NKANA COLLEGE OF APPLIED SCIENCES AND

EDUCATION
School of Health Sciences

Blood Transfusion 2
31.03.2023
Objectives
❑ At the end of this lecture, you should be able to:
❑ Describe the ABO and Rh blood group systems
❑ Discuss blood transfusion
❑ Discuss the safety of blood transfusion
Introduction
❑ Blood transfusion (BT) is the transfer of blood or blood
components from one person (donor) into the bloodstream of
another person (recipient)
❑ Donor blood group must be compatible with that of the recipient
❑ BT may be done as a life saving manoeuvre to replace blood cells or
blood products lost through bleeding or due to depression of BM
❑ A blood type (blood group) is a classification of blood based on
the presence or absence of inherited antigenic substances on the
surface of red blood cells
❑ There are 8 blood groups based on ABO and Rh blood group systems
❑ Transfusion of one's own blood (autologous) is the safest
method but requires planning & not all pts are eligible for it
❑ Blood is usually given through a plastic tube inserted into a
vein in the arm and may take 30 minutes to 4 hrs
❑ Blood donors are unpaid volunteers, they're carefully selected
and tested to make sure the blood they donate is safe
Blood transfusion
❑ A blood transfusion (BT) involves taking blood from one
person (the donor) and giving it to someone else.
❑ One may need a BT for a number of reasons, including:
❑ To replace blood lost during surgery, childbirth or a severe accident
❑ To treat anaemia that has failed to respond to other treatments
❑ To treat inherited blood disorders (thalassaemia or SCA)
❑ The type of BT one receives depends on many factors such as
health, medical history, type of operation one is having and
severity of one’s condition
❑ The patient has the right to refuse a BT, but he or she needs to
fully understand the outcome of this before doing so.
❑ Ask for consent from the patient for BT
❑ Explain to the patient the need for BT
❑ In order to transfuse, the donor's blood is tested against the
patient’s blood to make sure the blood is compatible to prevent
BT reactions
❑ Blood grouping & cross-match tests)
 Blood transfusion
❑ Blood products and blood components
❑ A blood product is any therapeutic substance prepared from
the human blood (whole blood, blood components)
❑ A blood component is any blood product prepared from the
whole blood (WB) by centrifugation or apheresis
❑ Whole blood is separated into RBC concentrate, platelet concentrate,
fresh frozen plasma and cryoprecipitate
❑ Different blood products need different storage conditions for
therapeutic efficacy
❑ Each blood component is used for a different indication,
maximizing the utility of one whole blood unit.
❑ Replacement fluids are electrolyte-containing fluids with
composition similar to that of ECF
❑ 0.9% NaCl, Lactated Ringer’s solution, plasmalyte 148 & normosol-R
❑ Small amounts of blood loss (1.5L) can be replaced with a
replacement fluid, then replaced with new RBCs over a few
weeks
 Blood transfusion
❑ Blood products
❑ 1.0 Red blood cell transfusions
❑ Main reason for RBC transfusion is to treat anaemia
❑ 2.0 Platelets
❑ A platelet transfusion is used to treat people who have very
low levels of platelet cells (thrombocytopenia) in their blood
❑ If you have thrombocytopenia, you're at risk of excessive bleeding,
either through a minor accident, cut or graze, or as a result of surgery
or dental work.
❑ Causes of thrombocytopenia that may require treatment with a
platelet transfusion include:
❑ Cancers such as leukaemia or lymphoma, chemotherapy or BM
transplantation which reduces the production of platelets
❑ Chronic liver disease or cirrhosis (scarring of liver which has many
causes, including alcohol abuse)
❑ Sepsis or severe infection
❑ All this can cause abnormal clotting and low platelets
Blood transfusion
❑ Blood products
❑ 3.0 Plasma (cryoprecipitate or fresh frozen plasma)
❑ Plasma is the fluid in blood containing proteins that help blood
to clot
❑ A transfusion of plasma may be needed if there's severe
bleeding, such as after surgery, trauma or childbirth
❑ A transfusion may also be needed in conditions (such as liver
disease) that affect the production of clotting proteins.
❑ 4.0 Granulocytes
❑ Granulocytes are WBCs that help to fight infection.
❑ Granulocyte transfusions aren't commonly used
❑ May be needed if there's a severe infection that's not responding
to antibiotics after chemotherapy or BM transplantation.
❑ 5.0 Whole blood
❑ Whole blood is the preferred product for resuscitation of severe
traumatic haemorrhage.
Blood transfusion
❑ Surgical operations
❑ Surgeons always try to carry out surgery to minimise
amount of blood lost.
❑ This has become easier, due to increasing use of keyhole surgery
(laparoscopic surgery), where only small cuts are made in the body.
