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219 D2 - Blood Transfusion
219 D2 - Blood Transfusion
Blood Transfusion
− Replace blood components to restore the blood’s
ability to transport oxygen and carbon dioxide, clot,
fight infection, and keep extracellular fluid within the
intravascular compartment.
− Purposes: restore volume, restore oxygen-carrying
capacity, administer blood component.
− Managing blood transfusion therapies demand
knowledge of blood components and products
Blood Components
Component Synonyms Description
• Liquid component
− Rh factor is another way to group blood according to
(55%)
the presence or absence of the Rh antigen, which was
• Mixture of water,
discovered in 1940.
Plasma - sugar, fat, protein
− An Rh-negative patient should never be given Rh-
and salts
positive blood. The first time may not illicit negative
• Transport blood cells
effects, but after the Rh antibodies are formed,
throughout the body
subsequent transfusions could cause agglutination.
• Most abundant cell
(45%)
• Gives red color to the
blood
Red Blood RBC,
• Biconcave shape with
Cells Erythrocytes
flattened center
• Contains the
hemoglobin protein
that carries oxygen
• Comprise 1% of
blood volume
White WBC, • Protect body from
Blood Cells Leukocytes infection
• Types: neutrophil
and lymphocytes
• Fragments of cells
Platelets Thrombocytes • For coagulation
(clotting) process − There are eight different blood groupings based on Rh
factor, each either Rh-positive or Rh-negative
Blood Typing/Matching
− The four blood groups are A, B, AB, and O.
− The differences in each group are determined by the
presence of certain protein molecules known as − Cross matching is a procedure to check for antibodies
antigens (a foreign substance in the blood located on to different antigens after the blood group and Rh
red blood cells [RBCs]) and antibodies (a protein factor are known
manufactured in response to the presence of an − It’s the final step in testing for compatibility. The blood
antigen in the body located in blood plasma). from a donor is mixed in a test tube with the blood
− When the wrong type of blood is given to a patient, it from the recipient. If any clumping occurs, then the
clumps together—a potentially fatal process known as blood isn’t compatible and further testing will be
agglutination, an immunologic response that occurs needed.
when the cells of one type of blood interact with the − An autologous blood donation is one in which a person
antibodies of another type. donates blood for their own use prior to or during a
scheduled surgery. When the blood is given back, it is Packed Red Blood Cells (PRBC)
called an autologous blood transfusion. − Collected from whole blood by either centrifugation or
− An allogeneic blood transfusion, in which blood from sedimentation, after drawing off about 250 ml of
another from a person is used. plasma and platelets from the donor unit
− PRBCs have a hematocrit between 70% and 80%
The Blood Products (vicious)
− For each unit of PRBCs transfused, the average 70 kg
adult’s hemoglobin will generally increase by 1 g/dl;
hematocrit will usually rise by 2% to 3%
− Generally administered as blood replacement during
surgery
Nursing Considerations
• Preparation - prime the tubing and filter with 0.9%
sodium chloride before hanging; filters are for
maximum of 4hrs only
• Typing- Universal (due to plasma removal), however,
Rh- positive PRBCs should be given only to patients
known to be Rh-positive; Rh-negative PRBCs should be
given to patients who are known to be Rh-negative or
Whole Blood who have an unknown Rh status
− Rarely ordered, used and administered • Time considerations – PRBCs and filters are for
− Contains cells (red blood cells [RBCs], white blood cells maximum of 4hrs only
[WBCs], and platelets), plasma (plasma proteins, • Administration - Because of its viscosity, PRBCs can
antibodies, water, and waste), and electrolytes. be difficult to administer through a small catheter
− blood volume expander and a source of proteins that within the 4- hour time limit. Many hospitals have a
promote coagulation. policy that PRBCs must be infused through at least a
− Indicated for patients who need rapid, massive 20-gauge peripheral I.V. catheter.
replacement of lost blood (usually more than 25% of • Cautions – Do not administer in the same line with
their blood volume) and who have symptoms of most other infusions due to risk of hemolysis. The only
hypoxia, or patients who need an exchange exceptions are 0.9% sodium chloride, 5% albumin,
transfusion plasma protein fraction, or compatible plasma.
