BLOOD TRANSFUSION
 Can be a life saving interventions with
inherent risks and complications.
 Appropriate use of blood means the
transfusion of safe blood products only to
treat a condition that cannot be prevented or
managed effectively by other means.
SUCCESFUL transfusion therapy depends on
providing each patient the right blood
component, at the right time and for the right
reason.
BLOOD SAFETY
HOW?
 Each step in the process of blood transfusion,
starting with the physician who orders the
transfusion to the actual administration of the
ordered components should be validated.
THE RISK OF TRANSFUSION
 Risk Factor
 Hepatitis B
 Hepatitis C
 HIV
 Bacterial Contamination
 cuff my be placed around the unit of
 Immune
TO TRANSFUSE OR NOT TO TRANSFUSE?
“Blood transfusion should only be given when
the benefits outweigh the risks”
WHOLE BLOOD
1 unit contain 450ml of blood collected into
60-70ml preservative/anticoagulant
- Blood collected into a sealed container
can be store for 21 to 35 days
- Whole blood stored more than 24 hours
does not contain functional platelets or
pratctical amounts of coagulation
factors V and VII.
Notes:
FACTOR 5 AND 8- PROTEINS IN THE
BLOOD
 Indications:
Acute massive blood loss when
oxygen-carrying properties of red cells,
as well as volume expansion of plasma,
is required.
 Nursing Intervention
 Transfuse through a standard blood
infusion set with a 170-micron blood
filter.
 The indications for giving whole blood
(severe bleeding), usually necessitate
the rapid infusion of blood, observe
closely for adverse reaction.
 For rapid infusion a special pressure
blood.
NOTES:
Adverse reaction during blood transfusion-
monitor client for 15 minutes, 30 minutes,
then 1 hour
 PACKED RED CELLS
 Red cells are erythrocytes separated from a
unit of whole blood prepared by removing up
to 80% of the plasma by centrifugation or
sedimentation.
Red cells are concentrated form of
hemoglobin
If plasm is removed without breaking the
seal of the origical container, can be
stored for 21 to 49 days.
Notes:
 450 ml of wbc- is reduced - inc hgb
hematocrit
 HGB Normal value : 8-12g/dl
12-14 g/dl -Male
 Below 8 - report to the surgeon
 Below 7- check the patient pallor, dryness of
the skin, cold clammy skin, weak, - check for
the paleness (palm), soles of the feet,
 If the seal is broken, storage time is
reduced to 24 hours due to possible
bacterial contamination.
 Indication
 To restore or maintain oxygen-carrying
capacity with a minimal expansion of blood
volume.
Notes
Check the hgb hmt- 6 hours after the blood the
transfusion.
 Nursing Interventions:
 Use of a large-bore needle
 A Y-type blood infusion set allows the
addition of saline.
 Infused red cells over 2-3 hours
Notes:
 Use of a large bore needle - Kapag maliit -
possible na mag clot, hindi dadadloy.
 Check from time to time
 Nursing Alert
 Solutions other than 0.9% saline can
cause red cell agglutination and/or
hemolysis and must not be used as an
IV flush or diluent.
 Medications are never added to blood
products
Notes:
.9 SALINE IS compatible to blood
components
Hemolysis- disruptions of RBC
PLATELET CONCENTRATES
 Large numbers of plateletss in a
minumum amount of plasma.
 Also contains some lymphocytes and red
blood cells, the amount varying with
preparation techniques.
NOTES:
 Normal Value of Platelet- 150,000-
450,000
A. RANDOM DONOR PLATELETS
- Platelets prepared by centrifugation of a
unit of whole blood.
Indications - to stop or prevent bleeding
in patients with thrombocytopenia, or pt
with dengue fever.
Nursing Considerations
Each unit is suspended in 50-70 ml of
plasma.
Usual dose for thrombocytopenic,
bleeding adult is 6-10 units.
 If the seal is unbroken, platelets are stored
at room temperature with continuous
agitation for 3-5 days.
If the container is entered, platelets must
be transfused within 4 hours.
B. SINGLE DONOR PLATELETS
 6-8 units of platelets collected from a
single donor by apheresis.