❑ However, some types of surgical operations & procedures
have a higher risk of blood loss
❑ Therefore, a blood transfusion is more likely to be needed.
❑ It may be possible to use a procedure called intra-operative
cell salvage.
❑ It collects your blood that's lost during the surgery, and it can be
returned back to you.
❑ Ask your doctor or nurse if intra-operative cell salvage is
appropriate for the type of surgery you’re having.
❑ It's no longer possible to routinely collect your own blood in
advance of your surgery.
Blood transfusion
❑ The procedure
❑ Blood is usually given through a plastic tube inserted into a
vein in the arm.
❑ Each unit can take between 30 minutes and four hours.
❑ Depending on how much blood is needed, the whole
procedure can take a significant length of time.
❑ A unit (bag) of RBCs usually takes 2-3 hours to give.
❑ If needed, a unit can be given more rapidly – for example, to treat
severe bleeding.
❑ A unit of platelets or plasma is given in 30 to 60 minutes.
❑ 1.0 Preparing for a Blood Product Transfusion
❑ Verify the physician’s order for the specific blood product.
❑ Verify the health care provider’s orders for any pre- or post-
transfusion medications to be administered
❑ Obtain the patient’s transfusion history, and note any known
allergies and previous transfusion reactions
Blood transfusion
❑ The procedure
❑ 1.0 Preparing for a Blood Product Transfusion
❑ Verify that type and cross-match have been completed within
the past 96 hours
❑ Verify patency of IV site
❑ Ensure appropriate patient identification band is available
and legible
❑ Assess laboratory values HCT, HGB, & PLT
❑ Check that the patient has properly completed and signed the
transfusion consent form
❑ Know the indications for the transfusion
❑ Obtain and record the patient’s pre-transfusion baseline vital
signs
❑ Complete all documentation as required
❑ Obtain products from the transfusion areas within 30 minutes
of planned transfusion
Blood transfusion
❑ The procedure
❑ 2.0 Transfusion of Blood Products
❑ Verify physician orders
❑ Initiate primary infusion with normal saline IV solution
❑ Complete and document cardiovascular assessments and
initial vital signs
❑ Assess blood bag for any signs of leaks or contamination
(clumping, clots, gas bubbles, or a purplish discoloration)
❑ Initial verification
❑ Compare transfusion medical services (TMS) documentation
with the patient record to verify:
❑ Patient first and last name and unique identifier number
❑ Physician order
❑ Consent
❑ Patient ABO grouping
Blood transfusion
❑ The procedure
❑ 2.0 Transfusion of Blood Products
❑ Initial verification
❑ NB.
❑ Confirm the patient blood type and Rh are compatible with the donor
blood type and Rh.
❑ All verification numbers/information must match exactly
❑ Compare the TMS documentation with the product label
attached to the product tab and verify:
❑ Patient first and last name and unique identifier number
❑ Type of blood product and ABO blood grouping
❑ 11-digit serial number
❑ Product expiry date and time
❑ Special requirements (e.g., irradiated)
❑ NB.
❑ Ensure the blood product matches the physician’s orders
❑ If there are any discrepancies, stop the process and contact the TMS
for resolution and direction.
 Blood transfusion
❑ The procedure
❑ 2.0 Transfusion of Blood Products
❑ Administer pre-medications as ordered
❑ Final verification
❑ All verification numbers must match exactly.
❑ If there are any discrepancies, stop the process and contact the TMS
for resolution and direction.
❑ Compare the patient’s first and last name and unique identifier
number using all of the following:
❑ Patient identification band or equivalent ID process
❑ Patients who are alert and oriented should be asked to:
❑ Spell first and last name
❑ State their date of birth
❑ Compatibility tag and label attached to blood product.
❑ All identifying information attached to the blood bag must remain
attached at least until completion of transfusion
❑ Only after recipient identification and product check are
confirmed, invert product 5 to 10 times and insert spike of the
blood administration set into the blood product container
 Blood transfusion
❑ The procedure
❑ 2.0 Transfusion of Blood Products
❑ Perform hand hygiene.
❑ Prime the blood product administration set
❑ Close clamp and completely cover the filter with product.
❑ A straight blood administration set is used for all transfusions.
❑ NB.
❑ Do not remove product from the presence of patient; prime at bedside.
❑ If product is removed from bedside, the final verification process must
be completed again
❑ Initiate transfusion:
❑ Obtain vital signs immediately prior to transfusion, then 15 minutes
after initiation, then every hour until transfusion is complete.
❑ Maintaining asepsis, disconnect the NS infusion and connect blood
administration set and start transfusion.
❑ Advise patient on the signs and symptoms of transfusion reaction and
what and when to report.
❑ Adults: Initiate red cells slowly (25 ml in the first 15 minutes).
