BLOOD TRANSFUSION AND ITS NURSING

MANAGEMENT​
PRESENTED BY
NURSE FADARE A.F
Definition

Blood transfusion is the process of transferring blood products into

a person's circulation intravenously.

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Blood group and Genotype

The main difference between blood group and genotype is that

blood group constitutes the different kinds of blood found in
humans, governed by different antigens found on the surface of
the RBCs (red blood cells). ​
On the other hand, genotype forms the genetic constituency of
cells in humans

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​
Blood group
• The absence or presence of antibodies and inherited antigenic
particles on the surface of RBCs leads to the classification of blood
into different blood groups​
• Carbohydrates, proteins, and glycoproteins are the antigens based
on the blood group system​
• A few of these antigens are found on the surface of the other cell
types of different tissues

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Genotype

• It makes up for the genetic constitution of an individual – the genetic

makeup of an entity​
• One’s genotype makes up for the entire heritable genetic identity –
the genes transferred from the parent to the offspring​
• The RBCs (red blood cells) involved in determining the genotype of
humans​

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Blood group​ Genotype​
What are they?​
Refers to different human blood types determined by It makes up for the genetic makeup of a cell​
different antigens found on the surface of the RBCs​

Occurrence​
Found outside RBCs​ Found in every cell​
What is the phenotype?​
There are 8 phenotypes of blood groups – A-Positive, B- There are 6 phenotypes – AA, AC, AS, CC, SC, and SS​
Positive, A-Negative, B-Negative, AB-Positive, AB-Negative, O-
Positive, and O-Negative​

How are they determined?​

By absence or presence of antigens on the surface of the By amino acid sequences of haemoglobin in RBCs​
RBCs​
What traits does it control?​
Governs traits of RBC type only​ Governs all the characters that are observed​
Example​
A type, O type, AB type, B type, etc​ Height, hair colour, eye colour, etc. – those traits controlled
by single genes​

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 Blood Products used for transfusion
•Packed Cells (PRBC's)​
•Whole blood​
•Fresh frozen Plasma (FFP)​
•Platelets​
•Albumin
Packed Red Blood Cells

• Packed red blood cells (PRBCs) are made from a unit of whole
blood by centrifugation and removal of most of the plasma,
leaving a unit with a hematocrit of about 60%. ​
• PRBC's are used when the client is in need of increased
oxygen transporting red blood cells as may occur post
operatively and with an acute hemorrhage.

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Fresh Frozen Plasma
Fresh frozen plasma FFP, which does not contain any red
blood cells, contains all factors of the soluble coagulation
system.​
It is administered to clients who are in need of clotting
factors or are in need of increased blood volume as occurs
with hypovolemia and hypovolemic shock. Fresh frozen
plasma does not have to be typed and cross matched to the
client's blood type because plasma does not contain
antigen carrying red blood cells.
Platelets

A single platelet unit is derived from one whole blood unit

collected. Platelets are stored at room temperature and CANNOT
be frozen. They must be used in 5 days.

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Whole Blood

Whole blood (WB) is preferred for resuscitation of severe

traumatic hemorrhage. WB has RBCs for oxygen delivery, but also
contains coagulation factors and platelets more concentrated
than in separately transfused components. ​

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Albumin

Albumin is administered to clients who need expanded blood

volume and/or plasma proteins.

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 LAGOON HOSPITAL POLICIES FOR BLOOD
TRANSFUSION

Consent before a Blood transfusion​

The Medical officer should get an informed consent before a

blood transfusion and the information should:​
• Explain the need for a blood transfusion​
• Discuss if there are any alternatives​
• Explain potential risks or complications associated with
the transfusion.
• The instruction for the blood or blood component must be a
complete note that specifies exactly what will be administered.​
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Nursing roles before Blood Transfusion​
1. Check the physician's instructions with the requisition in
patient’s
medical record.
Note specific signs related to the client's pathology and
reason for transfusion (e.g. an anaemic client, note the
haemoglobin level less than 10g/L).

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Nursing roles before Blood Transfusion​

2. Obtain the correct blood component for the patient from the
laboratory using a blood bag.
Check the requisition form and the blood bag label, and
specially, the patient name, identification hospital number,
blood type and Rh group the blood donor number, and the
expiration date of blood.

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3. Identify patient​
Two nurses, doctors or a nurse and doctor should verify using
the blood transfusion checklist, sign before setting up the
blood. The content of the checklist include but not limited to
the following;
• The number on the blood bag corresponds with that on the
compatibility form
• Visually inspect the blood for any unusual color, precipitate,
clumping, gas bubbles cloudiness, clots and excess air
• Check the client's blood type against the type of blood that
will be infused, check the expiration of the blood.
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4. Checking the patient for appropriate venous access

The nurse must insure that the intravenous line is patent and
they must ensure that a 18 or 20 gauge catheter is being used
and patent.​
5. The Intravenous Giving set should be appropriate for
the Blood Product​
If a blood filter is used, for example in a blood transfusion giving
set, the filter must be inspected to insure that it is suitable
for the specific blood product that the client will be getting.
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6. Vital Signs
The nurse must take baseline vital signs just prior to the infusion
of blood or a blood product and record vitals in the blood transfusion
monitoring form.
7. Determine any known allergies or previous adverse reaction to
blood.

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NOTE

Make sure that the blood is not left at room temperature for no
more than 30 minutes before starting the transfusion. If the
transfusion is not commenced within 30 minutes, return blood
to the blood bank.

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During Blood Transfusion
Documenting the necessary information on the
administration of blood Products​
• This documentation must minimally include:​
• The date and time that the blood transfusion began​
• The name of the second nurse who did the two person
verification process​
• The name and amount of the specific type of transfusion such as
1 unit of packed red cells​
• The number of the blood product​
• The duration of the transfusion​
• The vital signs that were taken and when they were taken​​
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Transfusion reaction
• Transfusion reaction can be categorized as haemolytic, febrile,
circulatory over load and allergic. The nurse must assess a client closely
for reactions. Sign of an acute reaction include sudden chills or fever,
low back pain, drop in blood pressure, nausea, flushing agitation or
respiratory disorders. Sign of less severe allergic reaction include hives
and itching but no fever.

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 Nursing Management for Transfusion Reaction

• Stop the transfusion.

• Maintain the intravenous line with normal saline solution through new
intravenous tubing, administered at a slow rate.
• Asses the patient carefully, compare the vital sign with those
from the base line assessment.
• Notify the physician of the assessment findings and implement any
instructions obtained.
• Notify the blood bank that a suspected transfusion reaction has
occurred.
• Send the blood container and tubing to the blood bank for repeat
grouping and cross matching, the identifying tag and number are
verified. 23
 Post Transfusion
• Obtain vital sign and compare with base line assessment.
• Document procedure in patient's medical record using the
• nursing care plan to include finding and tolerance to the
• procedure.
• Monitor patient for response to and effectiveness of the
• procedure.
• Terminate the transfusion
• Discard administration set according to policy procedure

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