Learning outcomes :

1. Explain the term blood transfusion.

2. State the indications for blood transfusion.

3. State the types of blood components/products

4. Describe the ABO group system

5. State the group types and compatibilities - Is the transfer of blood or blood component from one
person ( donor) to another person ( recipient)

6. Describe the management for haemolytic reaction.

7. Describe the nursing interventions before, during

and after a blood transfusion

4. Anaemias eg. Thalassaemia

1. Major surgery
5. Blood disorders : DIVC , leukemia, haemophilia
2. Delivery with postpartum haemorrhage.

3. Severe bleeding eg abortions, haematemesis 6. Hypovolaemic shock

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1. Whole blood : - Used in clients with slow bleeding
- Contains plasma, red blood cells, plasma proteins - Examples : leukemia, anaemia
clotting factors.
- replace blood volume and oxygen- carrying
capacity eg. clients with shock, bleeding, surgery

- Used to control bleeding in clients with platelet Uses :

deficiency 1. Expands blood volume eg in shock
2. Replace blood volume and proteins eg. surgery

a) Factor VIII concentrate : - Contains prothrombin, factors VIII, IX and X

- to treat haemophilia A and
- to treat von Willebrand’s disease

b) Factor IX : to treat haemophilia B

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a) From whole blood – RBCs and platelets are
separated.
b) Remaining plasma contains all blood coagulation
factors, fibrinogen and other plasma proteins
c) Plasma is frozen to temperature -18º and stored
for 1 year.
d) Before use : thaw in water at 30º- 37º C
: transfused within 24 hours
: use set with 170-micron filter
a) Is prepared from a unit of FFP
b) When FFP is thawed to 1º - 6º C, a cold- insoluble
white precipitate is formed and removed
c) This is refrozen at -18ºC and can store till 1 year
d) This cryoprecipitate contains : factor VIII, von
Willebrand’s factor and fibrinogen
e) Cryoprecipitate must be transfused within 4-6 hours.
f) Infuse through 170-micron filter

b) A standard unit of donated blood is 1 unit or 450 ml

a) Blood donors are screened :
- Healthy individuals c) Freshly collected blood is sealed in plastic bags with
- Any of the following conditions / diseases anti-clotting compound and kept in a special fridge
} Pregnancy
} Heart problems/ diabetes mellitus d) Refrigerated blood is usable for 42 days.
} Anaemia / hepatitis / bleeding disorders
} Low B/P
} Recent major surgery e) A sample is tested for : hepatitis, syphilis and HIV

a) Is the safest transfusion. a) Individuals have different types of antigen on the

b) The donor is also the recipient surface of their red blood cells.
c) The person donates blood to be transfused at a later
date eg. during surgery b) These antigens are inherited and determine the
blood group
Example : Antigen A : group A
Antigen A and B : group AB

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c) Individuals who are transfused with blood of the a) 55% of the population are either :
same group, have the same antigens, the body - group A
immune system will not reject them.
- group B
They are said to be compatible
- group AB

b) 45% have no A nor B antigens ( group O)

c) There are antibodies called anti A and anti B

made by the blood group f) Group O – has no A or B antigen
- makes anti A and anti B
d) Blood Group A makes anti B - can donate to every group
- group A cannot make anti A and has no these universal donor
antibodies in their plasma.

e) Group AB do not make any antibodies

- No anti A nor anti B
- Group AB can receive from every group
universal recipient

a) Rhesus ( Rh) antigen or factor attach to the red ANTIGEN GROUP MAKES COMPATIBLE

blood cells
A A ANTI B A O
b) 85% of the people have this antigen ( Rh +positive)
- they do not make anti Rh antibodies B B ANTI A B O

c) 15% have no this antigen, they are Rh –negative AB AB - A B AB

- they can produce antiRh antibodies if exposed to O
Rh positive blood eg. blood transfusion
- O ANTI A O
ANTI B

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 a) ABO Blood groups are classified as A, B, AB, O 1. Febrile reaction
- patient’s antibodies attacking white blood cells in
the blood transfusion
b) Rh factor is classified as positive + or negative –
2. Hypersensitive reaction
- urticaria and itching of skin.
c) Blood group does not change, it stays with you for
life

3. Haemolytic reaction (anaphylactic shock)

- usually occurs after transfusion of 100 - 200ml of
- most dangerous reaction
incompatible blood
- result from ABO incompatibility
1. Face becomes flush
- red blood cells clump together and block
2. Urticaria on skin
capillaries
3. Fever and chills
- decrease blood flow to vital organs eg. kidneys
4. Headache, nausea, vomiting
5. Dyspnoea, restlessness
4. Circulatory overload
6. Tachycardia and hypotension
7. Pain at chest, abdomen and lumbar region
5. Infectious diseases eg. Hepatitis B, C, HIV, syphilis

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 Procedure
n Inform client and explain the
} IV infusion set with blood filter chamber
procedure.
} IV normal saline with solution 0.9%
n Check for signed consent for
} Blood warmer if required transfusion.
} Pressure bag if required
} Tape infusion stand n Instruct client to report chills,
itching, rash, shortness of breath,
headache, chest pain or unusual
symptoms during or after transfusion
Rationale
n To allay anxiety and gain
client cooperation.
n For medical legal purposes
and may specify risk factors.
n Prompt reporting of
transfusion reaction and
discontinuation can help to
minimize reaction.