❑ For all other BTs, refer to the blood and product sheet as per protocol.
 Blood transfusion
❑ The procedure
❑ 2.0 Transfusion of Blood and Blood Products
❑ For each and every unit:
❑ Remain with the patient for the first 5 minutes and assess for clinical
signs of transfusion reaction.
❑ Complete transfusion within 4 hours of removal from the blood bank.
❑ Most transfusion reactions occur within first 15 minutes of a
transfusion.
❑ Infusing small amounts of blood component initially
minimizes volume of blood to which patient is exposed,
thereby minimizing severity of reaction.
❑ Monitoring transfusion:
❑ Assess and observe for clinical signs and symptoms of reactions up to
24 hours post-transfusion.
❑ Complete all appropriate clinical documentation
❑ Vital signs must be monitored:
❑ Immediately prior to infusion
❑ Within 10 to 15 minutes
❑ Every hour until transfusion is complete
Blood transfusion
❑ The procedure
❑ 2.0 Transfusion of Blood and Blood Products
❑ Pictures below showing donors donating blood
 Blood transfusion
❑ The procedure
❑ 2.0 Transfusion of Blood and Blood Products
❑ Pictures below showing staff conducting blood transfusion
 Blood transfusion
❑ The procedure
❑ 2.0 Transfusion of Blood and Blood Products
❑ Picture below shows a patient undergoing surgery with blood
transfusion running
 Blood transfusion
❑ The procedure
❑ 3.0 In the event of a transfusion reaction
❑ The first step is to stop the transfusion.
❑ Manage transfusion reactions as per protocol.
❑ Complete required transfusion reaction form.
❑ Return remaining blood to blood bank for further
investigation
❑ Flush administration set with maximum of 50 ml of normal
saline and re-establish IV or SL as per physician orders.
❑ Flushing displaces any blood or blood product from administration set
❑ It is not necessary to flush between units of the same blood product.
❑ Complete all documentation as required.
❑ Documentation may include:
❑ Transfusion record form
❑ All vital signs and reactions
❑ Any significant findings, initiation and termination of transfusion
Safe blood transfusion
Safe blood transfusion
❑ Blood safety
❑ Blood donors are unpaid volunteers, they're carefully
selected and tested to make sure the blood they donate is as
safe as possible.
❑ In Zambia, there are strict regulations regarding blood donations
and blood transfusions.
❑ The aim is to reduce the risk of a person being given blood
contaminated with a virus or receiving blood from a blood
group that's unsuitable for them.
❑ Before making a blood donation, the potential donor is
asked about their health, lifestyle and history.
❑ After blood has been donated, it's always tested for the
following infections:
❑ Hepatitis B & C, HIV/AIDS, Syphilis, and Human T-cell
Lymphotropic virus (HTLV), e.t.c.
❑ Compared to other everyday risks, the chances of getting an
infection from a blood transfusion is very low.
Safe blood transfusion
❑ Blood safety
❑ The patient must be correctly identified to make sure he or
she get the right blood transfusion.
❑ Wearing an identification band with correct details is essential.
❑ Risks of a blood transfusion
❑ Blood transfusions are a fairly common procedure.
❑ The risk of serious side effects is low, as the blood is tested
against the donor blood to make sure it is compatible, and
you will be monitored regularly during the transfusion.
❑ 1. Allergic reaction
❑ Having an allergic reaction to the donated blood is a rare
complication of a blood transfusion.
❑ An allergic reaction is caused by the body’s immune system
reacting to proteins or other substances in the donated blood.
❑ The symptoms of the reaction are usually mild and occur
during or shortly after the transfusion.
Safe blood transfusion
❑ Risks of a blood transfusion
❑ 1.0 Allergic reaction
❑ Common symptoms include:
❑ A raised, red, itchy skin rash (urticaria)
❑ Swelling of the hands, arms, feet, ankles and legs (oedema)
❑ Dizziness
❑ Headaches
❑ Less common symptoms include:
❑ High temperature (fever) of or above 38°C (100.4F)
❑ Chills & Shivering
❑ Shortness of breath
❑ Swelling of the lips or eyelids
❑ These types of reactions can usually be successfully
managed by slowing down or stopping transfusion &
treating symptoms with antihistamines &, in some cases,
paracetamol.
Safe blood transfusion
❑ Risks of a blood transfusion
❑ 2.0 Anaphylaxis
❑ Anaphylaxis is a more serious and potentially life-
threatening allergic reaction to antibodies or other
substances in the blood.
❑ The symptoms of anaphylaxis may occur as soon as the
blood transfusion begins.
