BLOOD TRANSFUSION

 IT IS THE ADMINISTRATION OF
COMPATIBLE BLOOD AFTER BLOOD
TYPING AND CROSSMATCHING OF
BOTH THE DONOR AND THE
RECIPIENT ARE DONE.
 PURPOSE
 TO IMPROVE OXYGEN TRANSPORT
( RBC’s ) ;
 VOLUME EXPANSION ( whole blood,
plasma, albumin)
 PROVISION OF PROTEINS ( FFP,
albumin, plasma protein fraction)
 PROVISION OF COAGULATION FACTORS
( cryoprecipitate, FFP, fresh whole
blood)
 PROVISION OF PLATELETS ( platelet
concentrate, fresh whole blood.)
 PURPOSE
 TO INCREASE BLOOD VOLUME
AFTER SURGERY, TRAUMA OR
HEMMORHAGE.
 TO OVERCOME ACUTE AND
CHRONIC ANEMIA – INCREASE
RBC AND Hgb levels.
 TO REPLACE BLOOD LOSS.
( BLEEDING CLIENTS)
 BLOOD AND BLOOD
PRODUCTS
 1. Whole blood; provides all
components
 a. Large volume can cause
difficulty: 12 – 24 hours for Hgb &
Hct to rise.
 b. Complications: volume
overload, transmission of hepatitis
or AIDS, transfusion reaction.
 RED BLOOD CELLS
 A. PROVIDE TWICE THE AMOUNT OF
Hgb AS AN EQUIVQLENT AMOUNT OF
WHOLE BLOOD.
 B. INDICATED IN CASES OF BLOOD
LOSS, PRE- AND POST- OP CLIENTS.
 C. COMPLICATIONS : TRANSFUSION
REACTION ( less common than with
whole blood due to removal of plasma
proteins)
FRESH FROZEN PLASMA
 A. CONTAINS ALL COAGULATION
FACTORS INCLUDING V AND VIII
 B. CAN BE STORED FROZEN FOR
12 MONTHS; TAKES 20 MINUTES
TO THAW
 C. HANG IMMEDIATELY UPON
ARRIVAL TO UNIT ( loses its
coagulation factors rapidly).
 PLATELETS
 A. WILL RAISE RECIPIENT’S
PLATELET COUNT BY 10,000/mm
 BLOOD TYPING
 DETERMINES BLOOD TYPE ( ABO & Rh
BLOOD GROUPS)
 ERYTHROCYTES carry antigens, which
detemine the different blood groups.
 BLOOD TYPING SYSTEMS ARE BASED ON
THE MANY POSSIBLE ANTIGENS, BUT THE
MOST IMPORTANT ARE THE ANTIGENS OF
THE ABO & Rh blood groups because they
are most likely to be involved in
transfusions reactions.
 MAIN BLOOD GROUPS
 BLOOD GROUPS :CAN DON: can rec.
 O O,A,B,AB O
 A A, AB O,A
 B B,AB O,B
 AB AB O,A,B,AB
COMPLICATIONS OF BLOOD
TRANSFUSION
 1. HEMOLYTIC :
 CAUSES: ABO INCOMPATIBILITY
 Rh incompatibility
 use of dextrose solutions
 wide temp. fluctuations
 OCCURRENCE: ACUTE: first 5 mins after
completion of transfusion
 DELAYED: DAYS TO 2 WEEKS AFTER
 COMPLICATIONS
 SIGNS & SYMPTOMS: HEADACHE,
LUMBAR OR STERNAL PAIN, NAUSEA,
VOMITING, DIARRHEA, FEVER,
CHILLS, FLUSHING, HEAT ALONG
VEIN, RESTLESSNESS, ANEMIA,
JAUNDICE, DYSPNEA, SIGNS OF
SHOCK, RENAL SHUTDOWN ( DARK
URINE),HYPOTENSION, TACHYPNEA,
DEATH
 BT COMPLICATIONS…
 NURSING INTERVENTION:
 STOP TRANSFUSION
 CONTINUE SALINE IV, KVO
 NOTIFY PHYSICIAN
 SEND BLOOD UNIT,CLIENT BLOOD
SAMPLE AND URINE SAMPLES TO
LABORATORY.
 WATCH OUT FOR HEMOGLOBINURIA.
 COMPLICATIONS..
 ALLERGIC:
 CAUSES: TRANSFER OF AN ANTIGEN OR ANTIBODY
FROM DONOR TO RECIPIENT; ALLERGIC DONORS
 OCCURRENCE: WITHIN 30 MINS. OF START OF
TRANSFUSION.
 S/S: URTICARIA, LARYNGEAL EDEMA, WHEEZING,
DYSPNEA, BRONCHOSPASM, HEADACHE,
ANAPHYLAXIS ( ANAPHYLACTIC SHOCK)
 INTERVENTION: STOP TRANSFUSION
 ADMINISTER ANTI- HISTAMINE
&/OR EPINEPHRINE, CONT. NSS KVO,MONITOR V/S,
NOTIFY PHYSICIAN, SEMI- FOWLERS,O2 2-3 lpm.
 Complications:
 CIRCULATORY OVERLOAD:
 CAUSES: TOO RAPID INFUSION IN
SUSCEPTIBLE CLIENTS.
 MECHANISM: FLUID VOLUME OVERLOAD
 OCCURRENCE: DURING & AFTER
TRANSFUSION
 S/S: DYSPNEA, COUGH, DISTENDED NECK
VEIN, TACHYCARDIA, ORTHOPNEA,
INCREASED B/P, CYANOSIS, ANXIETY
 INTERVENTION: STOP BT/ SLOW INFUSION
RATE, NOTIFY PHYSICIAN, DIURETICS IF
ORDERED, SEMI- FOWLERS, O2 ADM.
