Blood Transfusions
By Christina Baier, Crystal Davidson, Dayna Legge,
Christine Leblond, Jessica Luckett, and McKenzie Quevillion
Overview
 What is a blood transfusion?
 Purpose
 Indications
 Blood products
 Nursing implications
 Administering a blood
transfusion (skill)
What is a Blood Transfusion?
 Administration of blood or one of its
components through an intravenous line (IV)
 Reaches patient’s blood vessels and enters the
circulatory system
Purpose of a Blood Transfusion
 Restore blood volume
 Replace clotting factors
 Improve oxygen carrying capacity
 Restore blood elements that are depleted
 Prevent complications
Question
 What would indicate the need for a blood
transfusion?
Lab Tests
Lab Test
Type and crossmatch
Hbg (hemoglobin)
Hct
(hematocrit)
Platelet count
Normal Results
Based on ABO system
Positive = incompatibility
Negative = probable
compatibility
Male 140-175 g/L
Female 123-153 g/L
Critical Value:
Male <130 g/L
Female <110 g/L
Male 41.5%-50.4%
Female 25.9%-44.6%
Critical Value:
<18% or >54%
Why is this ordered?
To determine the primary blood group,
screen for antibodies and determine
donor-recipient compatibility.
150,000-400000 cells/uL
Critical Value:
<50,000 cells/uL
Platelets initiate the coagulation
process. A decreased amount increases
the risk for hemorrhage.
Hbg carries oxygen in the blood. It can
decrease due to blood loss.
Hct measures the proportion of blood
volume occupied by RBCs. It decreases
with blood loss and anemia.
Whole Blood
 Composition:
- Red Blood Cells
- White Blood Cells
- Plasma
- Platelets
- Hematocrit
- Clotting Factors
 Purpose:
- Volume replacement
- Increase oxygen-carrying capacity
 Indications:
- Significant blood loss (>25% blood lost, i.e. hemorrhage)
- Newborn babies with hemolytic disease
Packed Red Blood Cells (RBCs)
 Composition:
- RBCs with little plasma (hematocrit about 75%)
- Some platelets and WBCs remain
 Purpose:
- Increase RBC mass and oxygen-carrying capacity
- Assists the body to rid carbon dioxide and other waste products
 Indications:
- Symptomatic and chronic anemia
- Blood loss due to injury or surgery
Platelets
 Composition:
- Platelets
- Plasma
- RBCs
- WBCs
 Purpose:
- Helps to stop bleeding (restore clotting ability)
- Essential for coagulation of blood
 Indications:
- Decreased platelet count
- Hemophilia
- Thrombocytopenia
- Platelet dysfunction (End stage renal disease, DIC)
White Blood Cells (WBCs)
 Composition:
- WBCs or leukocytes suspended in 20% of the plasma
 Purpose:
- Increase number of WBC’s
- Replaces WBC’s that are functioning abnormally
 Indications:
- Sepsis (not responsive to antibiotics)
- Persistent fever
- Granulocytopenia
Fresh Frozen Plasma
 Composition:
- Plasma
- All coagulation factors
 Purpose:
- Increase blood plasma
- Replenish clotting factors
 Indications:
- Bleeding in patients with coagulation factor deficiencies;
plasmapheresis
- Burn
- Liver Failure
- Severe Infection
Albumin
 Composition:
- Albumin
 Purpose:
- Volume expansion leading to increased blood volume
 Indications:
- Hypoproteinemia
- Burns
- Shock
- Trauma
- Surgery
- Infections
Nursing Implications
Before transfusion:
 Check physician’s orders
 Review hospital policy
 Ensure informed and written consent is provided
 Check laboratory values
 Understand the indications and rationale
 Verification procedure occurs with
two nurses
Nursing Implications Con’t
Before transfusion (con’t):
 Compatibility of blood type and Rh factor
 Inspect the blood product for discolouration, clots, leaking, or




presence of bubbles
Check the unit number on the unit of blood and on the form
Check the expiration date and time on unit of blood
Ask client to state first and last name
Check patient’s identification number on wristband and record
