Platelets

White blood cells

BLOOD
A mixture of cells A complex TRANSPORT mechanism

Transports hormones Removes waste products Regulates body temperature

Protects the body

Promotes hemostasis Supplies oxygen

 BLOOD VOLUME:
8% of total body weight = varies by age & body composition

Category Adult Male Adult Female Child

mL/kg 70 mL/kg 70 mL/kg 80 mL/kg

Blood Volume 90 kg = 6300 mL 60 kg = 4200 mL 30 kg = 2400 mL

Blood Volume

Kilograms of Body Weight

Neonate

8590 mL/kg

3 kg = 255 270 mL

COMPOSITION OF BLOOD
Temperature pH Specific Gravity Body weight 5 times the viscosity of water Volume
Male Female

38C (100.4F) 7.35 - 7.45 1.048 1.066 7%

5 6 Liters 4 5 Liters

Portions of the Blood

PLASMA
PLATELETS
GRANULOCYTES

Composed of: 55% plasma 45% cellular components

Plasma = fluid portion Coagulation factors Inorganic substances Antibodies

RED BLOOD CELLS

Plasma
Liquid part of the blood
Consists of serum and fibrinogen Contains plasma proteins such as:
Albumin = regulates & maintains Serum globulins = for transportation Fibrinogen, prothrombin, plasminogen = to stop the bleeding

Cellular Components
Formed elements of blood
RBC = responsible for oxygen transport

WBC = play a major role in defense against microorganisms

Platelets = function in hemostasis

Blood: An Emotional Topic

the sweeping story of a substance that has been feared, revered, mythologized, and used in magic and medicine from earliest timesa substance that has become the center of a huge, secretive, and often dangerous worldwide commerce.
From the publishers description of the book

TRANSFUSION
Refers to the administration of any of several blood products.

BLOOD TRANSFUSION
Is lifesaving therapy for patients with a variety of medical and surgical conditions in need for blood.

Blood Transfusion may be necessary for any of the following reasons:

Hemorrhage (blood loss) caused by trauma or high blood loss surgery Red cell destruction

Decreased red cell production

National Blood Services Act of 1994

Also known as the Republic Act 7719 AN ACT PROMOTING VOLUNTARY BLOOD DONATION PROVIDING FOR AN ADEQUATE SUPPLY OF SAFE BLOOD, REGULATING BLOOD BANKS, AND PROVIDING PENALTIES FOR VIOLATION THEREOF.

Who CAN and CANT give Blood

Eligible Donors Must:
Be at least age 18 Weigh at least 110 lb (50 kg) Free from skin disease Not have donated in the past 56 days Have a hemoglobin level of at least 12.5 g/dl (women) or 13.5 g/dl (men)

 Ineligible Donors include those:

Who have HIV or AIDS Who have taken illegal drugs I.V. Who have had sex with prostitutes in the past 12 months Who have had sex with anyone above categories Who have had hepatitis With certain types of cancer (other than minor skin cancer) With hemophilia Who have received clotting factor concentrations

Blood Collection Methods

3 Types of Blood Donor Sources for Routine Blood Collection:
Unrelated Donor (Allogeneic) Directed Donor Autologous Donor (Self)

NURSES MUST BE:

Knowledgeable about blood products

Safe administration

How to monitor patients before, during and after therapy

NURSES MUST BE:

Assure that informed consent has been obtained before starting a transfusion. Appropriate information to include in patient education includes:
Benefits Risks Alternatives to transfusion

Document all patient education regarding transfusion therapy, and the responses of patients and family members after teaching.

Patient Education
Provide patient and family information to blood transfusion therapy:
The need for blood transfusion Advantages of blood transfusion Possible reactions related to the blood transfusion therapy Voluntary blood donation act

Transfusion Precautions
Dont add medications to the blood. Dont transfuse the blood product if you discover a discrepancy in the blood number, blood slip type, or patient identification number.

Dont piggyback blood into the port of an existing infusion set.

