BLOOD to stimulate the production of mature red blood cells, to

maintain healthy oxygen levels in our tissues.

TRANSFUSION ETIOLOGY OF BLOOD CELL

Course Outline Blood cells do not originate in the bloodstream itself but in
specific blood-forming organs, notably the marrow of certain
DEFINITION OF BLOOD
bones. In the human adult, the bone marrow produces all the
PORTIONS OF THE BLOOD
ETIOLOGY OF BLOOD CELL red blood cells.
UNDERSTANDING BLOOD TRANSFUSION THERAPY
The lymphatic tissues, particularly the thymus, the spleen, and
ELIGIBLE & INELIGIBLE TO BLOOD DONATION
BLOOD CLOTTING FACTORS the lymph nodes, produce the lymphocytes. And then, the
NURSE’S RESPONSIBILITY reticuloendothelial tissues of the spleen, liver, lymph nodes,
TRANSFUSION PRECAUTIONS and other organs produce the monocytes.
DOCUMENTATION
BLOOD PRODUCTS UNDERSTANDING BLOOD TRANSFUSION THERAPY
BLOOD TRANSFUSION
TRANSFUSION REACTIONS BLOOD TRANSFUSION

 The infusion of whole blood or blood component into

BLOOD is a mixture of cells and a complex TRANSPORT
the patient’s venous circulation.
mechanism
 Lifesaving therapy for patients with medical or surgical
T – transports hormones conditions that need blood.
 RA 7719 [National Blood Services Act of 1994] – an act
R – removes waste products of promoting voluntary blood donation.
 The volume of fluids will adjust within a few hours
R – regulates body temperature
after your donation. The RBC will be replaced within a
P – protects the body few weeks.
 The minimum interval between 2 donations is 12
P – promotes hemostasis weeks or 3 months.

S – supplies oxygen Indications of blood transfusion:

(a) Hemorrhage caused by trauma

PORTIONS OF THE BLOOD
(b) High blood loss surgery
Blood is composed of 55% of plasma and 45% cellular (c) Hemolysis
components. The body contains 10-12 pints (5-6 L) of blood, (d) Anemia
your whole blood donation approximately 1 pint or equivalent
to 450-500 ml. Purposes:

Plasma is the main component of blood and consists mostly of  To restore and maintain blood volume.
water with CHON, ions, nutrients, lipids, glucose, and salt  To improve the oxygen-carrying capacity of the blood.
mixed in.  To replace deficient blood components.

Platelets is a blood cell that is responsible for blood clotting. It WHO CAN & WHO CAN’T GIVE BLOOD
stops the bleeding and promote blood clotting.
 Eligible donors must:
White blood cells are cells that play a major role in defense in  18 and above
microorganisms, so they fight viruses, bacteria, and other  Weigh at least 110lb
foreign invaders that threaten your health.  Skin disease free
 Not donated in the past 56 days
Red blood cells are responsible for carrying and transportation  Hgb level is at least 12.5g/dl [women] or
of oxygen and carbon dioxide. 13.5g/dl [men]
 Normal VS
Erythropoietin is a hormone that is produced by the kidneys
when oxygen levels in the blood are low. It acts in bone marrow
  Blood volume collected will depend mainly on  Gently suspend the RBC within the plasma
your body weight.  Observe signs of hemolytic reaction that generally
 Ineligible donors include: occurs within first 10-15 minutes.
 HIV, AIDS, STD
 Took illegal drugs Shivering, headache, low back pain, increased RR &
 Had sex with prostitutes in the past 12 PR, hemoglobinuria, oliguria, and hypotension
months  Observe signs of febrile reaction that usually occurs
 Had sex with anyone above categories withing 30 minutes
 Pregnant
 Hepatitis B/C Shaking, headache, elevated temperature, back
 Certain types of cancer pain, confusion, and hematemesis.
 Hemophilia  Act promptly if the patient develops bronchospasm
 Who have receive clotting factor and wheezing. This may indicate allergic reaction or
concentration anaphylaxis.
 Chronic alcoholism
 Body piercing and tattooing INTERVENTIONS PRIOR BLOOD TRANSFUSION