❑ They include:
❑ Severe shortness of breath
❑ Feeling faint or clammy
❑ A rash or swelling of lips or eyelids
❑ Treatment for anaphylaxis is usually an injection of a type
of medication called adrenaline
 Safe blood transfusion
❑ Risks of a blood transfusion
❑ 3.0 Fluid overload
❑ Occasionally, too much blood is transfused into the body in
too short a time for the body to properly cope with it.
❑ This is known as fluid overload.
❑ It’s more common in people who are elderly or frail, and in
those who have a lower body weight.
❑ The excess fluid can result in the heart being unable to
pump enough blood around the body (heart failure).
❑ The lungs also become filled with fluid, which can result in
shortness of breath.
❑ Older patients and those with serious health conditions,
such as heart disease, are at greater risk of fluid overload.
 Safe blood transfusion
❑ Risks of a blood transfusion
❑ 4.0 Lung injury
❑ A rare but very serious risk associated with blood transfusions is
transfusion-related acute lung injury (TRALI).
❑ It occurs more often with platelets & plasma than with RBCs.
❑ TRALI is a poorly understood condition, in which a person’s
lungs suddenly become very inflamed within six hours of the
transfusion.
❑ The high levels of inflammation cause lungs to become starved
of oxygen
❑ In some cases, this can be fatal.
❑ Most experts believe that some type of abnormal immune
response causes the inflammation associated with TRALI.
❑ Treatment for TRALI requires using a ventilator to provide the
body with oxygen until the inflammation of the lungs subsides.
Safe blood transfusion
❑ Risks of a blood transfusion
❑ 5.0 Haemolytic reactions
❑ A haemolytic transfusion reaction (HTR) is when the
immune system reacts to the donated blood and begins
attacking the blood cells.
❑ HTRs can happen during or soon after transfusion, or they
can be delayed, happening a few days or even a week after
transfusion.
❑ Haemolytic reactions can cause symptoms like other
transfusion reactions, but the urine may turn darker, due to
destruction of RBCs.
❑ HTRs are rare.
❑ They may be caused by a rare antibody that couldn’t be
picked up during the checking procedure
Safe blood transfusion
❑ Risks of a blood transfusion
❑ 5.0 Haemolytic reactions
❑ In delayed reactions, a new antibody can develop after
transfusion, which can break down the blood that has been
transfused
❑ In very rare circumstances, the wrong blood may
mistakenly be given to a patient
❑ Therefore, great care is taken to make sure the details on the
sample tube are correct
❑ Checks on patient and the bag of blood should be carried
out before starting the transfusion
❑ 6.0 Bacterially contaminated blood
❑ Despite every effort being made to keep donated blood
germ-free (sterile), bacteria can occasionally develop in
donated blood, but this is very rare.
Safe blood transfusion
❑ Risks of a blood transfusion
❑ 6.0 Bacterially contaminated blood
❑ Donations of platelets are particularly vulnerable to
contamination, because they need to be stored at room
temperature.
❑ If a person receives a donation of contaminated blood, they
may develop symptoms of blood poisoning (sepsis),
including:
❑ High temperature
❑ Chills
❑ A fast heartbeat
❑ Fast breathing
❑ Cold, clammy skin
❑ Changes in mental states, such as confusion
❑ Sepsis usually needs to be treated with injections of
antibiotics.
Safe blood transfusion
❑ Risks of a blood transfusion
❑ 7. Viral contaminated blood
❑ It’s extremely rare for someone to develop a viral infection
from a blood transfusion, as the blood services use strict
testing processes.
❑ For example, it is estimated that:
❑ The risk of getting hepatitis B is about 1 in 1.3 million
❑ The risk of getting hepatitis C is about 1 in 28 million
❑ The risk of getting HIV is about 1 in 6.5 million
❑ Giving blood
❑ Most people are able to give blood, but only 4% actually
do.
❑ You can donate blood if you:
❑ Have a good overall level of health
❑ Are 17 to 66 years of age (if it's your first time)
❑ Weigh at least 50kg
Conclusion
❑ Blood transfusion (BT) is the transfer of blood or blood
components from one person (donor) into the bloodstream of
another person (recipient)
❑ Donor blood group must be compatible with that of the recipient
❑ BT may be done as a life saving manoeuvre to replace blood cells or
blood products lost through bleeding or due to depression of BM
❑ A blood type (blood group) is a classification of blood based on
the presence or absence of inherited antigenic substances on the
surface of red blood cells
❑ There are 8 blood groups based on ABO and Rh blood group systems
❑ Transfusion of one's own blood (autologous) is the safest
method but requires planning & not all pts are eligible for it
❑ Blood is usually given through a plastic tube inserted into a
vein in the arm and may take 30 minutes to 4 hrs
❑ Blood donors are unpaid volunteers, they're carefully selected
and tested to make sure the blood they donate is safe
END