Stop transfusion if your patient shows:

Shows changes in vital signs

Is dyspneic or restless Develops chills, hematuria, or pain in the flank, chest or back

BEFORE TRANSFUSION
When assessing your patient before a transfusion:
Obtain important medical history information Review pertinent laboratory values
Review the doctors order, including any special processing requested

Perform physical assessment

 When you received the delivery from the blood bank, you should receive both the product and the transfusion record that corresponds to it. Inspect for the following: Labels

Integrity of Unit
Appearance

 Perform the verification process to ensure the correct blood is being given to the correct patient.
Two qualified individuals should verify the patient and unit identification. Assess the patency of the patients vascular access. Check and recheck vital signs 15 minutes after starting the transfusion.

DURING TRANSFUSION
Administer the blood or component at the recommended rate. Stay with the patient for the first few minutes of the transfusion
Review signs and symptoms of what the patient should report to you.

 Discontinue transfusion immediately once the patient manifest symptoms of transfusion reaction, assess the patient and notify the doctor.
Finally, document the transfusion in the patients chart.

AFTER TRANSFUSION
Continue to monitor patient for any signs and symptoms of reaction for at least one hour after the transfusion.

Obtain any ordered post-transfusion laboratory studies.

Blood Products Whole Blood

Indications

Nursing Considerations

To restore blood volume in hemorrhaging, trauma, or burn patients

PRBC

To restore or maintain oxygen carrying capacity To correct anemia and surgical blood loss

Dont infuse over more than 4 hours. Warm blood if giving a large quantity. Avoid giving when the patient cant tolerate the circulating volume. Dont infuse over more than 4 hours. RBCs have the same oxygen carrying capacity as whole blood, minimizing the hazard of volume overload.

Blood Products Platelets

Indications
To treat thrombocytopenia To treat acute leukemia and marrow aplasia

Nursing Considerations
ABO compatibility isnt necessary but is preferable with repeated platelet transfusions; Rh type match is preferred. Infuse 100 ml over 15 minutes. Administer at 150 to 200 ml / hour, or as rapidly as the patient can tolerate; dont exceed 4 hours. Avoid administering platelets when the patient has a fever. Cross matching: ABO compatibility isnt necessary but is preferable with repeated plasma transfusions; Rh type match is preferred. Large volume transfusions of FFP may require correction for hypocalcemia. Citric acid in FFP binds calcium.

FFP

To expand plasma volume To treat postsurgical hemorrhage or shock To correct an undetermined coagulation factor deficiency

SAFETY PRECAUTIONS
Make sure that YOU are protected too by:
Wear proper Personal Protective Equipment (PPE) Always perform disinfection technique. If possible, use a needleless system. If using sharps, do not recap the needle. Always observe proper waste disposal according to your institutions policy. If there are spills, never touch the blood with bare hands. Make sure that blood bag is secured. Always double or triple check. Always perform HAND HYGIENE

 Acute Transfusion Reactions usually appear within the first 5-15 minutes after the transfusion is started.

Types of Acute Transfusion Reactions:

Acute hemolytic Transfusion Reaction Febrile nonhemolytic Transfusion Reaction Mild allergic (Urticarial) Anapylactic Transfusion Associated Circulatory Overload Transfusion Related Acute Lung Injury Septic Transfusion Reaction

 Symptoms you might see during an acute transfusion reaction include:

Temperature increase of more than 1C or 2F Bloody urine Chills Hypotension 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 IF TRANSFUSION REACTION OCCURS

When they do occur, it is usually because of ABO incompatibility between patient and donor during transfusion of red cells.
Ensure that the intended recipient is getting the intended unit at the time of transfusion.

 Should any of these symptoms occur, discontinue the unit immediately, hang normal saline (on a new tubing) to maintain vascular access, and call for assistance. Closely monitor the patients vital signs and symptoms.

Notify the physician and obtain further orders to address the patients symptoms.
Recheck the patients identifying information against the transfusion record and blood bag. All bags, tubings, filters, and paperwork should be retained and forwarded per hospital policy.

DOCUMENTING BLOOD TRANSFUSIONS

Date and time the transfusion was started and completed Name of the health care professional who verified the information of the patient and the blood Catheter type and gauge Total amount of the transfusion Patients vital signs before and after the transfusion

 Infusion device used Flow rate and if blood warming was used Vital signs obtain prior to, during, and after the transfusion Name of the component, unit number Evidence of possible transfusion reaction.
Document interventions done and to whom you notified.

Patients outcome.