
back pain, nausea, pain at the intravenous
site, or anything “unusual”
• Reassure the patient that the blood is
carefully tested against the patient’s own
blood (cross-matched) to diminish the
likelihood of any untoward reaction.
What Religion will not accept transfusions?
• JEHOVIAH WITNESS
 Pre- transfusion assessment
1. Patient history:
• history of previous transfusions as well as previous reactions to
transfusion,
• pregnancies,
• Other concurrent health problems should also be noted, with
careful attention to cardiac, pulmonary, and vascular disease.
2. Physical assessment:
• vital signs,
• respiratory system should be assessed, including careful
auscultation of the lungs and for use of accessory muscles.
• Cardiac system assessment should include careful inspection for any
edema as well as other signs of cardiac failure (eg, jugular venous
distention).
 Administration of blood
• Pt needs 18 or 20 gauge IV needle so cells are not lysed
(destroyed)
• Prior to administration, blood needs to be checked by 2
licensed nurses. Check the expiration date, name, medical
record number, type of blood, blood band id, pt birthday
• Check vitals prior to administration
• **blood must be initiated within 30 minutes of arrival from
lab to floor
• Use blood tubing for administration (With filter)
• Monitor for blood reactions
• Monitor vitals continuously during administration
 Crossmatch
• The crossmatch is the final step of
pretransfusion testing as a routine procedure.
A portion of donor blood is combined with
patient plasma or serum and is checked for
agglutination, which would signify
incompatible blood.
 Complications
1.Febrile non hemolytic reactions
2.Acute hemolytic reaction
3.Bacterial contamination
4.Disease Acquisition
5.Delayed hemolytic reaction
6.Circulatory overload
7.Transfusion related acute lung injuries
8.Allergic reaction
 COMPLICATIONS OF LONG-TERM
TRANSFUSION THERAPY
• Patients with long-term transfusion therapy (eg,
thalassemia, sickle cell anemia) are at greater risk for
infection transmission and for becoming more sensitized to
donor antigens, simply because they are exposed to more
units of blood and, consequently, more donors.
• Iron Overload. One unit of PRBCs contains 250 mg of iron.
Patients with chronic transfusion requirements can quickly
acquire more iron than they can use, leading to iron
overload. Over time, the excess iron deposits in the tissues
and can cause organ damage, particularly in the liver, heart,
testes, and pancreas. Promptly initiating a program of iron
chelation therapy (e.g, with deferoxamine [Desferal]) can
prevent end-organ damage from iron toxicity

Mrs.NienAkouch
NURSING MANAGEMENT FOR
TRANSFUSION REACTIONS
Mrs. Nisreen Akkouch
 Continue nursing management for
transfusion reactions
• Circulatory overload: dyspnea, tachycardia, cough,
frothy sputum, cyanosis, increased BP that drops
suddenly, distended neck veins, crackles
- High risk are elderly and those with history of CHF
- cardio system is unable to manage the additional fluid
load
- Occurs anytime during transfusion and up to several
hours after completion
- Occurs if infusing too rapidly or too much quantity
- Intervention: stop infusion, call for help, be prepared for
code, be prepared to administer oxygen and Lasix
ABO blood group