UNIT 8:BLOOD
TRANSFUSION
OBJECTIVE 1
DISCUSS
TREATMENT
WITH BLOOD
COMPONENTS
TRANSFUSION

Infusion of blood products for the purpose of
restoring circulating volume.
Increases the blood’s oxygen carrying capacity
 Reverses tissue hypoxia

Statistics
14 million units collected
 12 million administered
 60% eligible to donate, only 5% do


May be whole or components
Platelets
 Plasma
 PRBC
 Albumin

Administering Blood Products

Whole blood:
Most common blood product given in the
hospital
 Used to treat shock, low blood volumes, low
hematocrit and hemoglobin, hemorrhage


Packed RBCs:
Separated from plasma
 Used to treat anemia, and reduce risk of volume
overload
 FROM MY NURSING LAB

Administering Blood Products
Leukocyte-poor RBCs:

Most WBCs removed to reduce risk of reaction

FROM MY NURSING LAB
Administering Blood Products

Fresh frozen plasma (FFP): separated from
whole blood by a centrifuge process


Used to restore plasma volume, treat some
bleeding problems
Platelets
Maintain normal coagulability of blood
 Used to treat some bleeding disorders, and to
compensate when marrow can not produce
enough
 FROM MY NURSING LAB

Donation Guidelines

Per the American Red Cross, donor must:
Be healthy
 Be at least 17 y/o (16 y/o if allowed by state
law)
 Weigh at least 110 pounds
 Not have donated blood in the last 8 weeks


FROM MY NURSING LAB
Donation Guidelines

Individuals with the following are not
permitted to donate blood:
Fever
 High blood pressure
 Very high or very low pulse rate (with the
exception of highly conditioned athletes)
 Irregular heartbeat
 FROM MY NURSING LAB

Donation Procedures
Donation procedures use standard
precautions for both donor and phlebotomist
 Donor is asked to remain in a recumbent
position until s/he feels ready to sit up.
Blood banks typically offer donors both food
and fluids


FROM MY NURSING LAB
Donation Procedures

Donors are asked to:
Leave the dressing in place
 Avoid heavy lifting for several hours
 Increase fluid intake for 2 days
 Avoid alcoholic beverages for 3 hours
 Avoid smoking for 1 hour
 Eat healthy meals for 2 weeks
 FROM MY NURSING LAB

Complications of Donating
Excessive bleed at donor site
 Anginal chest pain



Can occur with those with CAD
Seizure

(rare but can occur with those with epilepsy)
Fainting : most common
 Hypotension
 Syncope

Blood Supply Safety
The FDA is responsible for ensuring the
safety of the blood supply in the United
States
 Once blood has been received from the
donor it is immediately tested for blood type
and infectious diseases


FROM MY NURSING LAB
Type and Crossmatch

Blood undergoes “type and crossmatch”:
Typing to determine ABO and Rh factor
 Crossmatching to determine compatibility
between donor and recipient blood
 FROM MY NURSING LAB


http://science.discovery.com/videos/100greatest-discoveries-shorts-the-beginningof-blood.html
ANTIGEN: is a substance that prompts the
generation of antibodies and can cause an
immune response
 ANTIBODY: are gamma globulin proteins
that are found in blood or other bodily fluids
of vertebrates, and are used by the immune
system to identify and neutralize foreign
objects, such as bacteria and viruses

4 types
A
B
 AB
O

Blood Typing

Most people have two related inherited
antigens – A and B – that form the basis for
the ABO blood typing
Individuals with A antigen have type A blood
 Individuals with B antigen have type B blood
 Individuals with both A and B have type AB
blood
 Individuals with neither antigen have type O
blood
 FROM MY NURSING LAB

Blood Typing

Antibodies with each blood type:
Blood type A: Has B antibodies
 Blood type B: Has A antibodies
 Blood type AB: Has no antibodies
 Blood type O: Has both antibodies


FROM MY NURSING LAB
Blood Typing

The Rh factor is made up of numerous
complex antigens

When it is present, the person is Rh positive
(Rh+); if not present, the person is Rh negative
(Rh–)

FROM MY NURSING LAB
Blood Typing
An Rh positive person may receive either –
or + blood
 An Rh negative person must receive only
Rh– blood

If an Rh– person receives Rh+ blood,
antibodies will form
 If another transfusion of Rh+ blood is given, the
antibodies will agglutinate with the Rh antigens
of the blood being transfused
 FROM MY NURSING LAB

Blood compatibilities
Blood typing for transfusion

Universal donor= O

Universal recipients= AB+


Does not contain A, B, or Rh antigens
Blood contains A, B, and RH antigens
Usually blood banks exactly match the pt
blood
products

PRBCs: 250-300ml/unit infuse over 2-4 hours

Platelets: 80-60ml/pack: usually 4-6 packs are
pooled for transfusion infuse as quickly as the pt
tolerates

