BLOOD TRANSFUSION

Definition
Blood transfusion consists of administration of compatible donor’s whole blood or any of its
components to correct/treat any clinical condition.

Purposes
1. To restore circulating blood volume.
2. To correct platelet and coagulation factor deficiencies.
3. To increase the number of red blood cells and to maintain the haemoglobin level.
4. To combat infection due to decreased or defective white cells or antibodies.

Indications
1. After surgery, trauma or haemorrhage
2. Severe anemia
3. Haemophilia
4. Leucopoenia
5. Agranulocytosis
6. Throblastosis fetalis

Blood groups
 Human blood is classified into four groups. (A, B, AB, O) based on the type of antigens
(agglutinogens) present in the erythrocytes, as well as the type of antibodies
(agglutinins) present in the plasma.
 Two major agglutinogens found are ‘antigen A’ and ‘antigen B’.
Blood groups and their respective antigens
Group Agglutinogens in the red cells Agglutinins in the plasma
AB A and B No agglutinins (-)
A A Beta agglutinins (β)
B B Alpha agglutinins (α)
O No agglutinogens Both alpha and beta (αβ)

Selection of donor
1. Should not be suffering from disease of heart, kidney, liver, lungs, cancer, jaundice,
tuberculosis, hepatitis, AIDS, allergies etc.
2. Should not have donated blood within the previous 90 days.
3. Should be healthy and in age group of 18-65 years.
4. Should not be pregnant.
5. Should have Hb level above 12 gm%.
6. Should have normal vital signs (TPR, BP).
7. Should not be empty stomach.
Articles
1. Blood transfusion set
2. Normal saline
3. Blood/blood components-sterile in appropriate container with name of the recipient
4. Cannula No: 18/20 (adult)
5. Alcohol/Iodine swabs (disinfectant)
6. Sterile gauze
7. Tourniquet
8. Adhesive tape
9. Scissors
10. Roller bandage and splint (optional)
11. Infusion stand
12. Disposal bag/kidney tray
13. Disposable gloves
14. Pressure bag (optional in case of severe bleeding)
15. Specimen container
16. Mackintosh and towel

Procedure
1. Check physician’s order, patient’s condition and history of transfusion/infusion
reaction, reason for present transfusion etc.
2. Identify patient.
3. Check availability of blood with in blood bank.
4. Explain the procedure to the patient, need for transfusion, blood product to be given,
approximate length of time, desire outcome etc.
5. Emphasize the need for patient to report unusual symptoms immediately.
6. Obtain informed consent from patient.
7. Obtain blood from blood bank in accordance with agency policy. If transfusion cannot
begin immediately, return product to blood bank. Blood which is out of refrigerator for
more than 30 minutes, above 10C cannot be re-issued. Never store blood in
unauthorized area like ward refrigerator. Blood must be stored in refrigerated unit at
carefully controlled temperature (4C).
8. Encourage patient to empty bowel and bladder and assist to a comfortable position.
Collect urine specimen.
9. Ensure privacy.
10. Wash and dry hands.
11. Check vital signs and record.
12. Don disposable gloves.
13. Insert IV cannula (18 G/20 G), if not already present in a large peripheral vein and
initiate infusion of normal saline solution using blood transfusion set.
14. Inspect the blood product (by 2 nurses) for
a. Identification number
b. Blood group and type
c. Expiry date
d. Compatibility
e. Patient’s name
f. Abnormal colour, clots, excess air etc.
15. Warm blood if needed using special blood warmer or immerse partially in tepid water.
16. If blood product is found to be correct, Stop the saline solution by closing roller clamp.
Remove insertion spike from saline container and insert spike into blood container.
17. Start infusion of blood product slowly, at the rate of 25 to 50 ml per hour for the first
15 minutes. Stay with patient for first 15 minutes. Check vital signs every 15 minutes
for first 30 minutes, or as per agency policy.
18. Increase the infusion rate if no adverse reactions are noticed. The flow rate should be
within safe limits.
19. Assess the condition of patient every 30 minutes and if any adverse effect is observed
stop transfusion and start saline. Send urine sample, blood sample and remaining blood
product in container with transfusion set, back to the blood bank.
20. Complete transfusion and administer saline (as per physician’s order), if no adverse
reaction is observed.
21. Dispose blood product container and set in appropriate receptacle.
22. Wash hands.
 23. Record the following:
a. Product and volume transfused
b. Identification number
c. Blood group
d. Time of administration- started and completed
e. Name and signature of nursing staff carrying out procedure
f. Patient’s condition
g. If agency policy requires remove label from blood bag and paste it on patient’s
record
24. Assist patient to comfortable position.