Procedure
nCountercheck blood and blood
request form with another staff
nurse or medical officer
Øclient name, registration number,
blood group, rhesus factor, blood
pack number, date of blood
collected and expiry date of blood
Procedure Rationale
Rationale
n Ask the client to pass urine n To ensure that client is
nTo reduce risk of comfortable during procedure
administering wrong
n Check that IV cannula is patent n Dextrose solution is never used
blood to client
because can cause coagulation
of blood
n Check client’s vital signs prior
n For base line data. To detect
to the administration (BP, PR,
any transfusion reaction
RR, temperature).
through changes in vital signs.

Procedure Rationale
n Wash, dry hands and put on clean n Practicinguniversal Procedure Rationale
gloves precaution when n Place roller clamp 2-4cm below n To allow accurate regulation of
handling blood drip chamber and move roller flow rate and prevent accidental
product. clamp to ‘off ’ position spillage
n To prevent clumping n Insert spike into opening of n To maintain sterility of blood

of cells blood pack taking care not to giving line

n Invertblood pack gently several times
n To prevent bacteria
touch it
n Open a blood administration set while
from entering blood n Fill chamber ½ full of blood nTo prevent air from entering
maintaining sterility of both ends stream tubing

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 Procedure Rationale Procedure Rationale
n Remove needle protector n Toallow fluid to travel from nReplace needle protector nTo maintain sterility
and release roller clamp drip chamber through tubing nTo ensure blood
to needle adapter transfusion is in
nConnect end of blood
n Fill sterile tubing with blood n To discard air to prevent air progress safely
administration set into IV cannula
from blood pack embolism while maintaining aseptic technique
n Return roller clamp to off n To prevent accidental

position after tube is filled spillage

Procedure Rationale
n SecureIV cannula in position and n To stabilize IV
tubing with plaster cannula to avoid
dislodgement Procedure Rationale
n Too rapid flow will
n Rapid transfusion may be required
n Remain with the client during 1st
cause overload and too to restore intravascular volume in
15-20 minutes
slow will block the massive hemorrhage (to use
tubing and needle pressure bag as ordered by doctor)
n Adjust flow rate as ordered n Slow transfusion may be required
Ø Should be slow for the 1st 15 for elderly patient, children and
minutes cardiac problems
Ø Should be given not less than 3 hrs

Procedure Rationale Procedure Rationale

n Administered IV diuretic as n Toprevent pulmonary n Document the administration n For document purposes
ordered by the doctor prior or edema of blood transfusion in the
midway of transfusion observation/intake-output
n Monitorclient vital signs chart and in the blood pack
n To ensure continuous
(BP,RR,PR) hourly card (blood pack, rhesus factor,
flow and avoid blood blood pack number, amount of
n Observe for signs of blood clotted along tubing and blood, time blood transfusion
reactions needle started)
n Check the flow rate
n Make the client comfort

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 Procedure Rationale } The nurse should identify the purpose of the blood
transfusion for the client
n Record the time blood n For document purposes
} The blood must be transfused within 30 minutes
transfusion has completed in
after it had been collected from the blood bank
observation chart and blood
Ø To prevent bacterial growth and destruction of red
pack card
blood cells
n Wind the IV drip tubing
n For analyzing purpose in case Ø Whole blood or packed red cells should remain in
around the blood pack and place cold environment (1-6 degree Celsius)
it in transparent plastic bag, tie it of blood reaction, to rule out
Practice aseptic technique when administer blood
before sending back to the blood possibility of incompatible
•

blood transfused transfusion

bank
• Check to ensure that ( tubing is not folded, there is
no air bubble and blood clot in tubing)

} Adjust the flow rate as ordered

} Observe the client closely for any reaction and
monitor the vital signs
Ø Every 5 minutes for the 1st 15 minutes, every 15
minutes for next hour, hourly until the unit of
blood is infused and for 1 hour after the infusion
is completed
• Inform the client about signs and symptoms of
blood transfusion reaction and advise him to
report to the nurse or doctor
Ø Chills, itching, rash, shortness of breath,
headache, chest pain or unusual symptoms
during and after transfusion
} Saline solution should remain until transfusion
is completed to flush line of blood or to keep
IV line patent for supportive measures in case
of transfusion reaction
} Never inject any medication into IV line with
blood or a blood component infusion because
of possibly of physical incompatibility and
bacterial contamination of the blood product
} Record blood that has been transfused

