BLOOD &BLOOD PRODUCTS

ADMINISTRATION
EDUCATION TEAM
PARAS GLOBAL HOSPITAL
DARBHANGA
 PRE TEST TIME: 10 MTS
MARKS.: 10

1. Blood transfusion is for treating-----------------------.

a) anemia b) blood pressure c) diabettic

2. Whole blood is used to prevent bleeding in platelet disfunctions.

a) TRUE b) FALSE

3. Client to receive a unit of packed red blood

cells….unable to initiate an IV access. What actions
should you take?
a) try to initiate iv line b) return blood to blood bank .
 PRE TEST TIME: 10 MTS
MARKS.: 10

4.In addition to transfusion reaction; what is a major risk related to

administration of whole blood?
a) Circulatory overload due to volume b) febrile reaction

5. one packet of whole blood contains -------------

a) 350 ml b) 500 ml

6. Your client receives a unit of RBC’s…what response to this unit of blood is

anticipated?
a) Increases the HB b) Decrease platelets

7. Check the unit of blood for ------------

a) Expiry b) hb
 PRE TEST TIME: 10 MTS
MARKS.: 10

8.• Hemolytic reaction occur then the first step is ----------------

a) draw blood sample b) stop blood transfusion

9. Before transfusing blood the patient should have ---------------

a) ID bands b) NG tube

10.Phlebotomy means
a) opening of vein b) removal of vein
1. Blood Bank : It is a compact unit where blood is
accepted from donors, processed, and stored and
then issued to recipients in need as and when
required.
2. Phlebotomy: The procedure used to draw blood
from a person.
3. Anticoagulant : A Substance which prevent
coagulation or clotting of the blood.
6.Plasma : The straw colored fluid in which the blood
cells are suspended.
7. Aphaeresis : A method of blood collection in which
whole blood is withdrawn, a desired component separated
and retained, and remainder of the blood returned to the
donor.
8. Cross match : Test to determine compatibility between
donor & patient’s blood.
9. Adverse Donor Reaction : Donor reactions occurring
during donation or after donation.
 PLATELETS ARE USED TO
TREAT?

• Hemophilia
• Thrombocytopenia
• Polycythemia
• Low white cell count
 BLOOD PRODUCTS
Packed RBC’s
• From whole blood; 2/3 of plasma removed);
*most commonly used!
• Inc. O2 carrying capacity
• Treat anemia; replace blood volume
• Use leukocyte poor red cells or leukocyte filter
if history of febrile reaction
Vol. 250-300 cc
• Only RBCs used (remaining platelets, albumin, plasma
used for other purposes)
• Less chance for fluid overload.
• Ordered when HGB 8-9 and HCT 24-27; each unit inc..
• No viable platelets or granulocytes
Whole blood:
•Replace blood volume.
•Inc. O2 carrying capacity in hypovolemic
shock.
•Contains RBC’s, plasma proteins, clotting
factors and plasma.
•Few platelets or granulocytes.
Vol. 500 cc
• Danger of fluid overload and incompatibility.
• Deficient in some clotting factors.
• Rarely used.
Platelets:
• To control, prevent bleeding in platelet
dysfunction, thrombocytopenia
• From whole fresh blood
• From multiple donors
Vol. 30-60 cc of platelets in 1 unit
• Expected inc-10,000 per/unit-each unit
• Measure at 1 hr & 18-24 hr post admin.
• Usually given if platelet count less than 10-
20,000 danger of bleeding!
Frozen RBC’s (from RBC’s)
•can be frozen stored for 3 years
•Infrequently used
Use within 24 hours of thawing
•successive washing with saline solution removes majority of
WBC/’s and plasma proteins
Fresh Frozen Plasma (FFP)
•Contains clotting factors
•Used for DIC, liver failure patients
•Improves coagulation, PT and PTT
Vol. 200-300cc = 1 unit
• Rich in clotting factors
• NO platelets
• Good for volume expansion to restore clotting
factors in hypovolemic shock
Albumin-Plasma derivative
• Prepared from plasma.
• Volume expander
• Use for clients who are 3rd spacing and hypovolemic
(hyperosmolar solution moves water from extravascular
space to intravascular space)
• Outcome: adequate BP and volume
• Available in 5% or 25% solution
• Albumin 25g/100ml = to 500 ml of plasma
• Can be stored for 5 years
Cryoprecipitate-
• Clotting factors VIII, Xiii< von Willebrand’s factor &
fibrinogen from plasma and commercial concentrates
•Prepared from fresh frozen plasma
•Store for 1 year,.
•Prothrombin complex-Prothrombin, factors Vii, IX, X and part
of Xi
•Used to specific clotting factor deficiencies
•May cause ABO incompatibilities
•Used to specific clotting factor deficiencies
WBC’s or Granulocytes
•Rarely used except for cancer patients, chemotherapy patients.
•Surgery and in emergency setting
•Autologous blood-collection of own blood prior to scheduled
surgery or in emergency situation ( blood salvage; cell saver)
•Requires special equipment; filters, patients own blood is
returned
•if pre-donation, begin collection within 5 weeks of transfusion
date and end at least 3 days prior to transfusion need.
 BLOOD TRANSFUSION
POLICY
• Physicians order.
• Verify informed consent.
• Routine compatibility testing takes about 1 hour to
identify recipient ABO and Rh type; in emergency O-
negative RBC’s can be safely given to most clients
without serologic testing.
• Universal RBC donor is O negative; universal
recipient is AB positive.
• Blood must be completed within 3-4 hours after
receipt from blood bank.
 Compatibility Chart