FFP: 180-270ml/unit infuse in less than 4 hours

Cryoprecipitate:10-15ml/bag; usually 10 bags are
pooled for transfusion infuse in less than 4 hours
(contains factor 1 and 8)
Blood Screening
Prior to be being released for patient use
 NAT blood screening detects minute
amounts of the RNA and DNA of specific
viruses
 NAT testing has been FDA-approved for:

Hepatitis C
 Human immunodeficiency virus (HIV)
 West Nile virus
 FROM MY NURSING LAB

OBJECTIVE 2
DEMONSTRATE
SAFE
NURSING INTERVENTIONS
IN BLOOD TRANSFUSIONS
PT EDUCATION
EXPLAIN RISKS AND BENEFITS
 WHAT TO EXPECT
 WHAT SIGNS/SYMPTOMS TO LOOK FOR
 Discuss possible alternatives if unable to
accept donation


What Religion will not accept transfusions?

JEHOVIAH WITNESS
Other Alternatives

Volume Builders
Crystalloids
 Artificial Crystalloids

 Dextran



for example
May cause bleed problems or allergic reactions
THEY ONLY REPLACE VOLUME
DONATIONS

Autologous
 Predonation

by the client themselves
Client will donate blood 1 unit/week for 3-4 weeks taking FE
and/or EPO
Infusion Therapy Risks

Risk factors:
 Disease transmission
 Hepatitis B 1:140,000
 Hepatitis C 1: 225,000
 Hepatitis A 1:1 million
 HIV 1: 1.5 million
 Syphillis 1: 1 million
 Bacterial contamination
 Acute or delayed transfusion reactions
 Mismatched ABO 1: 35,000
 Incompatible Death Rate 1:600,000
 Circulatory overload
Infusion Therapy Risks

Risk factors:
Disease transmission
 Bacterial contamination
 Acute or delayed transfusion reactions
 Circulatory overload


FROM MY NURSING LAB
Infusion Therapy Risks
Each unit of blood currently undergoes tests
for nine diseases
 Bacterial contamination is very rare, but may
occur at any point



Refrigeration helps prevent bacterial growth
Transfusion reactions

Allergic reactions, incompatibilities, anaphylactic
response to plasma proteins

FROM MY NURSING LAB
Infusion Therapy Hazards

Some risks specific to massive transfusion
(replacement of > one blood volume in 24
hours):




Hypothermia
Hemodilution
Platelet dysfunction
Electrolyte problems
 BUT WHICH ONES???




Calcium toxicity: LOW
Iron overload
http://www.youtube.com/watch?v=ctg44Z_4Z6M
FROM MY NURSING LAB
Infusion Therapy Risks

Noninfectious Serious Hazards
Mistransfusion and ABO/Rh incompatibility
 Cardiopulmonary toxicity/circulatory overload
 Transfusion-related graft-vs.-host disease
 Transfusion-related acute lung injury
 Metabolic derangements in pediatric and
massive transfusion
 Undertransfusion
 FROM MY NURSING LAB

ADMINISTRATION PROCESS

ASSESS Transfusion history
Previous transfusions, allergies and reactions
 Type of transfusion reaction, manifestations,
and treatment


GET SET OF BASELINE VITALS
Interventions
Once the blood has been taken from the
blood bank, it must be administered within
30 minutes
 The nurse must ensure:

Positive patient identification
 Appropriateness of blood component
 Blood product inspection
 Verification of donor – recipient compatibility
 Verification of product expiration date

adminstration on blood


Pt needs 18 or 20 gauge IV needle so cells are not lysed
(destroyed)
Prior to administration, blood needs to be checked by 2
licensed nurses. Check the expiration date, name,
medical record number, type of blood, blood band id, pt
birthday
 Check vitals prior to administration

**blood must be initiated with in 30 minutes
of arrival from lab to floor

Use blood tubing for administration
Monitor for blood reactions
Monitor vitals continuously during administration


Figure 23.1 Y-type blood
tubing.
From My Nursing Lab
Figure 23.2 Sample blood administration record fromMy Nursing Lab
OBJECTIVE 3

ASSESS TRANSFUSION REACTIONS
AND SAFE INTERVENTIONS
Chart 23-6 (continued) Transfusion Reactions from My Nursing Lab
RX continued

Circulatory overload: dyspnea, tachycardia, cough,
frothy sputum, cyanosis, increased BP that drops
suddenly, distended neck veins, crackles

High risk are elderly and those with history of CHF
cardio system is unable to manage the
additional fluid load
 Occurs anytime during transfusion and up to
several hours after completion

 Occurs

if infusing too rapidly or too much quantity
Tx: stop infusion, call for help, be prepared for
code, be prepared to administer oxygen and
Lasix
The END
CRITICAL THINKING





You as the nurse are administering a PRBCs to a
client. Baseline vitals are HR72 RR16 BP125/78
and 99.2F. After 1 hour when you take the vitals
you find 100.8F and 90/50 for the BP. What might
the client be experiencing?
A. Septicemia
B. Iron Overload
C. Circulatory Overload
D. Delayed Transfusion Reaction
Answer

Septicemia