 Proper cross-matching of donor’s and recipient’s blood

BLOOD CLOTTING FACTORS
to assure compatibility.
I Fibrinogen  After receiving delivery from blood bank, check if you
II Prothrombin receive both the product and the transfusion record
III Thromboplastin
that corresponds to it.
IV Calcium
V Proaccelerin  Inspect the label, integrity of unit, and the appearance.
VII Proconvertin (stable factor)
VIII Antihemophilic Factor A SAFETY PRECAUTIONS
IX Antihemophilic Factor B
 PPE
X Stuart-Prower Factor
XI Plasma thromblastin antecedent  Hand hygiene or hand washing.
XII Hageman factor  If possible, use needleless system.
XIII Fibrin stabilizing factor  Do not recap the needle.
NURSE’S RESPONSIBILITY  Observe proper waste disposal.
 Don’t touch blood with bare hands.
NURSES MUST:  Secure blood bag.
 Always double or triple check.
 Assure that informed consent has been obtained prior  Perform disinfection technique.
starting transfusion.
 Patient education regarding benefits, risks, TRANSFUSION PRECAUTIONS
alternatives to transfusion [iron/ ESAs]
1 Don’t add medications to the blood.
RESPONSIBILITIES: 2 Don’t transfuse if you suspect or discover discrepancy
in blood number, blood type or pt identification
 Check blood or blood components have been typed & number.
cross-matched for compatibility. Two nurses verify the 3 Don’t piggyback blood into the port of an existing
blood type, Rh factor, serial number, extraction date infusion set.
and expiration date.
 Don’t administer blood without warming it. DOCUMENTATION
 Obtain VS before and 15 minutes after transfusion.
 Always have an isotonic solution set up as a primary □ Date and time of transfusion was started and
line along with the transfusion. completed.
 Maintain standard precaution in handling blood or IV □ Name of HCW who verified information of the patient
equipment and the blood.
 Inform the client or assure them that risk for AIDS is □ Type of catheter and gauge.
minimal because the blood is screened. □ Total amount of transfusion.
□ Pt vital signs before and after transfusion
 □ Infusion device It is made from 1 unit partially thawed FFP and the amount is
□ Flow rate and blood warmer if used 15mL. It is very rich in fibrinogen and Factor VIII.
□ Name of component, unit number
Indications: it helps control bleeding or immediately prior to an
□ Evidence of possible transfusion reaction and the invasive procedure in patients with significant
interventions done. hypofibrinogenemia. It contains specific proteins for clotting.
□ Patient’s outcome. Indicated clients with missing factor VIII and factor XIII this
helps platelets stick together.
RISKS OF BLOOD TRANSFUSION Nursing Considerations: crossmatching is not required but it
(1) HIV should be ABO compatible. It must not store in ward fridges if
stored in fridge, require re-thawing by blood bank.
(2) Hepatitis B
Administered at a rate of 5-10 minutes per unit. Faster
(3) Hepatitis C administration is for acute bleeding situations only.
(4) BT reactions
BLOOD TRANSFUSION
BLOOD PRODUCTS
EQUIPMENT NEEDED FOR BLOOD TRANSFUSION
WHOLE BLOOD
1) Blood product
Indications: to restore blood volume from hemorrhaging, 2) Blood transfusion set
trauma, or burn patients. One unit is given over 2-3 hours or 4- 3) IVF = 0.9 NaCl
6 hours. The total volume is approximately 450-500mL.
4) IV pole
Nursing Considerations: do not infuse more than 4 hours, warm 5) IV catheter
the blood if giving large quantity, and stop when the patient 6) Disposable gloves
can’t tolerate the circulating volume. 7) Micropore tape

