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BT New Template
BT New Template
Touches heart.
Educates mind.
Articulates vision.
Prepared By: Models excellence.
NR-NUR 122 Team 2019-2020
BLOOD AND BLOOD COMPONENTS
Blood is:
• a mixture of cells
• a complex transport mechanism that:
– transports hormones
– removes waste products
– regulates body temperature
– protects the body
– promotes hemostasis
– supplies oxygen
BLOOD AND BLOOD COMPONENTS
Composition of Blood:
Temperature: 38˚C (100.4˚F)
pH: 7.35-7.45
Specific Gravity: 1.048 – 1.066
Body weight: 8%
Volume: Male - 5-6 liters
Female - 4-5 liters
Body Weight /
Blood Volume Ratio
BLOOD AND BLOOD COMPONENTS
• Portions of the Blood Composed of:
• 55% plasma
• 45% cellular components
_____________________________________
• Plasma = fluid portion
• Coagulation factors
• Inorganic substances
• Antibodies
BLOOD TRANSFUSION THERAPY
• Blood transfusion is the
transfer of blood or its
components from one
individual (donor) to
another (recipient).
• Done to:
– Increase oxygen transport
to tissues
– Prevent and stop bleeding
– Combat infection
WHO CAN AND CAN’T GIVE BLOOD?
THE BAG
LABEL
WHAT TO CHECK…
UNIT
INTEGRITY
WHAT TO CHECK…
APPEARANCE
WHAT TO CHECK…
• RBCs should not be appreciably darker than the
bag segments and the remaining plasma should
not be murky, purple/blue, brown, or reddish.
Whole Blood
Packed RBCs
WBCs
Platelets
FFP
Whole Blood
• Complete (Pure) blood
• Volume: 500 mL
• Ideal infusion time:
4 hours
Indications:
• Restore blood volume in
hemorrhaging, trauma,
or burn patients
Whole Blood
Nursing Considerations:
• Cross-matching must be ABO identical
• Use a straight-line or Y-type IV set
• Whole blood is used frequently in emergency
treatment
• Reduce the risk of transfusion reaction by
adding a microfilter
• Warm blood if giving a large quantity
• Avoid giving whole blood when the patient
can’t tolerate the circulating volume.
Packed Red Blood Cells
• Same RBC mass as whole blood with
80% of the plasma removed
• Volume: 250 mL
• Ideal infusion time: 4 hours
Indications:
• To restore or maintain oxygen-
carrying capacity
• To correct anemia and surgical blood
loss
• To increase RBC mass
Packed Red Blood Cells
Nursing Considerations:
• Follow blood compatibility table for recipients
• Use a straight-line or Y-type IV set
• RBCs have the same oxygen-carrying capacity as
whole blood, minimizing the hazard of volume
overload.
• Using packed RBC avoids the potassium and
ammonia buildup that sometimes occurs in the
plasma of stored blood.
White Blood Cells
• Whole blood with all the red blood cells and
80% of the plasma removed
• Volume: usually 150 mL
• Ideal infusion time: slowly over 2-4 hours
Indications:
• To treat a patient with life-threatening
granulocytopenia who isn’t responding to
antibiotics
White Blood Cells
Nursing Considerations:
• Cross-matching follows that for PRBC
• WBCs are preferably human leukocyte antigen
(HLA)-compatible
• Use a straight-line IV set with a standard in-line
blood filter.
• Dosage is 1 unit daily for 5 days or until the
infection clears.
• Because reactions are common, administer
slowly over 2 to 4 hours.
White Blood Cells
• Check the patient’s vital signs and assess him every 15
minutes throughout the transfusion
• Give the transfusion in conjunction with antibiotics to treat
infection
• Agitate the container to prevent WBCs from settling, thus
preventing delivery of a bolus dose of WBCs.
• Don’t use a microaggregate filter
Platelets
• Platelet sediment from red
blood cells or plasma
• Volume: 35-50 mL/U; 1 unit
of platelets = 7x107 platelets
• Ideal infusion time:
– Infuse 100 mL over 15 minutes
– Administer at 150-200 mL/hr,
or as rapidly as the patient can
tolerate; don’t exceed 4 hours
Platelets
Indications:
• To treat thrombocytopenia caused by
decreased platelet production, increase
platelet destruction, or massive transfusion
of stored blood
• To treat acute leukemia and marrow aplasia
• To restore platelet count in a preoperative
patient with a count of 100,000/mL or less
Platelets
• Cross-matching: ABO compatibility isn’t
necessary but is preferable with repeated
platelet transfusions; Rh type match is
preferred.
• Use a blood component drip administration
set
• Don’t use a microaggregate filter
• Platelet transfusions aren’t usually indicated
for conditions of accelerated platelet
destruction
Platelets
• Patients with a history of platelet reaction
require premedication with antipyretics and
antihistamines
• Avoid administering platelets when the
patient has a fever
• A blood platelet count may be ordered 1
hour after platelet transfusion to determine
platelet transfusion increments.
Fresh Frozen Plasma
• Uncoagulated plasma
separated from RBCs,
rich in coagulation
factors V, VIII, IX
• Volume: 200-250 mL
• Ideal infusion time: As
rapidly as the patient
can tolerate
Fresh Frozen Plasma
Indications:
• To expand plasma volume
• To treat postsurgical hemorrhage or shock
• To correct an undetermined coagulation
factor deficiency
• To replace a specific factor when that factor
alone isn’t available
• To correct factor deficiencies resulting from
hepatic disease
Fresh Frozen Plasma
Nursing Considerations:
• Cross-matching: same as with Platelets
• Use a straight-line IV set
• Large-volume transfusions of FFP may require correction for
hypocalcemia. Citric acid in FFP binds calcium
S afety
P recautions
What to do if you suspect
a transfusion reaction…
ACUTE TRANSFUSION REACTIONS
Types of Acute Transfusion Reactions:
• Acute Hemolytic Transfusion Reaction
• Febrile Non-Hemolytic Transfusion Reaction
• Mild Allergy (Urticarial)
• Anaphylactic
• Transfusion Associated Circulatory Overload
• Transfusion – Related Acute Lung Injury
• Septic Transfusion Reaction
ACUTE TRANSFUSION REACTIONS
Symptoms you might see
during an AHTR include:
• Temperature increase of
more than 1˚C
• Bloody urine
• Chills
• Hypotension
ACUTE TRANSFUSION REACTIONS
• Severe low back, flank, or chest pain
• Low or absent urine output
• Nausea and vomiting
• Dyspnea, wheezing
• Anxiety, “sense of impending doom”
• Diaphoresis
• Generalized bleeding, especially from
punctures and surgical wounds.
WHAT TO DO WHEN TRANSFUSION REACTION OCCURS
T
ransfusion
…The Procedure
PREPARATION FOR
TRANSFUSION
Patient
Materials
Suitable Vein
Handling of Blood
MATERIALS NEEDED
ACTUAL TRANSFUSION PROCESS
Blood component
to be transfused
• Compatible BT set
• G 18 needle (only if needed)
PROCEDURE
• Plain NSS, IV set