Special consideration
1. Do not administer medication through same line, where blood products is transfused.
Start another IV line if medications are to be infused, because of possible
incompatibility and bacterial contamination. Blood transfusion should be completed
over a period of 4 hours from the time of initiation.
2. Cover the blood bag with a towel when it hangs on the IV pole.
3. Gently rotate the blood bag periodically to prevent clumping of cells.
4. When rewarming the blood by immersing in tap water, do not immerse the blood bag
fully into the water as it may cause hemolysis.
5. Rewarming of blood may be done by covering the blood bag with a blanket.
6. Pre medications such as avil may be prescribed.

Care after procedure

1. Following the completion of the blood transfusion, the patient’s vital signs are checked
after 15 minutes, 30 minutes, 1 hour and the IV is removed.
2. Record the following:
a. Product and volume transfused
b. Identification number
c. Blood group
d. Time of administration- started and completed
e. Name and signature of nursing staff carrying out procedure
f. Patient’s condition
g. If agency policy requires remove label from blood bag and paste it on patient’s
record
3. Assist patient to comfortable position.
4. Check IV site for any pain, hematoma, bluish discoloration, edema, redness, swelling.
5. For a couple of days after the transfusion, patients may experience some soreness near
the puncture for the IV.
6. The patient’s doctor may request a check up after the transfusion to see the body’s
reaction to the new blood.
BLOOD TRANSFUSION REACTIONS AND NURSING MANAGEMENT

Transfusion reactions and nursing management

Reaction Sign and Nursing Management

Symptoms

1. Allergic reaction  Hives  Stop transfusion immediately and keep

 Itching vein patent with normal saline.
 Anaphylaxis  Notify physician immediately.
 Administer antihistamine parenterally
as necessary.

2. Febrile reaction:  Fever and chills  Stop transfusion immediately and keep
fever developing  Headache vein patent with normal saline.
during infusion  malaise  Notify physician.
 Treat symptoms.

3. Hemolytic  Immediate onset  Stop transfusion immediately and keep

transfusion  Facial flushing vein patent with normal saline.
reaction:  Fever, chills  Notify physician immediately.
incompatibility of  Headache  Obtain blood samples from the site.
blood products  Low back pain  Obtain first voided urine.
 shock  Treat shock if present.
 Send remaining blood in bag, tubing and
filter to lab.
 Draw blood sample for serologic testing
and send urine specimen to lab.

4. Circulatory  Dyspnea  Slow/stop transfusion.

overload  Dry cough  Monitor vital signs.
 Pulmonary  Notify physician.
edema  Place patient in upright position with
feet dependent.

5. Bacterial reaction:  Fever  Stop transfusion immediately.

bacteria present in  Hypertension  Obtain culture of patient’s blood and
blood  Dry, flushed return blood bag to lab.
skin  Monitor vital signs.
 Abdominal pain  Notify physician.
 Administer antibiotics immediately.
Procedure
1. Immediately stop the transfusion.
2. Using gloved hands, remove tubing with blood and replace with new tubing.
3. Maintain the IV line patent with normal saline. Do not use any solutions containing
dextrose.
4. Obtain vital signs with oxygen saturation.
5. Remove gloves and wash hands.
6. Notify physician of patient’s transfusion reaction, including vital signs and specifically
symptoms with severity of reaction and time frame.
7. Administer oxygen and place in Trendelenburg position if shock occurs.
8. Monitor patient’s vital signs at least every 15 minutes.
9. Read the blood component bag to ensure that correct unit was given to the correct patient
10. Administer medications as prescribed:
a. Diphenhydramine
b. Epinephrine
c. Broad spectrum antibiotics
d. Intravenous fluids
11. Start cardiopulmonary resuscitation if indicated.
12. Obtain two samples from the other arm.
13. Return the remaining blood and tubing to blood bank.
14. Obtain first voided urine (within one hour of reaction).

QUALITY OF BLOOD PRODUCTS IN ONE UNIT

Quality of blood products in one unit

Type of blood product Amount

1. Fresh blood 350-450 ml

2. Plasma (different types) 130-160 ml

3. Packed cells 220 ml

4. Cryoprecipitate 15 ml

5. Platelets 30-60 ml
 Reference

1. Fundamentals of nursing, A procedure manual, The trained nurses’ association of India,

pp 391-395.
2. Clinical nursing procedures: The art of nursing practice, Annamma Jacob, Rekha R,
Jadhav Sonali Tara Chand, 2 nd edition, Jaypee, pp 265-270.
3. https://www.redcrossblood.org/donate-blood/blood-donation-process/what-happens-
to-donated-blood/blood-transfusions.html.
4. https://en.wikipedia.org/wiki/Blood_transfusion.
5. https://www.google.com/search?q=blood+transfusion+procedure&source=lnms&tbm=
isch&sa=X&ved=0ahUKEwi0mPSPrs3iAhX87HMBHYFZAj8Q_AUIECgB&biw=13
66&bih=625.