 COMPLICATIONS…
 SEPTIC REACTION (PYROGENIC)
 CAUSES: CAUSED BY TRANSFUSION OF
CONTAMINATED BLOOD PRODUCTS ( BACTERIAL
CONTAMINATION)
 OCCURRENCE: WITHIN 15 – 90 MINS. AFTER
INITIATION OF TRANSFUSION
 S/S: FEVER, CHILLS, FLUSHING, PALPITATIONS,
TACHYCARDIA, VOMITING, HYPOTENSION,LUMBAR
PAIN.
 INTERVENTION: STOP BT
 KVO W/ NSS, MONITOR V/S
 NOTIFY PHYSICIAN, ADM.
ANTIBIOTICS PRN. OBTAIN BLOOD SAMPLE FOR
CULTURE & SENSITIVITY, TRANSFUSE WITH
LEUKOCYTE- POOR BLOOD OR WASHED RBC’S.
 COMPLICATIONS
 AIR EMBOLISM:
 CAUSES: BLOOD GIVEN UNDER AIR
PRESSURE FOLLOWING SEVERE BLOOD LOSS
 MECHANISM: BOLUS OF AIR BLOCKS
PULMONARY ARTERY OUTFLOW
 OCCURRENCE: ANYTIME
 S/S: DYSPNEA, INCREASED PULSE,
WHEEZING, CHEST PAIN, HYPOTENSION,
APPREHENSION
 INTERVENTION: CLAMP TUBING, TURN
CLIENT ON LEFT SIDE.
 GENERAL NURSING
CARE:
 1. ASSESS CLIENT FOR HISTORY OF
PREVIOUS BLOOD TRANSFUSIONS
AND ANY ADVERSE REACTIONS
 2. ENSURE THAT THE ADULT CLIENT
HAS AN 18 0R 19 GAUGE IV CATHETER
IN PLACE.
 3. USE 0.9 % SODIUM CHLORIDE.
 4. AT LEAST TWO NURSES SHPULD
VERIFY THE ABO GROUP, RH TYPE,
CLIENT AND BLOOD NUMBERS,
EXPIRATION DATE.
GENERAL NURSING CARE
 5. TAKE BASELINE VITAL SIGNS
BEFORE INITIATING TRANSFUSION.
 6. START TRANSFUSION SLOWLY (
2ML/ MKIN.)
 7. STAY WITH THE CLIENT DURING
THE FIRST 15 MINS. OF THE
TRANSFUSION AND TAKE V/S
FREQUENTLY.
GENERAL NURSING CARE
 8. MAINTAIN PRESCRIBED
TRANSFUSION RATE:
 A. WHOLE BLOOD: APPROXIMATELY 3
– 4 HOURS
 B. RBC’s : approximately 2- 4 hours
 C. FRESH FROZEN PLASMA: AS
QUICKLY AS POSSIBLE ( LOSES ITS
COAGULATION FACTORS RAPIDLY)

GENERAL NURSING CARE
 D. PLATELETS: AS QUICKLY AS
POSSIBLE
 E. CRYOPRECIPITATE: RAPID
TRNSFUSION
 DOCUMENT THE
FOLLOWING:
 A. BLOOD COMPONENT UNIT NUMBER (
APPLY STICKER IF AVAILABLE )
 B. DATE INFUSION STARTS AND ENDS.
 C. TYPE OF COMPONENT AND AMOUNT
TRANSFUSED
 D. CLIENT REACTION AND VITAL SIGNS
 E. SIGNATURE OF TRANSFUSIONIST.
BLOOD TRANSFUSION
PLATELETS
BT SET
 Transfusion Reactions
Hemolytic Reactions
 Hemolytic reactions occur when the recipient's serum contains antibodies
directed against the corresponding antigen found on donor red blood cells.
This can be an ABO incompatibility or an incompatibility related to a different
blood group antigen.
 Disseminated intravascular coagulation (DIC), renal failure, and death are not
uncommon following this type of reaction.
 The most common cause for a major hemolytic transfusion reaction is a
clerical error, such as a mislabelled specimen sent to the blood bank, or not
properly identifying the patient to whom you are giving the blood. DO NOT
ASSUME IT IS SOMEONE ELSE'S RESPONSIBILITY TO CHECK!
Allergic Reactions
 Allergic reactions to plasma proteins can range from complaints of hives and
itching to anaphylaxis.
Febrile Reactions
 White blood cell reactions (febrile reactions) are caused by patient antibodies
directed against antigens present on transfused lymphocytes or granulocytes.
 Symptoms usually consist of chills and a temperature rise > 1 degree C.
Transfusion related acute lung injury (TRALI)
 TRALI is caused when plasma contains HLA or granulocyte
specific antibodies which correspond to antigens found on
donor WBC's.
 Granulocyte enzymes are released, increasing capillary
permeability and resulting in sudden pulmonary edema.
 Most often occurs with administration of blood products
with plasma, such as FFP.
Bacterial Contamination
 Bacterial contamination of blood can occur during
collection. Bacteria can grow during storage at room
temperature and during refrigeration (psychrophilic
organisms). Transfusing a contaminated unit can result in
septic shock and death.
Circulatory Overload
 Circulatory overload can occur with administration of blood
or any intravenous fluid, particularly in patients with
diminished cardiac function.