UPDATES ON

BLOOD
TRANSFUSION

Prepared by: May Princes T. Abucejo,

RN RM MAN
 OBJECTIVES:
Review the different blood
components.
Discuss common indications for the
use of different blood components
Discuss the General Guidelines for
appropriate blood administration
Discuss the common adverse effects
of Blood Transfusion and its
management
 BLOOD
COMPONENT
WB
PREPARATION

PRBC Liq. Plasma FFP

others

WBC Platelets Cryosupernat

washed filtered frozen e
Cryoprecipitate
FRESH WHOLE BLOOD/ WHOLE
BLOOD

Fresh whole blood (FWB) is blood

collected within 48 hours into a blood
bag with appropriate anticoagulant. It
provides RBC, plasma and platelets.
After 48 hours it is termed whole
blood (WB) contains the red cells and
plasma component of donor blood.
 Uses of Whole Blood:
Indications: Transfuse WB for the treatment of acute,
massive hemorrhage or in an emergency when there is no
time to prepare or obtain a specific component needed.

Shelf life: refrigerated within eight hours of collection,

stored up to five days; more than 24 hours in room
temperature FWB should be destroyed

Volume: 450 ml

Duration time for transfusion: 2-4 hours

Blood typing and cross matching required

PACKED RED BLOOD CELL
Red cell concentrate (also called
packed red cells (PRBC),
concentrated red cells or plasma
reduced blood) is prepared by
allowing the blood to separate under
gravity overnight in a refrigerator at
a temperature of +2C to +6C or by
centrifuging the blood pack in a
special refrigerated centrifuge.
 PACKED RED BLOOD CELLS
General Indication :
to increase the blood oxygen carrying
capacity in anemic patients

Duration: 2-3 hours. PRBC should be

transfused slowly 10-15 minutes drops/min
for the first 10 minutes.

Volume: 150 -250 ml

Blood typing and crossmatching required.

 PRBC Transfusion:
3 mL PRBC/kg will raise hemoglobin by
approximately 1 gm/dl eg. 50 kg, Female
3x50 = 150 ml

10 mL PRBC/kg will raise hematocrit by

approximately 10%

In normal sized adult (70 kg), 1 unit PRBC

will raise the hematocrit by 3-4% or 1 gm/dl
 Conditions that may benefit
from PRBC transfusion:

chronic anemia
preoperative or predelivery
transfusion
replacement of surgical blood loss
anemic patient in CHF
anemic patients with liver failure
uremia
bone marrow failure syndromes
 WASHED RED CELL
PREPARATION
The red cells are washed with 0.9%
sterile isotonic saline by a manual
method to remove the majority of
plasma proteins, antibodies and
electrolytes. The washed red cells
are then re-suspended in additive
solution. (Australian Red Cross
Blood Service, 2008) It is depleted
of plasma, platelets and leukocytes.
 LEUKOCYTES-REDUCED
Red Cell
Leucocyte-depleted (filtered) red cell
is obtained by removing most of the
plasma using third
generation filter either at blood
service facility or patient bedside.
The red cells are filtered to remove
most leucocytes. (Australian Red
Cross Blood Service, 2008)
 IRRADIATED BLOOD COMPONENTS (RED CELLS,
PLATELETS, WHOLE BLOOD,
GRANULOCYTES)

Blood components be irradiated to

prevent the proliferation of T-
lymphocytes, which is the immediate
cause of transfusion-associated graft-
versus host-disease.
minimum dose: 25Gy
maximum dose: 50Gy.
Remember:
FFP is made from plasma which is separated from donor
blood and frozen to minus 35 Centigrade to preserve it.
Cryoprecipitate is made from FFP which is frozen and
repeatedly thawed in a laboratory to produce a source
of concentrated clotting factors including Factor VIII,
von Willebrand factor and fibrinogen.
FFP and cryo are stored as frozen packs until needed.
They are then thawed in the laboratory before
being sent to the ward.
Cryosupernate (also called cryo-poor plasma,
cryoprecipitate depleted) refers to plasma from
which the cryoprecipitate has been removed.
 FRESH FROZEN PLASMA
TRANSFUSION:
Indications:
- Liver disease with coagulopathy
- Hemophilia
- DIC
Volume: 200-250 mL
Duration:
2-4 hours (but may be allowed up to 6 hours)
Blood typing required
CRYOPRECIPITATE TRANSFUSION:

Indications:
- congenital factor VIII deficiency
- von Willebrands disease
- acquired bleeding disorder as in DIC
Volume: 30 mL
Duration: fast drip, 2-4 hours
Blood typing required
 CRYOSUPERNATE
TRANSFUSION:
Indications:
- factor IX deficiency
- congenital deficiency of
factors II, VII, X
- hemorrhage due to overdose
with coumadin-type drugs
 Cryosupernate Transfusion
Volume: 200 ml
Duration
2-4 hours
Blood typing required
Clotting Factor Concentrates:

Bleeding, active or
anticipated, in patients
with documented
coagulation factor
deficiencies, such as
Hemophilia A or B

Severe or variant forms

of von Willebrands
disease
PLATELET TRANSFUSION:

Physiologic principle
Platelets are essential to:
1. formation of primary hemostatic plug
2. provide hemostatic surface upon which
fibrin formation occurs
RANDOM DONOR PLATELET

Platelets derived from whole blood

wihtin 8 hours of blood donation are
called random donor platelet (RDP).
Volume 30-50 ml
 SINGLE DONOR PLATELET
(PLATELET PHERESIS OR SDP)
PREPARATION

Single donor platelet (SDP) is

obtained using automated
instrumentation
Single donor unit in a volume of 250-
300 ml of plasma should contain; 1)
at least 55 x 109
platelets, 2) ,1.2 x 109 red cells and
 PLATELET CONCENTRATE
TRANSFUSION:
Indication : active bleeding or in danger of bleeding
due to thrombocytopenia or platelet function defects

Shelf life : 5 days at room temperature

Volume 30-50 ml

Dose: 1 unit/10 kg weight (6-8 units)

Duration: fast drip

Blood typing required

 Handling, Storage,
Transfusion
Platelets must be agitated gently and continuously
on a platelet agitator during storage in a single
layer.
Transfuse platelets through an intravenous line
approved for blood administration and
Incorporating a clean standard (170-200 um) filter.
Transfusion of each unit may proceed as fast as
tolerated but should be completed within four
hours after commencing transfusion. The number
of platelet units to be administered depends on the
clinical situation of each patient.
 Platelet transfusion:

Assessment:
Measurement of post transfusion
platelet increment (10 min to 1
hour post BT)
 GENERAL PRINCIPLES FOR ISSUING &
TRANSFUSING BLOOD & COMPONENTS
1. INFORMED CONSENT
2. TRANSPORT METHOD
3. IDENTIFICATION
4. EQUIPMENT
5. ADDITION OF DRUGS & SOLUTIONS
6. INFUSION RATE
7. ADMINISTRATION
8. BLOOD WARMERS
9. MONITORING
10. ADVERSE EFFECTS
 1. INFORMED CONSENT

The physician in charge of the

patient should be responsible for
obtaining informed consent for RBC or
plasma administration and the
patients consent should be obtained
and recorded in the medical chart.
(Grade A; Level 3)
 2. TRANSPORT METHOD
Red cell components - Ice should NOT
be allowed to come into direct contact
with the blood as the red cells nearest to
the ice may freeze and hemolyse.
Appropriate materials and packing
arrangements are therefore necessary.
Plasma - There should be at least as
much wet ice in the cold box as there is
plasma. If possible, they should have been
placed in cardboard boxes before freezing
to protect the bags from developing small
cracks.
 Platelets - Containers for transporting
platelets should be equilibrated at
a temperature of +20 C to +24
C before use. If outdoor
temperatures are extremely high,
special chemical.
 FFP and cryoprecipitate - They are
thawed at between +30 C and +37
C IN THE BLOOD BANK before
issue and transported to the ward at
ambient temperature. They must
be used immediately and should
never be refrozen.
 Only 1 unit of FWB/PRBC should be taken
at a time for each patient unless rapid
transfusion of large amount of blood is
needed.
Blood should be transfused as soon as
possible after delivery to the ward or
operating room. If more than 30 minutes
has elapsed and a unit of blood is still not
transfused or cannot be transfused, the
blood should be returned to the blood bank.
 As long as the platelets remain
in suspension, the agitation
speed is not important. Agitation
of the platelet concentrates ensures
that the platelets are continuously
oxygenated, that sufficient oxygen
can enter the storage container and
that excess carbon dioxide can be
expelled..
 3. IDENTIFICATION
Blood at Blood Bank
Check screening (donor)
Special requirements (irradiation, leuko reduction)
Proper ID (recipient)
MOST COMMON CAUSE of major transfusion reaction is
CLERICAL ERROR

At least two member of staff, at least one must

be a doctor or a registered nurse, should be
responsible for carrying out identify check of the
patient and the unit of blood at the patients
bedside. (BCSH, 1999) (Grade A; Level 3)
The blood unit must be discarded if:
It has been out of the refrigerator for longer than 30
minutes, or
The seal is broken, or
There is any sign of haemolysis, clotting or
 4. EQUIPMENT

Use g18-20 (adult)

Use g22-24 (pediatrics)
ALL components must pass
through a FILTER
 Transfusion Set
Blood components particularly red
cells and whole blood should be
mixed thoroughly by gentle
inversion before use and then
transfused through an intravenous
line approved for blood
administration incorporating a
standard 170-200 micron filter.
 A new transfusion set should be used
for every new unit of blood product.
In an emergency or operating room
procedure where several units may be
administered in a short time, the transfusion
set should be changed every 6 hours.
A transfusion set used for red cells
should NOT be re-used for platelet
transfusion since red cell debris trapped in
the filter would trap the platelets.
 5. ADDITION OF DRUGS AND
SOLUTIONS
DRUGS/MEDICATIONS
should NOT be added

