BY: RONAN VER S.

REYNO, RN, CRN

RED BLOOD CELLS
WHITE BLOOD
CELLS
PLATELETS


formed elements of blood
RED BLOOD CELLS
responsible for
oxygen transport


WHITE BLOOD CELLS
play a major role in
defense against
microorganisms

PLATELETS
function in
hemostasis
Liquid part of the
blood
Contains dissolved proteins, glucose,
clotting factors, electrolytes, hormones,
etc.
Serves as the main medium for
excretory product transportation.


Serves as protein reserve of the human
body; contains plasma proteins such
as:
Albumin (regulates & maintains fluid
balance)
Serum globulins (protection from
infection)
Fibrinogen, prothrombin,
plasminogen (to prevent bleeding)

RESPIRATION
NUTRITION
EXCRETION
IMMUNITY
THERMOREGULATION
HEMOSTASIS

8% OF TOTAL BODY WEIGHT
varies by age & body composition

Blood
Volume
Kilograms of
Body Weight
30 kg = 2400
mL
80 mL/kg Child
3 kg = 255
270 mL
8590
mL/kg
Neonate
60 kg = 4200
mL
70 mL/kg
Adult
Female
90 kg = 6300
mL
70 mL/kg Adult Male
Blood Volume mL/kg Category
Temperature 38C
(100.4F)
pH 7.35 - 7.45
Specific Gravity 1.048 1.066
Body weight 8%
5 times the viscosity of water
Volume:
Male 5 6 Liters
Female 4 5 Liters
Composed of:
55% plasma
45% cellular components
Coagulation factors
Inorganic substances
Antibodies
RED BLOOD
CELLS
GRANULOCYTES
PLATELETS
PLASMA
PORTIONS OF THE BLOOD

Refers to the
administration of
any of several blood
products.
Is lifesaving
therapy for patients
with a variety of
medical and surgical
conditions in need for
blood.

Hemorrhage
trauma (automobile accident)
high blood loss surgery (heart surgery,
organ transplant, bone marrow)
Burn, Menorrhagia
GI losses
Decreased red cell production
Renal
Nutritional
Destruction blood cells

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
Weigh at least 110 lb (50 kg)
Free from skin disease
Not have donated in the past
56 days
Have a hemoglobin level of at
least 12.5 g/dl (women) or
13.5 g/dl (men)
Ineligible Donors include those:
Who have HIV or AIDS
Who have taken illegal drugs I.V.
Who have had sex with prostitutes in the
past 12 months
Who have had sex with anyone above
categories
Who have had hepatitis
With certain types of cancer (other than
minor skin cancer)
With hemophilia
Who have received clotting factor
concentrations
Unrelated Donor
(Allogenic)
Directed Donor
Autologous Donor (Self)
BLOOD PRODUCTS USED
FOR TRANSFUSION
Blood
Products
Indications Nursing Considerations
Whole
Blood
To restore blood
volume in
hemorrhaging,
trauma, or burn
patients
Dont infuse over more than 4 hrs.
Warm blood if giving a large
quantity.
Avoid giving when the patient
cant tolerate the circulating
volume.
Use blood transfusion set
PRBC To restore or
maintain oxygen
carrying capacity
To correct anemia
and surgical blood
loss
Dont infuse over more than 4 hrs.
RBCs have the same oxygen
carrying capacity as whole blood,
minimizing the hazard of volume
overload.
Use blood transfusion set
Platelets
To treat
thrombocytopenia
To treat acute leukemia
and marrow aplasia
ABO compatibility isnt necessary but is
preferable with repeated platelet
transfusions; Rh type match is preferred.
Infuse 100 ml over 15 minutes.
Administer at 150 to 200 ml / hour, or as
rapidly as the patient can tolerate; dont
exceed 4 hours.
Avoid administering platelets when the
patient has a fever.
FFP
To expand plasma
volume
To treat postsurgical
hemorrhage or shock
To correct an
undetermined
coagulation factor
deficiency
Cross matching: ABO compatibility
isnt necessary but is preferable with
repeated plasma transfusions; Rh type
match is preferred.
Large volume transfusions of FFP may
require correction for hypocalcemia.
Citric acid in FFP binds calcium.
Blood
Products
Indications Nursing Considerations

Must be knowledgeable about blood products, its
safe administration and how to monitor
patients before, during and after therapy.
Assure that informed consent has been
obtained before starting a transfusion.
Appropriate information to include in patient
education includes: benefits, risks, alternatives
to transfusion
Document all patient education regarding
transfusion therapy, and the responses of
patients and family members after teaching.