PACKED RED BLOOD CELL (PRBC) PRE-ASSESSMENT

Indications: to restore or maintain the oxygen-carrying
capacity, correct anemia or surgical blood loss and the total
volume of blood is 250mL.
Nursing Considerations: do not infuse for more than 6 hours.
RBCs have the same oxygen-carrying capacity as whole blood,
minimizing the hazard of volume overload.
PLATELETS
DOING BLOOD TRANSFUSION
Indications: to treat thrombocytopenia, acute leukemia, and
marrow aplasia. The total volume is approximately 50mL.
Nursing Considerations: RH type matching is compared to ABO
compatibility is preferable with repeated platelet transfusions.
100mL is infuse over 15 minutes. Administer at 150 to 200mL
per hour or as rapidly as the pt can tolerate and don’t exceed to
4 hours. Avoid administering platelets to febrile patients.
FRESH FROZEN PLASMA (FFP)
Indications: one unit is 200-250mL and this can treat
postsurgical hemorrhage/shock and correct an undetermined
coagulation factor deficiency.
Nursing Considerations: RH type matching is compared to ABO
compatibility is preferable with repeated platelet transfusions.
Large volume of FFP may require correction for hypocalcemia.
Citric acid in FFP binds in calcium.
CRYOPRECIPITATE
 Secure BT consent
 Obtain baseline vital signs, lung sounds, and urinary
output.
 Review recent laboratory values.
 Ask for previous transfusion reactions.
 Inspect IV insertion site and check type of solution.
1) Determine whether patient knows reason for
transfusion.
2) Explain to patient what will happen. Check for signed
consent. Advise the patient to report any hemolytic or
febrile reactions.
3) Give pre-medications, if ordered by the physician.
4) Hang container of NSS with blood transfusion. Initiate
infusion.
5) Start IV with gauge 18 or 19. Run normal saline at KVO.
6) Obtain the blood product.
7) Complete identification and checks.
8) Take baseline VS.
9) Start infusion of blood [thawed].
 Prime in-line filter with blood.
 Start administration slowly.
 Stay with the patient for the first 5 to 15
minutes of transfusion.
 Check vital signs q15 for the first hour
  Observe for blood transfusion reactions.
10) Consume blood within 6 hours.
11) Assess frequently for transfusion reactions.
TERMINATING THE TRANSFUSION
 Flush the blood tubing with an adequate amount of
NSS according to patient’s condition.
 On a Y-type set, close the clamp on the bloodline and
open the clamp on the saline solution line.
 Discard tubing, filter, and blood bag according to
policy of institution.
 Reassess the patient’s condition and vital signs.
TRANSFUSION REACTIONS
DEFINITION
 Reaction of the body to transfusion of blood that’s not
compatible with its own blood.
 Usually attributed to major antigen-antibody
reactions.
 Acute transfusion reactions usually appear within the
first 5 to 15 minutes after transfusion started.
WHEN BT REACTION OCCURS… SPIN
S – stop the infusion
Nursing Interventions: administer antihistamines
Prevention: premedicate with antihistamine if pt has hx of
allergic reactions. Observe pt closely for the first 30 minutes
of the transfusion.
(iv) Plasma Protein Incompatibility
Nursing Interventions: treat shock by administering O2,
fluids, epinephrine, or steroid as ordered.
Prevention: transfuse only IgA-deficient blood or well
washed RBCs.
(v) Bacterial Contamination
Nursing Interventions: broad-spectrum antibiotics and
steroids treatment.
Prevention: inspect blood prior transfusion for gas, clot, &
dark purple color. Use air free, touch-free methods to draw
& deliver blood. Maintain strict storage control. Change the
blood tubing and filter q4h. Infuse each unit of blood over2-
4hrs; terminate the infusion if the time period exceeds
4hours. Maintain sterile technique when administering
blood products.
(vi) Circulation Overload
Nursing Interventions: stop infusion and maintain IV with
NSS. Administer O2 while the head is elevated. Administer
diuretics as ordered by the physician.
Prevention: transfuse blood slowly. Don’t exceed 2 units in
4 hours; less for elderly, infants or pt with cardiac
conditions.

P- pulse and other vital signs assessment

I – infuse NSS

N – notify the physician

TRANSFUSION REACTION MANAGEMENT

(i) Hemolytic
Nursing Interventions: keep track BP, treat shock as
indicated [IVF, O2, epinephrine, diuretic, and vasopressor].
Obtain post transfusion reaction, blood and urine sample
for evaluation. Observe signs of hemorrhage resulting from
DIC
Prevention: Before transfusion, check donor & recipient
blood types to ensure compatibility. Identify pt with
another nurse or doctor present. Transfuse the blood slowly
for the first 15 to 20 minutes closely observe the patient for
the first 30 minutes of the transfusion.
(ii) Febrile
Nursing Interventions: Administer antipyretic, antihistamine
or meperidine.
Prevention: premedicate with an antipyretic, antihistamine
or steroid. Use leukocyte-poor or washed RBCs. Use
leukocyte-poor removal filter specific to the component.
(iii) Allergic Reaction