Blood Transfusion Therapy

BLOOD
TRANSFUSIO
N THERAPY
Blood transfusion (BT) therapy involves
transfusing whole blood or blood components
(specific portion or fraction of blood lacking
in patient). Learn the concepts behind blood
transfusion therapy and the nursing
management and interventions before, during
and after the therapy.
WHOLE
BLOOD
TRANSFUSIO
NGenerally indicated only for patients who need both increased
oxygen-carrying capacity and restoration of blood volume when
there is no time to prepare or obtain the specific blood components
needed.
PACKED
RBCS
Should be transfused over 2 to 3 hours; if patient cannot tolerate volume over a
maximum of 4 hours, it may be necessary for the blood bank to divide a unit into
smaller volumes, providing proper refrigeration of remaining blood until needed.
One unit of packed red cells should raise hemoglobin approximately 1%,
hemactocrit 3%.
PLATELETS
Administer as rapidly as tolerated (usually 4 units every 30 to 60 minutes).
Each unit of platelets should raise the recipient’s platelet count by 6000 to
10,000/mm3: however, poor incremental increases occur with
alloimmunization from previous transfusions, bleeding, fever, infection,
autoimmune destruction, and hypertension.
GRANULOCY
TES
May be beneficial in selected population of infected, severely granulocytopenic
patients (less than 500/mm3) not responding to antibiotic therapy and who are
expected to experienced prolonged suppressed granulocyte production.
PLASMA
Because plasma carries a risk of hepatitis equal to that of whole blood, if
only volume expansion is required, other colloids (e.g., albumin) or
electrolyte solutions (e.g., Ringer’s lactate) are preferred. Fresh frozen
plasma should be administered as rapidly as tolerated because coagulation
factors become unstable after thawing.
ALBUMIN
Indicated to expand to blood volume of patients in hypovolemic shock and to
elevate level of circulating albumin in patients with hypoalbuminemia. The large
protein molecule is a major contributor to plasma oncotic pressure.
CRYOPRECIPITA
TE
Indicated for treatment of hemophilia A, Von Willebrand’s disease,
disseminated intravascular coagulation (DIC), and uremic bleeding.
FACTOR IX
CONCENTRATE
Indicated for treatment of hemophilia B; carries a high risk of hepatitis because
it requires pooling from many donors.
FACTOR VIII
CONCENTRATE
Indicated for treatment of hemophilia A; heat-treated product decreases the risk
of hepatitis and HIV transmission.
PROTHROMBIN
COMPLEX
Indicated in congenital or acquired deficiencies of these factors.
OBJECTIVES
• To increase circulating blood volume after
surgery, trauma, or hemorrhage
• To increase the number of RBCs and to
maintain hemoglobin levels in clients with
severe anemia
• To provide selected cellular components as
replacements therapy (e.g. clotting factors,
platelets, albumin)
NURSING
INTERVENTIONS
• Verify doctor’s order. Inform the client and explain the
purpose of the procedure.
• Check for cross matching and typing. To ensure
compatibility
• Obtain and record baseline vital signs
• Practice strict asepsis
NURSING
INTERVENTIONS
5. At least 2 licensed nurse check the label of the blood transfusion. Check the following:
⚬ Serial number
⚬ Blood component
⚬ Blood type
⚬ Rh factor
⚬ Expiration date
⚬ Screening test (VDRL, HBsAg, malarial smear) – this is to ensure that the blood is
free from blood-carried diseases and therefore, safe from transfusion.
NURSING
INTERVENTIONS
6. Warm blood at room temperature before transfusion to prevent chills.
7. Identify client properly. Two Nurses check the client’s identification.
8. Use needle gauge 18 to 19 to allow easy flow of blood.
9. Use BT set with special micron mesh filter to prevent administration of blood clots and particles.
10. Start infusion slowly at 10 gtts/min. Remain at bedside for 15 to 30 minutes. Adverse reaction
usually occurs during the first 15 to 20 minutes.
11. Monitor vital signs. Altered vital signs indicate adverse reaction (increase in temp, increase in
respiratory rate)
12. Do not mix medications with blood transfusion to prevent adverse effects. Do not incorporate
medication into the blood transfusion. Do not use blood transfusion lines for IV push of medication.
NURSING
INTERVENTIONS
13. Administer 0.9% NaCl before; during or after BT. Never administer IV fluids
with dextrose. Dextrose based IV fluids cause hemolysis.
14. Administer BT for 4 hours (whole blood, packed RBC). For plasma, platelets,
cryoprecipitate, transfuse quickly (20 minutes) clotting factor can easily be
destroyed.
15. Observe for potential complications. Notify physician.