1. Stop blood transfusion and continue with I/V normal

ü Stop the blood transfusion and inform the doctor
immediately saline
ü Carry out doctor’s immediate orders 2. Inform doctor
ü Replace the blood pack with a new normal saline 3. Continue checking vital signs
solution with the new IV giving set because the 4. Assess manifestations and give treatment
previous blood administering set contained
incompatible blood cells accordingly eg. dyspnoea – clear airway and give
ü Reassure the client oxygen.
ü Collect urine and blood specimens for 5. Save blood bag and remaining blood to blood bank
investigation for tests
ü Monitor general conditions and vital signs
ü Provide O2 if client has breathing difficulty

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 6. Follow hospital’s standard policy and procedure in
collection of urine and blood samples

7. Continue close monitoring of vital signs.

After this lecture, students will be able to:

1) Define bone marrow aspiration procedure. } The process of obtaining a specimen of
2) State the purpose of bone marrow bone marrow tissue by introducing a special
aspiration.
large needle into iliac crest or sternum
3) State the requirements needed for bone
marrow aspiration.
4) Explain pre, intra and post care of patient
under bone marrow aspiration.
5) Assisting doctor in bone marrow
aspiration procedure.

a) Adults : iliac crest /sternum Top shelf trolley Bottom shelf trolley
b) Children : sternum / vertebrae / tibia } Sterile pack containing: } Small tray containing:
ü Thermoplastic tray ü Skin cleansing and
ü Dressing towel & paper antiseptic lotions
towel ü Local anesthetic
ü Sponge holding forceps ü collodion/occlusive
ü Plain dissecting forceps dressing
ü 5ml & 10ml syringe X 2 ü Adhesive tape, scissors
ü 10ml glass syringe and & masks
adaptor ü Laboratory forms

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 ü Hypodermic needle } Mackintosh &
ü Needle size 20G treatment towel
ü Bone marrow needle } Receptable for used
ü 8-10 glass slides instruments
ü Sterile rubber gloves
} Sedation e.g Inj.
Dormicum

Bone marrow
aspiration

Procedure Rationale
n Check consent & hematological and
biochemical results
n Explain the procedure to client To gain client’s
n Serve pre-medication as ordered cooperation
n Screen the bed To provide privacy
n Encourage client to empty bladder To avoid interruption of
procedure

Procedure Rationale
Procedure Rationale
n Position client according to chosen
site: n Inform client on the need to remain To prevent sudden
1) Sternum-supine position with a still during procedure movement which may
pillow under shoulders cause trauma
2) Iliac crest-lateral position n Assist the doctor as needed
3) Tibia-supine throughout the procedure
n Expose area to be punctured n Observe the client carefully

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} Procedure is carried out by the doctor as
follow:
1) Doctor wear mask, scrubs hands and wears
gloves 5) The marrow puncture needle is withdrawn
2) Skin is cleansed with antiseptic and the site 6) A dry dressing is applied to the puncture
is draped with hole towel site
3) After injecting the local anesthesia, the 7) Marrow fragments are removed from the
marrow puncture needle is then carefully blood in the petri dish and thin films are
and slowly inserted
made on the slides with this material
4) 2-3 mls of bone marrow tissue/aspirate are (prepare by lab technician in the ward)
withdrawn into the glass syringe and then
injected into the petri dish

Procedure Rationale Procedure Rationale

nMake client comfortable
nMake client comfortable
nNurse client in supine position for 6 To promote
nNurse client in supine position for 6 To promote
hours homeostasis hours homeostasis

(if iliac crest is used, lie client on affected (if iliac crest is used, lie client on affected
area) area)
nSend specimen to laboratory nSend specimen to laboratory
nKeep dressing dry for at least 2 days nKeep dressing dry for at least 2 days

Procedure Rationale 1) Describe and explain to client the procedure,

n Observe client for:
ü Vital signs
ü Hematoma at puncture site
ü Pain/discomfort
ü Warmth/redness at puncture site
sensations will be experienced, risks, benefits
To detect early signs of
and alternatives.
bleeding, perforation of
underlying structures, • Explain that they will feel pressure sensation
as the needle is advanced into position
bone fracture and
infection • The actual aspiration causes sharp but brief
pain resulting from suction exerted as the
marrow is aspirated into the syringe
• Advice to take deep breaths or using
relaxation technique to ease the discomfort

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2) Take signed informed consent from the client
before procedure.
3) Stay with client during procedure and advice 1. Pain
them to stay still and maintain the position. 2. Haemorrhage
4) Observe client for signs of complication such 3. Infection
as bleeding and infection after the procedure.
5) Make client comfortable after procedure by
advising them to take warm tub baths and
use mild analgesic e.g. acetaminophen.
6) Avoid aspirin-containing analgesics because
can aggravate any bleeding

} Black, J.M. & Hawks, J.H. (2009). Medical

Surgical Nursing (8th ed.). Saunders: Elsevier.

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