Adult Health Nursing II
Block 7.0
Blood Products and Blood
Transfusions
Adult Health II Block 7.0
University of Southern Nevada
Block 7.0 Module 1.3
Learning Outcomes
• Discuss various blood components
• Distinguish between various blood types
• Compare and contrast indications for various
types of blood transfusions
• Describe nursing responsibilities prior, during,
and post blood transfusion
• Prioritize plan of care for clients experiencing
transfusion reactions and complications
Block 7.0 Module 1.3
Blood Components
• Packed Red Cells- Anemia, Hg <6-10g/dl
• Platelets- Thrombocytopenia, Plt count < 80,000
• Fresh Frozen Plasma- Deficiency in coagulation
factors, PT or PTT 1.5 times normal
• Cryoprecipitate- Sepsis, neutropenic infection not
responding to antibiotic therapy, clotting problems,
usually given IV push over a few minutes
• Albumin- Replace for low albumin
• Whole Blood-Traumatic injuries, extensive burns,
dehydration, shock
Block 7.0 Module 1.3
Albumin
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Expands circulating volume
Used to Treat:
Hypovolemia
Burns
Adult Respiratory Distress
Severe Nephrosis
Cirrhosis
Block 7.0 Module 1.3
Albumin and Nursing Considerations
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Monitor Vital Signs
Monitor Central Venous Pressure
Assess Respiratory Status for Overload
Must be given IV
Assess Lab Values- Look for an increase in the
albumin level after transfusion
• Assess edema
Block 7.0 Module 1.3
Blood Types-ABO System
• Blood Type is based on the presence of
antigens
• Must check for compatibility to prevent any
reaction
• A antigen= Type A blood type
• B antigen=Type B blood type
• Both A and B antigens=Type AB blood type
• Neither A nor B antigen = Type O blood type
Block 7.0 Module 1.3
Blood Types
• Within the first few years of life circulating antibodies
develop against the blood type antigens that person
did not inherit
• EX: A person born with/inherited Type A blood forms
antibodies against Type B blood, a person born with/inherited
• Type O blood has not ‘inherited’ either A or B antigens and will form
antibodies against RBCs with either A or B antigens.
• If RBCs that have an antigen are infused in a person who does not share
that antigen a reaction can occur.
Block 7.0 Module 1.3
Blood Types and Compatibility
Blood Type
Antigen
Antibody
Compatible
With:
A
A
B
A,O
B
B
A
B,O
AB
AB
O
A, B, AB, O
O
O
A,B
O
Block 7.0 Module 1.3
Rh Factor
• Rh system is different than ABO system
• An Rh negative person is born without the Rh antigen, and does
not form antibodies unless exposed to the antigen
• Exposure can occur if the person receives Rh positive blood or
exposure during pregnancy/birth
• Once an Rh negative person is exposed, any contact with Rh
positive blood will trigger a reaction
• NOTE: An Rh+ person can receive blood from a Rh negative
donor, but Rh negative people should not receive Rh+ blood
• Therefore: O- is the universal donor and AB+ is the universal
recipient
Block 7.0 Module 1.3
Blood Transfusions
• Types:
• Transfusions from blood donors
• Autologous- Client’s own blood is collected
and used for an elective surgery. Only can be
used by the client.
• Intra-operative- Blood loss during surgery is
collected through a “cell saver” machine and
re-transfused to client during procedure or for
a set # of hours after a procedure.
Block 7.0 Module 1.3
Indications for Transfusions
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Excessive blood loss- Trauma, Surgeries
Anemia
Chronic Renal Failure
Coagulation Deficiencies
Thrombocytopenia
Block 7.0 Module 1.3
Transfusion Procedure
• Nursing Considerations and Actions for
transfusions are pre-transfusion, during the
transfusion, and post-transfusion
• I would know this if I were you 
Block 7.0 Module 1.3
Pre –Transfusion (Prior)
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Assess lab values- Hg, Hct, Albumin, PT, PTT
Verify order for blood transfusion
Obtain Type and Crossmatch (ABO/Rh)
Obtain patient consent
Initiate IV (large bore usually #20 minimum or larger)
Always use Y-connector tubing (comes with a filter)
Always use Normal Saline (.9NS) for transfusion
Always use a pump for controlled infusion time
Block 7.0 Module 1.3
Pre-Transfusion (Prior)
• Obtain baseline vital signs- Especially temp.