Nursing Implications Con’t
During the transfusion:
 Monitor vital signs closely during the blood
transfusion
 Inspect condition of IV site
 Observe for signs and symptoms of a
reaction
Nursing Implications Con’t
After the transfusion:
 Dispose of materials/equipment
 Observe patient for clinical
improvements
 Assess the laboratory values for
effectiveness of transfusion
Documentation
 Verification procedure
 Type of blood
 Amount administered
 Vital signs
 Patient’s response to therapy
Acute haemolytic reaction
Mechanism
Onset
5-15 minutes
following
ABO, Rh
initiation of
incompatibility
blood
transfusion
Signs and Symptoms
Increased temperature, increased
heart rate, heat and pain surrounding
vein, chills, headache, nausea, chest
or back pain, chest tightness, dyspnea,
bronchospasm, hypotension, anxiety,
vascular collapse, hemoglobinemia,
hemoglobinuria, disseminated
intravascular coagulation
Delayed haemolytic reaction
Mechanism
Onset
Immune
response
against non- 2-14 days
ABO donor
antigens
Signs and Symptoms
Fever, decrease in Hgb/Hct, increased
bilirubin levels, jaundice
Febrile, nonhaemolytic reaction
Mechanism
Onset
Signs and Symptoms
30 minutes
Sensitivity to after initiation
leukocytes or to 6 hours
Fever, flushing, chills, headache,
platelets in
after
muscle pain
donor’s blood completion of
transfusion
Allergic reaction
Mechanism
Onset
5-15 minutes
Allergy to a
following
plasma
initiation of
protein or
blood
antigen in
transfusion, up
donor’s blood
to 1 hour after
Signs and Symptoms
Local erythema, gives, urticaria,
pruritus, coughing, nausea, vomiting,
respiratory distress, wheezing,
hypotension, loss of consciousness,
cardiac arrest
Graft-versus-host disease
Mechanism
Onset
Signs and Symptoms
Attack of
transfused
Skin rash, fever, jaundice, liver
lymphocytes Days to weeks dysfunction, bone marrow
on host
suppression
lymphocytes
Circulatory overload
Mechanism
Onset
Any time
Transfused at during or
an excessive within 1-2
volume or rate hours after
transfusion
Signs and Symptoms
Dyspnea, cough, crackles, tachypnea,
headache, hypertension, tachycardia,
increased central venous pressure,
distended neck veins
Sepsis
Mechanism
Onset
Signs and Symptoms
During
Bacterial
transfusion to Fever, chills, abdominal cramping,
contamination 2 hours after vomiting, diarrhea, hypotension
transfusion
Lab Tests
Lab Test
Antiglobulin (DAT)
Negative
Normal Results
Bilirubin
Indirect: 0.1-1.0 mg/dL
Urinary Hemosiderin
Negative
CBC (Complete Blood Count)
WBC 4.8-10.8 x10 9/L
RBC 4.2-5.4x10 12/L
HGB 120-160G/L
HCT 0.370-0.470
MCV 78-98 FL
MCH 25-24 PG
MCHC 320-360 G/L
RDW 0.110-0.150
Platelets 130-400 x10
MPV 7.0-11.0 FL
Lymphocyte 0.15-0.41 x10
Neutrophil 0.6-0.7 x10
Monocyte 0.06-0.41 x10
Esoinophil 0-0.04 x10
Basophil 0-0.2 x10
Luc 0-0.4 x10 9/L
Why is this ordered?
Direct use is for post transfusion work-up to detect RBC
incompatibility. Positive result = hemolytic transfusion
reaction.
An elevated indirect value may indicate ABO incompatibility.
Used to measure hemoglobin in urine resulting from
intravascular hemolysis. Positive reaction = blood transfusion
reaction.
To assess cellular characteristics of blood cells in response to
transfusion i.e. ABO compatibility through  WBC.
Nursing Implications in a Reaction
 Stop transfusion
 Remove tubing that contains blood product
 Infuse with 0.9% normal saline
 Monitor vital signs
 Notify physician
 Notify blood bank and return blood component
 Administer medication depending on type of reaction
 Epinephrine, antihistamines, antibiotics, antipyretics,
analgesics, diuretics, corticosteroids
Nursing Skill: Administering a
Blood Transfusion
Questions?
References
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