BLOOD

TRANSFUSION
A N D R E W I S I A H P. B O N I F A C I O , R N
DEFINITION

• Transfusion therapy or blood

replacement is the
intravenous (IV)
administration of whole
blood, its components, or a
plasma-derived product for
therapeutic purposes
PURPOSES OF BLOOD
TRANSFUSION

restore intravascular volume

restore the oxygen-carrying capacity of blood

provide clotting factors

METHODS

AUTOLOGOUS ALLOGENEIC
• Blood salvaging • Blood is donated
• Patient’s own by another
blood is collected person
and reinfused
RISKS & COMPLICATIONS
ASSOCIATED WITH BLOOD
TRANSFUSION

Blood type incompatibility

Disease transmission

Allergic reactions

Overloading

Sepsis
BLOOD TYPING
SYSTEMS
 ABO SYSTEM

• Uses the presence or absence of specific antigens

on the surface of red blood cells to identify blood
groups.
• Blood types are named after whatever antigen type
is present
 ABO SYSTEM

BLOOD TYPE Antigen Antibodies

(agglutinogen) (agglutinin)
UNIVERSA
L
• Type
A A B
RECIPIENT
AB
B B A

AB A&B NONE
UNIVERSA
L DONOR • Type O
O NONE A&B
 Rh SYSTEM

• The presence or absence of the Rh (D) antigen

determines a person’s Rh type.
• Person with the D antigen is Rh positive, and a
person without the D antigen is Rh negative.
 Rh SYSTEM

BLOOD TYPE CAN RECEIVE CANNOT

HEMOLYTIC RECEIVE

TRANSFUSION
REACTION Rh + both none

• Transpires when
incompatible blood types Rh - Rh - only Rh +
are combined causing
rapid breakdown of RBCs
 HLA SYSTEM

• Human leukocyte antigens (HLA)s are located on the cell

surface of leukocytes.
• They may also be found on lymphocytes, granulocytes,
monocytes, and platelets
• HLA are highly immunogenic antigens that can cause
serious transfusion complications.
• Most commonly linked to transplant rejection
BLOOD PRODUCTS
 WHOLE BLOOD

ABO/RH
Source Usual volume Infusion time Actions Indications
testing
• Single • 300-550 mL • Within 4 • Both • Replaces • Severe
donor; hours required RBC mass hemorrhage,
allogeneic (Must be and plasma shock
or ABO volume
autologous identical) • Raises Hgb
(1g/100ml)
and Hct
(3%)
 PACKED RED BLOOD CELLS (PRBCs)

ABO/RH
Source Usual volume Infusion time Actions Indications
testing
• Single • 250-350 mL • Within 4 • Both • Replaces • Severe
donor; hours required RBC mass anemia,
allogeneic • Raises Hgb hypoxemia,
or (1g/100ml) hemorrhage
autologous and Hct
(3%)
 FRESH FROZEN PLASMA (FFP)

ABO/RH
Source Usual volume Infusion time Actions Indications
testing
• Single donor • 200-250 mL • Thawed first • ABO • Replaces • DIC, TTP
prior to required plasma
infusion • RH not without
• Within 4 required RBCs or
hours platelets;
• Contains
most
coagulation
factors and
complement
 CRYOPRECIPITATE

Source Usual volume Infusion time ABO/RH testing Actions Indications

• Multiple/random • 5-20 mL/unit; 1 • Infuse within 6 • Both not • Replaces • DIC, TTP
donor; pooled unit/10 kg body hrs of thawing required factors VIII, XIII,
weight or 4 of pooling von Willebrand’s
factor,
fibrinogen.
 PLATELETS

Source Usual volume Infusion time ABO/RH testing Actions Indications

• Multiple/ random • 40-70 mL/unit; 1 • Within 6 hours of • Both required • Raise platelet count • Used in patients
donor, pooled unit/10 kg body pooling with
weight thrombocytopenia.
BLOOD
TRANSFUSION
PROCEDURE
 DELEGATION AND COLLABORATION

The skill of initiating transfusion therapy cannot be delegated to nursing

assistive personnel (NAP).

The skill of initiating transfusion therapy by a licensed practical nurse

(LPN) varies by state Practice Acts.

After the transfusion has been started and the patient is stable,
monitoring of a patient by NAP does not relieve a registered nurse (RN)
of the responsibility to continue to assess the patient during the
transfusion.
 Insert Image

BLOOD
TRANSFUSION
REACTIONS
 ACUTE HEMOLYTIC TRANSFUSION REACTION

Mechanism
• ABO, Rh incompatibility causes intravascular destruction of transfused RBCs

Onset
• Within 15 minutes of transfusion initiation

Manifestations
• Severe pain in kidney area and chest
 FEBRILE NON-HEMOLYTIC REACTION

Mechanism
• possible sensitivity of recipient to leukocytes or platelets in donor’s blood

Onset
• 30 min after initiation to 6 hrs after completion of transfusion

Manifestations
• Fever, chills, headache
 SEVERE ALLERGIC TRANSFUSION REACTION

Mechanism
• Caused by recipient allergy to a plasma protein in donor’s blood

Onset
• Within 5-15 min of initiation of transfusion

Manifestations
• Urticaria, pruritus, and bronchoconstriction
 GRAFT-VERSUS HOST DISEASE

Mechanism
• Donor lymphocytes are destroyed by recipient’s immune system.

Onset
• Days to weeks

Manifestations
• Skin rash, fever, jaundice
 NCLEX-RN QUESTION

During the administration of blood the health care provider

orders intravenous (IV) antibiotics to be infused. The most
appropriate intervention is to:
1 Stop the transfusion.
2 Piggyback into the transfusion.
3 Question the order.
4 Start a new IV site.
 NCLEX-RN QUESTION

A patient is to receive blood that has been stored for a long

period of time. Which recent laboratory value should the
nurse check before administering the unit?
1 Sodium
2 Hematocrit
3 Hemoglobin
4 Potassium