 Platelets and a small amount of plasma
are removed from the donor.
 Platelets can be stored 1-5 days.
Notes:
one unit equivalent to 5 random units
 Indications
Platelets from a single donor reduce the risk
of donor-related transmissible disease and
antigen sensitivity.
 Nursing Intervention for Platelet
Transfusions
Verify plasma compatibility prior to
transfusion.
Infuse through a component administration
set with a standard 170-micron filter. (10
drops/min).
 Nursing Alert
 DO NOT use a microaggregate filter or
administration set with a rubber
connections. Platelet will aggregate and
adhere to the filter and rubber.
Notes:
Microgaggregate - maliit, hindi susuot
PLASMA
 Liquid portion of blood after removal of
cellular components (red cells, platelets,
leukocytes).
 Composed of approximately 91% water, 7%
protein, and 2% carbohydrates and lipids.
Note:
 Plalsma carries a risk of hepatitis equal to that
of whole blood.
 If only volume expansion is required
albumin, plasma protein, or crystalloid
solutions are safe products.
PLASMA
FRESH FROZEN PLASMA (FFP)
 Prepared from the whole blood by
separating and freezing the plasma within
8 hours of collections
 Stored frozen - 30 degree C or colder
 Contains clotting factors V and VIII (the
lablile factors) as well as factors I, II, VII,
IX, X, XI, XII, and XII.
 Approximately 200-250 ml
 Dengue -fever
 Indications
 FFP is transfused for coagulation factor
related to liver disease, DIC and
dilutional coagulapothy resulting from
massive blood replacement.
 May also be indicated for congenital
coagulation deficiencies.
PLASMA DERIVATIVES
 Specific proteins removed from plasma
for administration in concentration form.
KULANG
1. CRYOPRECIPITATE
 A component the cryoglobulin fraction of
plasma
 Contains a major portion of factor VIII,
VWF (Von Willebrand’s Factor) and
factor XIII
 Prepared by thawing one unit of FFP at 4
degree C.
 1 unit about 15ml.
Indications
 Used in the treatment of:
 Hemiphilia A (factor VIII; C
deficiency)
 VWF Disease (Factor VIII: VWF
Deficiency
 DIC
  Uremic Bleeding
Nursing Intervention for Cryoprecipitae
fusions
 Store cryoprecipitate after thawing at room
temperature and transfuse within 4 hours.
 Transfuse through component recipient set
with 170-micron filter over 30-60 minutes.
 Know that the most common reaction is
related to foreign protein substances
(allergic).
BLOOD TRANSFUSION THERAPY
The giving of blood into the veins
Purposes:
1. To replace losses of circulatory volume and
O2 carrying capacity
2. To restore metabolic homeostasis
3. To replenish normal RBC’s
PRESCRITPTION OF BLOOD
 Responsibility of the doctor
 Should include the following details
 The blood or blood component to be given
 The quanity requested
 The duration for the transfusio of each unit
 Any special instruction (e.g. medications
required BEFORE OR DURING
transfusion.
REQUESTING FOR BLOOD
 Specify:
 Blood or blood components needed
 Number of units
 Blood type and Rh group
 Date and time needed
 Indication for transfusion
 Full name, age, and gender of the patient
PRE-TRANSFUSION TESTING
 Essential that all blood is tested for red cell
compatibility before transfusion
 The following should be provided about
the units of blood and the patient.
ABO Group
RhD Type
Presence of red cell antibodies that
could cause hemolysis in the
recipient.
Notes
 Rh negative - client has no antigen
Blood samples intended for use in corss
matching should be collected no more
than 3 days before the intended
transfusion unless the patient is:
- Not pregnant within the last 3 months
- Not transfused within the preceding 3
months.
ABO BLOOD GROUP ANTIGENS AND
ANTIBODIES
 There are foure main red cell types: O, A,
B, and group AB.
 Healthy normal adults of Group A, B and
O and have antibodies in their plasma
against the red cell types (antigens) that
they have not inherited.
 Group AB have no antibodies in their
plasma.
  MERON PA