Recipient
Donor A B AB O
A X X
B X X
AB X
O X X X X
• Verify informed consent for blood.
• Check physician’s orders.
• Identify patient, draw blood for cross matching in red top tube;
start 18-20 gauge IV .
• place blood band and label tube. Blood tubing & 0.9NS IV fluid
ready.
• Cross matching blood to lab.
•Obtain blood from blood bank (2 persons verify)

•Blood to unit for administration: 2 RN’s check

unit of blood with lab slip, patient’s chart; forms
to include patient’s name, hospital, and blood type

•Expiry date of unit of blood

•Patient’s ID.
• Issue transfusion card.
•Blood component, donor expiration date, and
Rh factor.
•If blood not to be given, must be returned to
blood bank within 20 minutes; CANNOT be
kept in unit refrigerator (requires special
refrigeration)!
• Compare all labels second time.
• Check vital signs and record.
• IV 18-20 gauge adult, 24-child.
• Invert unit to mix cells.
• Spike blood bag,.
• Cover blood filter with blood.
•Use appropriate filters
•Use blood administration set not more than 4
hours – infusion must be complete in 4 hours
•May give blood on a pump- use pump tubing
 Critical Points

•Client identification and blood compatibility.

•Drip rate not higher than 2 cc per minute X 15 minutes (25-50 cc).

•Remain with patient for first 15 minutes.

•Vital signs prior to administration, in 15 minutes, then q 30 minutes,

until transfusion complete--then X 2.

•No meds or fluid other than NS to be given in line with blood .

• Monitor for signs of transfusion reaction.

• Infuse over period specified (2-4 hours).

• Blood cannot be out of blood bank refrigerator more than 30

minutes prior to administration-PLAN ahead.

• Do not allow blood to hang no longer than 4 hours (longer time,

greater chance of bacterial contamination/septicemia)

• If multiple units being given for rapid blood loss; may have to
give under pressure and warm blood prior to administration .(only
agency approved warming devices)
1.Client to receive a unit of packed red blood
cells….unable to initiate an IV access. What actions
should you take?