Never add medication to a unit

of blood or administer
medication through a
transfusion line during the
transfusion. (Grade A; Level 2)
 The standard set to be used in a blood transfusion
should be primed with normal saline (0.9 NSS)
or the blood component.
Electrolyte and colloid solutions containing
calcium or 5% dextrose should NOT be given with
blood components. (ANZSBT, 2004) (Grade A; Level
2)
Blood transfusion sets should not be
piggybacked into other lines. A blood
administration set should not be affixed
("piggybacked") into a main line that has been
used for any solution other than isotonic saline
 Premedications
The use of acetaminophen or
diphenhydramine as pre-
medications for patients scheduled
for blood administration is NOT
recommended. (Grade A; Level 2)
 6. INFUSION RATE
Rate should be no greater than 5ml/minute for
the first 15 minutes.
Blood products Start Rate Complete
transfusion transfusion

Whole blood Within 30 No greater than Should be

minutes from 5ml/minute for completed
laboratory the first 15 within 4 hours
minutes
PRBC Within 30 10-15 drops/min Should be
minutes from for the first 10 completed
laboratory minutes. Then within 3 hours
increase flow
rate.
Platelet Immediately Fast drip Should be
concentrate completed
within 4 hours
Fresh Frozen should be Plasma should Should be
Plasma infused be administered completed
immediately or in doses within 2-4 hours
stored at 1-6 oC calculated to
for up to 6 hours achieve a
once thawed minimum of
30% of plasma
factor
concentration
(indicated by
Physician)
Cryoprecipitate Immediately No greater than Should be
once thawed 5ml/minute for completed
the first 15 within 2-4 hours
minutes then
fast drip
Cryosupernatant Immediately No greater than Should be
once thawed 5ml/minute for completed
the first 15 within 2-4 hours
minutes
 7. ADMINISTRATION
Infusion start slow @ 5ml/min for
the 1st 15mins. then flow rate

SEVERE reactions frequently occur

within the first 50ml of transfusion

BLOOD FILTER should not be used

>6hrs
 8. BLOOD WARMERS
There is no evidence that warming blood
is beneficial to the patient when
transfusion is slow. At transfusion rates of
greater than 100 ml/minute, cold blood
may be a contributing factor in cardiac
arrest. However, keeping the patient warm
is probably more important than warming
the blood.
 9. MONITORING
In general, for each unit of blood transfused,
monitor the patient at the following stages (WHO,
1997) (Grade A; Level 3):

before starting the transfusion

as soon as the transfusion is started
15 minutes after starting the transfusion then;
every 15 minutes until consumed for fast-drip transfusions
every 30 minutes until consumed for non-fast drip
transfusions
on completion of the transfusion and
four hours after completing the transfusion.
 MONITORING
At each of these stages, record the following
information on the patients chart (WHO, 1997)
(Grade A; Level 3):

patient general apperance

temperature
pulse
blood pressure
respiratory rate
fluid balance of oral and IV fluid intake and
urine output
 MONITORING
The following should be record in patients
medical chart (WHO, 1997) (Grade A; Level
3):

time the transfusion is started

time the transfusion is completed
volume and type of all products transfused
unique donation numbers off all products
transfused
any adverse effects.
 MONITORING
In cases of suspected severe reaction
to blood transfusion, the
transfusion episode should be
stopped and urgent medical
advice sought. The blood
administration set should be changed
and venous access maintained using
normal saline running slowly to keep
the vein open.
 PROCEDURE
1. Verify the blood product and the client with another
nurse.
1. Clients name, blood group, RH type.
2. Cross-match compatibility.
3. Donor blood group and RH type.
4. Unit and hospital number.
5. Expiration date and time on blood bag.
6. Type of blood product compared with written order.
7. Presence of clots in blood.
2. Wash hands and put on gloves.
3. Open blood administration kit and close roller
clamps.
 PROCEDURE
For Y-tubing set:
a) Spike the normal saline bag and prime the tubing between the saline bag
and the filter.
b) Squeeze sides of drip chamber and allow filter to partially fill.
c) Open lower roller clamp and prime tubing to the hub.
d) Close lower clamp.
e) Invert blood bag once or twice. Spike blood bag, open clamps, and fill
tubing completely, covering the filter with blood.
f) Close lower clamp.

For single tubing set:

g) Spike blood unit using filter tubing.
h) Squeeze drip chamber and allow the filter to fill with blood.
i) Open roller clamp and allow tubing to fill with blood.
j) Piggyback a saline line into the blood administration tubing.
k) Secure all connections with tape.
 PROCEDURE
4. Attach tubing to venous catheter aseptically and open
clamps on blood tubing.
5. Infuse the blood product at the ordered rate.
6. Remain with the client for the first 15-30 minutes,
monitoring vital signs frequently according to
institutional policy.
7. After blood has infused, flush the tubing with normal
saline.
8. Dispose of bag, tubing, and gloves appropriately.
Wash hands.
9. Document the procedure.

What to do?

1. STOP the blood transfusion

2. Keep the IV line open with 0.9% normal
saline
3. Report reaction to the transfusion
service
4. Check ID of donor and patient
5. Initiate Symptomatic treatment
6. Send blood bag & administration set to
transfusion service
7. Collect blood & urine samples & send
to the lab for testing
8. Document the transfusion reaction on