1. Group A have antibody to Group B

2. Group B have antibody to Group A
3. Group O have antibody to Group
4.

IGM NATURAL CONSTITUENT

ANT

STORING BLOOD PRODUCTS PRIOR

TO TRANSFUSION
 Whole Blood
 Platelet Concentrate
- Kept in agitator at 20-24 degree C
-Never place in refrigirator

RhD RED CELL ANTIGENS AND

ANTIBODIES
 Rh D - positive
 Rh D - negative
 D negative patients SHOULD receive D-
negative red-cell to avoid immunization to
the D antigen
FFP and CRYOPRECIPITATE 

- Stored in blood bank at -25 degree

Centrigrade
- Infused within 30 minutes of thawing
- If not

“30 MINUTE RULE”

 Blood should be trannsfused within 30
minutes from the time to issuance of the
unit.
 Unless transfusions can be completed within 4
hours, the blood should be returned
promptly.
 It should not be left at room temperature or
stored in unmonitored refrigerator.
 Unsuitable

THE BLOOD UNIT

 Discoloration or signs of leakage may be the
only warning that the blood has been
contaminated by bacteria.
 Do not administer the transfusion if the pack
appears abnormal or damage or it has been
out of the refrigerator
ADMINISTRATION OF BLOOD
COMPONENTS
 Accurate identification of the transfusion
component and the intended recipient
may be the single most important step
in ensuring transfusion
 

COMPATIBILITY LABEL
 Should be attached to each unit of blood
showing the following information: IMMEDIATE MANAGEMENT OF
 THE BLOOD IS COMPATIBLE WITH LIFE THREATENING REACTIONS
 1. Stop the infusion. Replace the infusion
set and keep IV line open with NSS
2. Infuse NSS (initially 20-30 ml/kg) to
maintain systolic BP
3. Maintain airway and give high flow O2
by mask
4. Give adrenaline by slow IM
5. Give corticosteroids and brochodilators if
with stridor or spasm.
6. Give diuretic: furosemide
7. Notify AP and blood bank ASAP
8. Send blood unit+ infusion set, fresh urine
sample and new blood samples from vein
opposite infusion site
SIGNS AND SYMTOMS OF 9. Check fresh urine specimen visually for
TRANSFUSION REACTION signs of hemoglobinuria
10. Start 24H urine collection and fluid
CATEGORY 1 balance chart.
Mild Reaction
Fever General Guidelines: Acute Tranfusion
Urtacaria Reactions
Rash
Pruritis

CATEGORY 3
Life threatening Reactions
(Severe Reaction)
Pyrexia, Rigors

 Immediate steps for all reactions:

1. Stop transfusion
2. Keep IV open with 0.9% NaCI (PNSS)
3. Check VS
4. Verify correct unit was given to correct
patient
5. Give antihistamine or antipyretic if allergic
reaction is su

6. s Immediate Management
pected. 1. Slow the transfusion
7. 2. Administer Antihistamine IM
8. 

ACUTE TRANSFUSION REACTIONS

 Clerical error is the commonest cause of life-
threatening acute hemolytic transfusion
reactions
 Bacterial contamination in red cells or platelet
concentrates is an under-recognized cause of
acute transfusion reactions.
Immediate Management
1. Stop the transfusion. Replace the infusion
set and keep IV line open with NSS.
2. Notify the AP and blood bank ASAP.
3. Send blood unit with infusion set
 FINAL PATIENT IDENTITY CHECK
“BEDSIDE CHECK”
1. Ask the patient to state his or her name
- if unconscious, ask a relative or member
of the staff.
2. Check the patient’s identity

4. Administer antihistamine and antipyretic,

avoid aspirin if thrombocytopenic.
5. Give IV corticosteriods

6.

3.

4. No discrepancies between the ABO and

RhD group on:
-Blood pack
Administration Procedure
STEP 2: check the Patient’s
- First Name
- Surname

Initiating the Transfusion

 Patient’s VS (BP, PR, HR, RR, Temp)
must be recorded before the transfusion
 Administration of antihistamine before is
NOT a routine
 All blood components must be infused
through a filter
 The unit of blood is infused as side drip to

3. Check the compatibility the IV NSS (NSS drip stopped during

transfusion)
 Absolutely NO medications should be
added to the NSS Bottle.

Pre- Tranfusion Event

 Sign the transf

 BLOOD FILTERS
 Designated to retain blood clots and
particles harmful to the recipient
 Use

COMPATIBILITY OF RBS WITH IV

SOLUTIONS

BLOOD WARMING
 Blood should nerver be warmed in a bowl of
hot water
 Warming of blood to body temperature is not
necessary
 Use only temperature-monitored

INITIATING THE TRANSFUSION

 Mix the unit of blood thoroughly
 Before initiating the transfusion


INFUSION TIME
 Initial flow rate 1-2ml/min to allow for RECORD
recognition of acute adverse reaction 
standar

Recommended Infusion Time

 RBC -> 2HRS unless the patient cant tolerate
only gradual

Monitoring the Transfused Patient

 WHAT
 Temperature
Pulse rate
Respiration
BP
General Appearance
Fluid Balance (I & O)

 WHEN