Provide patient and family information to
blood transfusion therapy:
The need for blood transfusion
Advantages of blood transfusion
Possible reactions related to the blood
transfusion therapy
Voluntary blood donation act


When assessing your patient before a
transfusion:
Obtain important medical history information
Review pertinent laboratory values
Review the doctors order, including any special
processing requested, pre-medications
(paracetamol, chlorphenamine), etc.
Perform baseline physical assessment (vital
signs)

When you receive the delivery from the
blood bank, you should receive both the
product and the transfusion record that
corresponds to it.

Inspect for the following:
Labels
Integrity of Unit
Appearance


Perform the verification process to
ensure the correct blood is being given
to the correct patient.
Two qualified individuals should verify
the patient and unit identification.
Assess the patency of the patients
vascular access.



Dont add medications to the blood.
Dont transfuse the blood product if you discover a
discrepancy in the blood number, blood slip type,
or patient identification number.
Use only 0.9% saline solution to piggyback the
blood into.
Use large bore IV catheters for blood transfusion
(GA 18-20)

Administer the blood or component at the RECOMMENDED
RATE using the appropriate administration set.
STAY with the patient for the first few minutes of the
transfusion
Review signs and symptoms of what the patient should
report to you.
Check and recheck vital signs 15 minutes after
starting the transfusion.
DISCONTINUE TRANSFUSION IMMEDIATELY ONCE THE PATIENT
MANIFEST SYMPTOMS OF TRANSFUSION REACTION, ASSESS THE
PATIENT AND NOTIFY THE DOCTOR.




STOP transfusion if your
patient shows:
Shows changes in vital signs
Is dyspneic or restless
Develops chills, hematuria, or
pain in the flank, chest or
back

Continue to monitor patient for any signs
and symptoms of reaction for at least one
hour after the transfusion.
Obtain any ordered post-transfusion
laboratory studies.
Ensure proper documentation of the blood
transfusion procedure.


DOCUMENT THE FOLLOWING ACCURATELY:
Date and time the transfusion was started and
completed
Name of the health care professionals who
initiated and verified the information of the
patient and the blood
Catheter type and gauge
Total amount of the transfusion
Patients vital signs before, during and after
the transfusion
Infusion device used


Flow rate and if blood warming
was used
Name of the component, unit
number
Evidence of possible transfusion
reaction.
Document interventions done and
to whom you notified.
Patients outcome.

Acute Transfusion Reactions usually appear within the
first 5-15 minutes after the transfusion is started.
Types of Acute Transfusion Reactions:
Acute Hemolytic Transfusion Reaction
Febrile Non-hemolytic Transfusion Reaction
Mild Allergic (Urticarial)
Anaphylactic
Transfusion Associated Circulatory Overload
Transfusion Related Acute Lung Injury
Septic Transfusion Reaction

Symptoms you might see during an acute
transfusion reaction include:
Temperature increase of
more than 1C or 2F
Bloody urine
Chills
Hypotension
Severe low back, flank, or
chest pain
Low or absent urine
output
Nausea and vomiting
Dyspnea, wheezing
Anxiety, "sense of
impending doom"
Diaphoresis
Generalized
bleeding, especially
from punctures and
surgical wounds.
1. Should any of these symptoms occur,
discontinue the unit immediately, hang normal
saline (on a new tubing) to maintain vascular
access, and call for assistance.
2. Closely monitor the patients vital signs and
symptoms.
3. Notify the physician and obtain further orders to
address the patients symptoms.
4. Recheck the patients identifying information
against the transfusion record and blood bag.
5. All bags, tubings, filters, and paperwork should
be retained and forwarded per hospital policy.

When they do occur, it is usually
because of ABO incompatibility
between patient and donor during
transfusion of red cells.
Ensure that the intended recipient is
getting the intended unit at the time of
transfusion.
Make sure that you are protected
too!
Wear 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