Return to blood bank within 20 minutes if left

out longer run risk of bacterial growth and
sepsis; get help with starting IV (should
have started IV before requesting…plan
ahead) blood)
In addition to transfusion reaction; what is a major risk
related to administration of whole blood?
Circulatory overload due to volume; whole
Blood is typically 500cc and would cause
fluid overload, especially in at risk client.
• Your client receives a unit of RBC’s…what
response to this unit of blood is anticipated?
Recall that 1 unit of PRBC’s increases the Hgb
by 1g/dl and Hct by 2-3%-result > Hgb 9 &
Hct 24
 Transfusion
Reactions/Complications
Febrile
•Sensitization to donor WBC, platelets, plasma proteins
Bacterial
•Transfusion of bacterially infected components
Allergic
•Mild allergic to severe
Hemolytic (life-threatening!)
•Acute hemolytic: ABO incompatible; red cell destruction
Circulatory overload
•Fluid given too fast & too much
Iron overload-
• delayed reaction
Hypocalcemia-
•citrate in blood binds with calcium & is excreted
 Febrile

Caused by leukocyte incompatibility; sudden onset:

usually within first 15 minutes of transfusion!

•Fever/chills (^1 degree)

•Sensations of Cold
•Hypotension/Shock
•Flushed skin, abdominal pain, vomiting and diarrhea
•Prevent by use of leukocyte poor blood!
•Stop infusion/antipyretics
 Hypersensitivity reactions
• Antibodies in patient’s blood react against proteins, such as
immunoglobulin A in donor blood

• May occur during or after the transfusion

• Mild and transient: stop infusion, possibly restart, give

antihistamine prophylactically, use washed RBCs

• Severe: stop infusion, keep line open with new saline tubing;
CPR & epinephrine (if indicated)
Most dangerous!
Develops within first 15 minutes of transfusion: free
hemoglobin in blood and urine specimens provide
evidence of acute hemolytic reaction; delayed at 2-14
days
Occurs after 100-200 ml blood infused!
Blood incompatibility
•*RBC’s clump (lysis of RBC’c), block capillaries,
decrease blood flow to organs.
•Hgb released (myogloburia), blocks renal tubules >
acute renal failure=ATN (acute tubular necrosis)
If hemolytic reaction occurs:
• Stop transfusion, keep IV line open with new tubing, saline,
colloid solution to maintain BP; monitor
• Notify physician for patient signs and symptoms

• Treat shock (anaphylactic) if present (epinephrine, oxygen,

antihistamines, vasopressors, fluids, corticosteroids)
• Draw blood samples for serologic testing; send urine to lab and
return blood tubing to blood bank for testing
• Prevent acute renal failure: give diuretic, fluid challenge
•Circulatory overload
–Fluid given too fast & too much
–Note cough, dyspnea, HTN, etc
–Slow infusion, elevate HOB, treat overload, phlebotomy
•Iron overload-
–delayed reaction
–Vomiting diarrhea, hypotension, altered hematological values
–Administer deferoxamine (Desferal) Iv to remove accumulated
iron via the kidneys (urine red)
•Hypocalcaemia-
–citrate in blood binds with calcium & is
excreted
–Check lab values
•Also hyperkalemia: stored blood liberates
potassium through hemolysis (older blood
greater risk for hemolysis)
Collection / Transportation of blood & blood products for
Transfusion

1. Blood (and its products) must be TRANSPORTED in a

THERMOCOL BOX or THERMOPROOF BOX,
2. Once placed into the transportation box the blood should
be transfused within 1hour.
3. After this time the blood must be returned to the relevant
blood bank
4. Blood components should collected for only be one
patient at a time by trained personnel
 Good Practice Points:

• Check the unit of blood for :

• Expiry,
• Clots,
• Discoloration
• Leaks
• Ensure the reason for transfusion is clearly
documented in patient notes
• All
patients receiving blood products MUST have a wrist
band

• All final identity checks must be performed correctly

• The final identity checks must be an uninterrupted

procedure

• If you are interrupted, you must start again!