BLOOD AND BLOOD COMPONENTS

BLOOD

A mixture of cells
A complex TRANSPORT mechanism
a. Transports hormones
b. Removes waste products
c. Regulates body temperature
d. Protects the body
e. Promotes hemostasis
f. Supplies oxygen

BLOOD VOLUME:
8% of total body weight = varies by age & body composition


CATEGORY


Ml/Kg

Blood Volume

Adult male


70 mL/kg


90kg=6300 ml

Adult female


70ml/kg

60kg=4200ml

Child


80ml/kg

30kg=2400ml

Neonate


85-90ml/kg

3kg=255-270ml


* Temperature 38C (100.4F)
* pH 7.35 - 7.45
* Specific Gravity 1.048 1.066
* 5 times the viscosity of water




COMPOSITION OF BLOOD
1. PLASMA
o Liquid part of the blood
o Consists of serum and fibrinogen
o Contains plasma proteins such as:
Albumin = regulates & maintains
Serum globulins = for transportation
Fibrinogen, prothrombin, plasminogen = to stop the bleeding
2. CELLULAR COMPONENTS formed elements
a. RBC = responsible for oxygen transport
b. WBC = play a major role in defense against microorganisms
c. PLATELETS = responsible in clot formation

BLOOD TYPES
Everybody has a Blood type. The most common Blood type classification system is
the ABO system discovered and defined by Karl Landsteiner in the early 1900s..

The surface of an individuals RBC contains a number of proteins known as
ANTIGENS( Agglutinogens )- which promotes agglutination or clumping of blood
cells.
*Agglutinins preformed antibodies to RBC antigens that are present in the plasma
-are protectors of our bodies and are responsible for ensuring that only
the Blood cells of our own particular Blood type exist in our bodies.




B L O O D T R A N S F U S I O N
* is the process of transferring blood or blood-based products from one person into the
circulatory system of another.

* The person receiving the blood is the recipient.
* The person giving the blood is the donor
Blood Transfusion may be necessary for any of the following reasons:
Maintenance of blood volume
Maintenance of coagulation properties.
Maintenance of oxygen-carrying capacity of blood.

BLOOD DONATION
National Blood Services Act of 1994
Also known as the Republic Act 7719
AN ACT PROMOTING VOLUNTARY BLOOD DONATION PROVIDING FOR AN
ADEQUATE SUPPLY OF SAFE BLOOD, REGULATING BLOOD BANKS, AND
PROVIDING PENALTIES FOR VIOLATION THEREOF.


Eligible Donors Must:
Be at least age 18-55
Weigh at least 110 lb (50 kg)
Free from skin disease
Have a hemoglobin level of at least 12.5 g/dl (women) or 13.5 g/dl (men)
Stable VS
- (-) hx of jaundice, malaria, TB, etc.
- (-) infection
-previous blood transfusion - 6 mos
- previous blood donation - 3 mos
- No surgical procedure, ear piercing, needle punctures, or major
illnesses 1yr on
Alcohol intake (-) 48 hours intake
(-) medication intake for 2 days
(-) pregnancy
TYPING AND CROSS MATCHING

Before any blood can be given to a patient, it must be determined that the blood of
the donor is compatible with the patient. The laboratory examination to determine a persons
blood group and Rh factor is called BLOOD TYPING.
The process of determining compatibility between blood specimens is
CROSSMATCHING.
RBCs from the donor blood are mixed with serum from the recipient, a reagent from
(Coombs serum) is added and the mixture is examined for visible agglutination. If
no antibodies to the donated RBCs are present in the recipients serum,
agglutination does not occur and the risk of transfusion reaction is small.