• Assess patient history to see if patient has
ever had a reaction to blood
• Obtain blood from blood bank- Check bag
• 2 nurse verification- Match patient ID band to
blood bag and slip for name, record number,
blood type, blood unit number, expiration
date and DOCUMENT on the blood slip
Block 7.0 Module 1.3
During the Transfusion
• Remain with patient during the first 15-30
minutes of the transfusion- Hemolysis
• Infuse at prescribed rate- Assess for overload
• Monitor vital signs (per agency policy)
• Notify primary care provider immediately for
any signs of reaction
Block 7.0 Module 1.3
Post Transfusion
• Obtain vital signs and chart them on the blood
slip
• Dispose of the blood administration bag and
tubing per agency protocol…usually in
biohazard waste.
• Reassess lab values- Hg should rise 1gm/dl
with every unit transfused.
Block 7.0 Module 1.3
Blood Transfusion Absolutes!!!
• Must ALWAYS be administered with Normal
Saline (NS)
• NEVER mix blood with any medications or
administer medications through blood line
• As a nursing student you may NOT be a cosigner for blood transfusion administration
• Infusion time (1 unit) should not exceed 4
hours
Block 7.0 Module 1.3
Client Education
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Explain procedure and process
Explain indication for transfusion
Explain complications
Allow client time to ask questions
Assess understanding
Obtain consent
Block 7.0 Module 1.3
Cultural Considerations
• Some clients of certain faiths or cultures will
not accept blood transfusions.
• Autologous transfusions may be an alternative
• Must respect and accept these clients’ wishes
Block 7.0 Module 1.3
Older Populations
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Assess circulatory, renal, fluid status
Higher risk for circulatory overload and CHF
Use no larger than a 19 gauge needle
Monitor vital signs paying particular attention
to heart rate, BP, and respirations
• Lower rates of transfusion- Normal transfusion
time is 2 hours but may need to transfuse over
4 hours
Block 7.0 Module 1.3
Transfusion Reactions
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Acute Hemolytic
Febrile
Mild Allergic
Anaphylactic
Circulatory Overload
Block 7.0 Module 1.3
Acute Hemolytic
• Onset
IMMEDIATE!!
• Etiology
Blood Type or Rh
incompatibility
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Signs and Symptoms:
Chills, Fever,
Low Back Pain
Tachycardia, Tachypnea
Chest Tightening or Pain
Anxiety, “Impending Doom”
Complications:
Cardiovascular Collapse
Renal Failure
DIC, Shock, and Death
Block 7.0 Module 1.3
Febrile
• Onset:
• 30 minutes- 6 hours
after transfusion
• Etiology:
Most often in clients
with anti-WBC
antibodies usually
developed after
multiple transfusions
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Signs and Symptoms:
Chills, Fever, Flushing
Headache
Anxiety
Block 7.0 Module 1.3
Mild Allergic
• Onset:
• During or up to 24
hours after transfusion
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Signs and Symptoms:
Itching
Urticaria
Flushing
Block 7.0 Module 1.3
Anaphylactic
• Onset:
IMMEDIATE!!!!
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Signs and Symptoms:
Wheezing
Dyspnea
Chest Tightness
Cyanosis
Hypotension
Feeling of Throat
Closing
Block 7.0 Module 1.3
Nursing Care of Transfusion Reactions
nurse
• STOP TRANSFUSION
IMMEDIATELY
• Start a saline infusion using a
separate IV line
nurse
• Save the blood bag with the
remaining blood and IV tubing
• Notify primary care provider
• Acute Hemolyic
nurse
• Monitor Vital Signs, I & O
• Oxygen PRN
Block 7.0 Module 1.3
Nursing Care of Transfusion Reactions
• Febrile
Nurse
Nurse
Nurse
• STOP TRANSFUSION
• Administer antipyretics
• Use white blood cell filters
• Notify primary care provider
• Complete transfusion reaction form per
policy
• May resume transfusion if symptoms
resolve
Block 7.0 Module 1.3
Nursing Care of Transfusion Reactions
• Mild Allergic
nurse
• Administer Antihistamines
• Administer leukocyte reduced or
“washed” RBCs
nurse
• Symptomatic- Stop transfusion
• Asymptomatic- may slow down and
continue transfusion
nurse
Block 7.0 Module 1.3
Nursing Care of Transfusion Reactions
Anaphylactic
STOP TRANSFUSION
IMMEDIATELY!!!
AND CALL PCP
MAINTAIN AIRWAY
ADMINISTER O2
IV FLUIDS
Block 7.0 Module 1.3
ANTIHISTAMINES
CORTICOSTEROIDS
VASOPRESSORS
Circulatory Overload
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Signs and Symptoms
Dyspnea
Chest Tightness
Tachycardia
Tachypnea
JVD
Peripheral Edema
Sudden Anxiety
Crackles at lung bases
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Nursing Care
SLOW THE RATE
Administer O2
Monitor Vital Signs
Notify PCP
Block 7.0 Module 1.3