COMPLICATIO
NS
ALLERGIC
REACTION
it is caused by sensitivity to plasma protein of donor
antibody, which reacts with recipient antigen.
Assess for:
• Flushing
• Rash, hives
• Pruritus
• Laryngeal edema, difficulty of breathing
FEBRILE, NON-
itHEMOLYTIC
is caused by hypersensitivity to donor white cells, platelets or
plasma proteins. This is the most symptomatic complication of
blood transfusion
Assess for:
• Sudden chills and fever
• Flushing
• Headache
• Anxiety
SEPTIC REACTION
it is caused by the transfusion of blood or components
contaminated with bacteria.
Assess for:
• Rapid onset of chills
• Vomiting
• Marked Hypotension
• High fever
CIRCULATORY
itOVERLOAD
is caused by administration of blood volume at a rate greater than
the circulatory system can accommodate.
Assess for:
• Rise in venous pressure
• Dyspnea
• Crackles or rales
• Distended neck vein
• Cough
• Elevated BP
HEMOLYTIC REACTION
it is caused by infusion of incompatible blood products.
Assess for:
• Low back pain (first sign). This is due to inflammatory response of
the kidneys to incompatible blood.
• Chills
• Feeling of fullness
• Tachycardia
• Flushing
• Tachypnea
• Hypotension
• Bleeding
• Vascular collapse
• Acute renal failure
ASSESSMENT
FINDINGS
• Clinical manifestations of transfusions complications vary depending on the
precipitating factor.
• Signs and symptoms of hemolytic transfusion reaction include:
⚬ Fever
⚬ Chills
⚬ low back pain
⚬ flank pain
⚬ headache
⚬ nausea
⚬ flushing
⚬ tachycardia
⚬ tachypnea
⚬ hypotension
⚬ hemoglobinuria (cola-colored urine)
• Clinical signs and laboratory findings in delayed hemolytic reaction include:
⚬ fever
⚬ mild jaundice
⚬ gradual fall of hemoglobin
⚬ positive Coombs’ test
• Febrile non-hemolytic reaction is marked by:
⚬ Temperature rise during or shortly after transfusion
⚬ Chills
⚬ headache
⚬ flushing
⚬ anxiety
Signs and symptoms of septic reaction include;
⚬ Rapid onset of high fever and chills
⚬ vomiting
⚬ diarrhea
⚬ marked hypotension
• Allergic reactions may produce:
⚬ hives
⚬ generalized pruritus
⚬ wheezing or anaphylaxis (rarely)
• Signs and symptoms of circulatory overload include:
⚬ Dyspnea
⚬ cough
⚬ rales
⚬ jugular vein distention
• Manifestations of infectious disease transmitted through transfusion may develop
rapidly or insidiously, depending on the disease.
• Characteristics of GVH disease include:
⚬ skin changes (e.g. erythema, ulcerations, scaling)
⚬ edema
⚬ hair loss
⚬ hemolytic anemia
• Reactions associated with massive transfusion produce varying manifestations
NURSING
DIAGNOSIS
• Ineffective breathing pattern
• Decreased Cardiac Output
• Fluid Volume Deficit
• Fluid Volume Excess
• Impaired Gas Exchange
• Hyperthermia
• Hypothermia
• High Risk for Infection
• High Risk for Injury
• Pain
• Impaired Skin Integrity
• Altered Tissue Perfusion
PLANNING AND
IMPLEMENTATION
Help prevent transfusion reaction by:
• Meticulously verifying patient identification beginning with type
and crossmatch sample collection and labeling to double check
blood product and patient identification prior to transfusion.
• Inspecting the blood product for any gas bubbles, clothing, or
abnormal color before administration.
• Beginning transfusion slowly ( 1 to 2 mL/min) and observing the
patient closely, particularly during the first 15 minutes (severe
reactions usually manifest within 15 minutes after the start of
transfusion).
• Transfusing blood within 4 hours, and changing blood tubing every
4 hours to minimize the risk of bacterial growth at warm room
temperatures.
Help prevent transfusion reaction by:
• Preventing GVH disease by ensuring irradiation of blood products
containing viable WBC’s (i.e., whole blood, platelets, packed
RBC’s and granulocytes) before transfusion; irradiation alters
ability of donor lymphocytes to engraft and divide.
• Preventing hypothermia by warming blood unit to 37 C before
transfusion.
• Removing leukocytes and platelets aggregates from donor blood
by installing a microaggregate filter (20-40-um size) in the blood
line to remove these aggregates during transfusion.
On detecting any signs or symptoms of reaction:
• Stop the transfusion immediately, and notify the physician.
• Disconnect the transfusion set-but keep the IV line open with
0.9% saline to provide access for possible IV drug infusion.
• Send the blood bag and tubing to the blood bank for repeat
typing and culture.
• Draw another blood sample for plasma hemoglobin, culture,
and retyping.
• Collect a urine sample as soon as possible for hemoglobin
determination.
NURSING
INTERVENTIONS
• If blood transfusion reaction occurs: STOP THE
TRANSFUSION.
• Start IV line (0.9% NaCl)
• Place the client in Fowler’s position if with
Shortness of Breath and administer O2 therapy.
• The nurse remains with the client, observing signs
and symptoms and monitoring vital signs as often
as every 5 minutes.
• 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.
EVALUATION
• The patient maintains normal breathing pattern.
• The patient demonstrates adequate cardiac output.
• The patient reports minimal or no discomfort.
• The patient maintains good fluid balance.
• The patient remains normothermic.
• The patient remains free of infection.
• The patient maintains good skin integrity, with no lesions
or pruritus.
• The patient maintains or returns to normal electrolyte and
blood chemistry values.

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BLOOD

15. Observe for potential complications. Notify physician.

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