BLOOD COLLECTION/ DONATION METHODS
* Homologous (Allogeneic)-
* Directed Donor
* Autologous Donor (Self)

TWO METHODS IN OBTAINING BLOOD FROM THE DONOR
1. Whole Blood Donation
2. Apheresis
plasmapheresis
plateletpheresis
leukopheresis

TRANSFUSION DEVICES
Blood Warmers
Administration sets( Y type tubing)
Filters - retain blood clots & other debris
special filters : microaggregate
leukoreduction
Needles
g.18- adults,
g22- for bigger children
g 23/24- infants, smaller children
Compatible Fluids 0.9% Saline is the only acceptable fluid
Pressure Bags used to increase flow rates usually during emergencies

BLOOD PRODUCTS
1. WHOLE BLOOD

Unprocessed blood containing all cellular and plasma components of donor
blood
450 ml in 63ml of anticoagulant solution
Actively bleeding patient
Shock
Neonatal exchange transfusion
Replaces blood volume and all blood products

Fresh Whole Blood -w/in 24 collection
- RBC + platelets + coagulation factors

2. PACKED RED BLOOD CELL

Product that remains after removal of most plasma by sedimentation or
centrifugation of whole blood
RBC, (-)plasma
Anemia, blood loss
Neonatal exchange transfusion

3. WASHED RED BLOOD CELL
RBC that has been washed with a compatible solution ( NSS ) to reduce leucocytes
3x-4x
RBC depleted of > 95% of leukocytes and plasma proteins ; 20 % RBC loss
Patients requiring repeated BT who develop repeated transfusion reactions ( febrile,
urticarial and anaphylactic reactions)

4. FRESH FROZEN PLASMA

Non cellular fluid portion of anti coagulated blood extracted from a single
donor unit within 8 hrs post donation and rapidly frozen
Plasma proteins & all coagulation factors
Control or prevention of bleeding in multiple coagulation defects
5. PLATELET CONCENTRATE
At least 5.5 x 10
10
platelets in 50ml plasma
w/ or w/o bleeding w/ APC <20,000
platelet dysfunction w/ bleeding
Fresh platelets most effective


6. CRYOPRECIPITATE cold insoluble portion of the plasma after FFP has been
thawed
Factor VIII, vWF( von Willebrand factor ), Fibrinogen
7. CRYOSUPERNATE residual plasma refrozen after removal of cryoprecipitate
(-) Factor VIII
Used for clients with clotting factor deficiencies

RECOMMENDED INFUSION TIME


WHOLE BLOOD

4 hours

450-500 ml

PRBC/WRBC


4 hours

250-350ml

PLASMA


2-3 hours

200-250 ml


PLATELETS

Fast drip/ 10-15 mins

50-70ml

Platelet Pheresis


300-400ml

Cryoprecipitate


15 ml

Cryosupernate


200 ml




PREPARATION TIME
FFP at least 24 hours
Cryoprecipitate &Cryosupernate at least 24 hours
Platelet Pheresis 4-5 hours
Platelet concentrate 4 hours
Washed RBC 3 hours
PRBC/ FP/ PRP 2 hours

Whole Blood 15-45 minutes


Blood product

Storage Temperature Expiration date
Fresh Frozen Plasma
- 18 C

6 hrs after thawing ; can be
stored for one year if not
used


Cryoprecipitate
-18 C
6 hrs after thawing ; can be
stored for one year if not
used


Packed Red blood Cell
1-6 C

35 days

Whole Blood
1-6 C

35 days

Platelet Concentrate
Room temperature

5 days




Nurses Responsibilities in Blood Transfusion
Before Transfusion
Obtain Informed consent
Explain the procedure to the patient/relatives including the benefits & risks
Review the doctors order, including any special processing requested
Assess the patient
Obtain important medical history information
Review pertinent laboratory values
Vital signs
Assessment for skin rashes, shortness of breath, wheezing, pain, chills or
nausea
In patient with cardiopulmonary disease, listen to lungs to establish a baseline
for the presence of any rales( crackles)
Give pre BT medication as ordered
Ex. Antihistamine Benadryl
Avoid obtaining either whole blood or packed RBCs until youre ready to begin the
transfusion.
Prepare the equipment when youre ready to start the infusion.
When you received the delivery from the blood bank, you should receive both the
product and the transfusion record that corresponds to it.