Nursing Considerations Modified PRBCs are similar to PRBCs
• Preparation - prime the tubing and filter with 0.9% − PRBCs washed in 0.9% sodium chloride and is
sodium chloride before hanging; filters are for intended for neonatal or intrauterine transfusion or
maximum of 4hrs only when patients have had recurrent or severe allergic
• Typing - type specific, and it must be ABO- and Rh- reactions to plasma proteins.
compatible to prevent serious transfusion reactions − Leukocyte-filtered PRBCs are given to patients
• Time considerations – whole blood and filters are who’ve had repeated febrile reactions to transfusions.
for maximum of 4hrs only
• Gradual and full – infuse 25ml slowly over 15 Platelet Products
minutes while monitoring the patient to check for − Available in two (2) preparations:
adverse reactions • random-donor concentrates made from single
• Infusion – depends on patient condition. Healthy units of whole blood, and
adults with chronic anemia can safely be given RBCs • single-donor concentrates obtained from
at a rate of 3 to 4 ml/kg/hour. Careful with patients plasmapheresis of a single donor.
with cardiovascular compromise - can’t tolerate rates − Platelet products also contain plasma (especially factor
of more than 1 ml/kg/hour. III, necessary for coagulation), some RBCs, and some
• Cautions – Do not administer in the same line with WBCs (leukocytes).
most other infusions due to risk of hemolysis. The only − Platelets are transfused to control or prevent bleeding
exceptions are 0.9% sodium chloride, 5% albumin, associated with deficiencies in platelet number or
plasma protein fraction, or compatible plasma. function and to aid in the coagulation process.
− Each unit of platelet concentrate should increase the
average adult patient’s platelet count by about 5,000
platelets/microliter.
BLOOD TRANSFUSION RETDEM 2
Aki Notes Administering Blood Transfusion Return Demonstration BSN 2-YB-9
− Patients with immune thrombocytopenic purpura • Typing - It must be ABO compatible, but Rh antibody
shouldn’t receive platelet infusions, unless life- status is irrelevant
threatening bleeding occurs.
Transfusion Reactions
Nursing Considerations
− Acute hemolytic transfusion reactions (AHTR) can
• Time considerations - Platelets should be infused cause serious, potentially fatal consequences
either within 4 hours of being removed from the
− Common causes: ABO incompatibility between patient
refrigerator due to the risk of bacterial contamination.
and donor during transfusion of red blood cells. Most
• Special filters - platelets should be administered cases of ABO incompatibility result from clerical error
through a standard 170- to 260-micron filter. Avoid
at some point in the transfusion process.
filters that were used to filter whole blood or PRBCs;
− Signs and symptoms of AHTR usually appear 5 to 15
red cell debris already accumulated in the filter might
minutes after the transfusion begins, but they can
trap the platelets. Instead, use a new filter.
develop anytime during the transfusion:
• Typing - For most adults, platelet concentrates don’t
• Febrile – chills, fever, headache, flushing,
require ABO crossmatching before infusion. But
tachycardia,↑anxiety
patients who’ve had numerous platelet transfusions
• Allergic – Mild: hives, pruritus, facial flushing;
may become resistant to pooled donor platelets and
Severe: SOB, branchospasms, ↑anxiety
may respond better to donor- matched platelets from
• Hemolytic – low back pain, hypotension,
a single donor.
tachycardia, fever and chills, chest pain,
• Age - Infants and small children must receive either
tachypnea, hemoglobinuria
ABO compatible or reduced-volume ABO incompatible
− Should any of these symptoms occur, immediately
platelets. The number of red cells in platelets isn’t high
discontinue the transfusion, hang 0.9% sodium
enough to cause an incompatibility reaction. But there
chloride to maintain vascular access (be sure to use
are enough red cells for an Rh-negative child to
new tubing), and call for assistance.
develop Rh antibodies if he receives Rh positive blood
− REACTION: Rash, Elevated Tem, Ache, Chills, Increase
products.
RR, Oliguria, Nausea
– Nursing interventions
• STOP transfusion
• KVO with PNSS
• Notify the physician immediately
• Monitor VS
• Administer CPR as needed
• Administer medication / oxygen as needed
Circulatory Overload – Blood administered faster than
the circulation can accommodate
– Cough, Dyspnea, Crackles, Distended neck veins,
Tachycardia, Hypertension
– Nursing interventions
• STOP or SLOW the transfusion
• Place the client upright, with feet dependent
• Administer diuretics and oxygen as needed
• Notify physician
Sepsis – Contaminated blood administration
– High fever, chills, Vomiting, Diarrhea, Hypotension
– Nursing interventions
• STOP transfusion
• Send remaining blood to laboratory Notify the
physician
• Obtain a blood specimen from the client for
culture
• Administer IV fluids and antibiotics
• KVO with PNSS
13) Remain with client for the first 15-30 minutes,
monitoring vital signs frequently according to
institutional policy.
14) After blood has infused, flush the tubing with normal
saline.
Complete the transfusion within 3- 4 hours.
15) Wash hands and documentation
transfusion time
blood product
volume of blood
vital signs
any abnormal reaction