Inspect the blood for the following:
1. Labels
2. Integrity of Unit
3. Appearance
Dont transfuse the blood product if you discover a discrepancy in the blood number,
blood slip type, or patient identification number

Two nurses must identify the patient and. blood productbefore administering a
transfusion (to prevent errors & potentially fatal reaction.





DURING TRANSFUSION
* Administer the blood or component at the recommended rate.
* Stay with the patient for the first few minutes of the transfusion
* Review signs and symptoms of what the patient should report to you.
* Dont add medications to the blood.
* Blood extraction during transfusion is not allowed.
* Monitor the patient regularly including the blood being transfused.
* Discontinue transfusion immediately once the patient manifest symptoms of
transfusion reaction, assess the patient and notify the doctor.

Blood transfusion regulation

Gtts/min= vol. of blood in cc x drop factor
No. of hours to be infused 60
AFTER TRANSFUSION
1. Continue to monitor patient for any signs and symptoms of reaction for at least one
hour after the transfusion.
2. Obtain any ordered post-transfusion laboratory studies.
3. Document the transfusion in the patients chart.
4. After completing the transfusion, youll need to put on gloves anddiscard the used
transfusion equipment.
DOCUMENTING BLOOD TRANSFUSION
Date and time the transfusion was started and completed
Name of the health care professional who verified the information of the patient and
the blood
Catheter type and gauge
Total amount of the transfusion
Type of blood component w/serial number
Patients vital signs before and after the transfusion
Infusion device used
Flow rate and if blood warming was used
Vital signs obtain prior to, during, and after the transfusion
Transfusion reactions & nursing action
Document interventions done and to whom you notified.
Patients outcome.
SAFETY PRECAUTIONS
Make sure that YOU are protected too by proper Personal Protective
Equipment (PPE)
Always perform disinfection technique.
If possible, use a needleless system.
If using sharps, do not recap the needle.
Always observe proper waste disposal according to your institutions policy.
If there are spills, never touch the blood with bare hands.
Make sure that blood bag is secured.
Always double or triple check.
Always perform HAND HYGIENE

BLOOD TRANSFUSION REACTIONS AND MANAGEMENT
1. FEBRILE
Pyrexia
Rigors
Anxiety
Restlessness
Treatment / Management
1. Stop transfusion /slow rate of flow
2. Give antipyretics as ordered
3. If no improvement in 30 mins, discontinue transfusion.
2. CIRCULATORY
Distention of cervical veins
Pulmonary edema
Dyspnea
Headache
Heaviness in limbs, may be pyrexia and rigors

Treatment / Management
1. Discontinue transfusion
2. Give diuretics.



3. ALLERGIC
Pyrexia and rigors
Urticaria
Facial edema
Dyspnea

Treatment / Management
1. Discontinue transfusion
2. Give antihistamines
3. Watch for laryngeal edema


4. HEMOLYTIC

Pyrexia , rigors, lumbar pain
Pain along vein
Jaundice
Hemoglobinuria
Oliguria later uremia

Treatment / Management
1. Discontinue transfusion
2. Refer to the physician
3. Save all urine, used bottles, packs and blood sample


5. INFECTED BLOOD
Hyperpyrexia
Pain in limbs and chest
Headache, pallor
Burning pain along injected vein
Low blood pressure, rapid pulse
Profound collapse and shock



Treatment / Management
1. Discontinue transfusion
2. Refer to the physician
3. Save all urine, used bottles, packs , blood samples with labels.
4. Anti-shock treatment, antibiotics in large amounts

Associated Acute lung Injury ( TRALI )
-syndrome of acute respiratory distress
Symptoms: non cardiogenic pulmonary edema, hypotension & often assocaited with fever.

Treatment/Management:
-Oxygen administration
- May require intubation and mechanical ventilation


Iron Toxicity
Consequence of chronic RBC transfusion

Citrate Toxicity
Hypocalcemia may occur


Transfusion Associated Graft Vs Host Disease
- the recipients (HOST) tissues are attacked by the donated white blood cells (
GRAFT).

Symptoms : fever, rash, low BP, low blood counts, tissue destruction & shock