Module 2 – Blood Transfusion
Introduction
You will need to be competent in all
areas of blood transfusion prior to
becoming a PRHO; This module will
direct your learning but it is up to you
to put the knowledge and skills into
practice. The skills should be
attempted in a skills centre before
being practiced in the clinical setting.
Aims and Objectives
This module is designed to direct your learning around the
knowledge and skills associated with blood transfusion
By the end of this module students should be
• Aware of the ‘when, where, why and who’ of blood
transfusion
• Aware of the steps necessary to order a blood transfusion
and the common reasons why this process fails
• Able to write up a blood transfusion
• Able to set up a blood transfusion
• Aware of the common complications of blood transfusion
and their treatments
• Calculate the required drip rate for a unit of blood
Challenging Knowledge - I
For each of the following patients list:(a) If you would transfuse them and
(b) How many units you would give them, if any.
(c) What other investigations would you order; What further management
would you think about
(1)
(2)
(3)
(4)
(5)
23 yo asymptomatic, healthy woman with menorrhagia - Hb 8.9
g/dl, MCV 73fl
86 yo asymptomatic man with occasional angina – Hb 9.6 g/dl,
MCV 104fl
61 yo man with severe gram negative sepsis – Hb 7.0 g/dl, MCV
81fl
54 yo woman post hemicolectomy Hb 8.3g/dl, MCV 84fl
73 yo man presenting with acute upper GI bleed; BP 80/60, Pulse
120 thready – Hb 8.0 g/dl, MCV 101fl
Patient
Hb
(g/dl)
MCV
(fl)
Transfusion
Other Treatment
23yo female
Menorrhagia leading to
iron deficiency anemia
8.9
73
No transfusion
FeSO4
Investigate if severe
86yo male
Macrocytic anaemia
9.6
104
No transfusion
Investigate for macrocytosis
Drugs, Alcohol,
Hypothyroidism, Haemolysis
61yo male
Severe G negative
sepsis leading to
normocytic anaemia
7.0
81
Transfuse 2 -3 units
initially
Treat severe sepsis –
ceftazidine and gentamicin
54yo female
Post-operative
normocytic anaemia
8.3
84
No transfusion
FeSO4
Re-check Hb to ensure no
further drop
73yo male
Macrocyosis probably
alcohol related with ?
Varicael bleed
7.9
101
Transfusion –
Xmatch 6 units;
Resuscitate
Urgent OGD: May also have
coagulpathy and
thrombocytopaenia
Challenging Knowledge II
Before attempting the skills in this module List the steps you would take
• In order to cross match a patient for a blood
transfusion
• To set up a blood transfusion
• List the common complications of a blood
transfusion and their treatment.
Blood and Blood Product Transfusion
You should be familiar with each of these blood products.
What are their indications and the complications
associated with them?
•
•
•
•
•
Whole Blood
Packed Cells
Platelets
Fresh Frozen Plasma (FFP)
Cryoprecipitate
The Principle Aims of
Blood Transfusion are to:(1) Improve oxygen carrying
capacity of blood.
(2) Symptomatic
improvement.
(3)
Reduce hypovolaemia.
•
1 UNIT of Blood should
increase the Hb by
approx.1g/dL.
•
If no improvement or
reduction in Hb – think
about ongoing blood loss
or destruction.
•
You need treat the
underlying cause.
Blood Transfusion Indications - I
The Sanguis Study, 1994
• No consensus on who, when, where and why
to transfuse a patient
• A lot of variation in practice – dependent
mainly on the individual clinician ordering the
transfusion
• ‘Strong suggestion that inappropriate use is
widespread’
Indications for Blood Transfusion
Acute Anaemia
(1) Symptomatic hypovolaemia and blood
loss.
(2) Peri-operative – ‘replacing losses’
(3) Haemolysis (treat the underlying cause)
(4) Severe, critical illness.
Blood Transfusion Indications - II
Acute Anaemia
•
Increase oxygen carrying capacity of blood
- Young adults can tolerate 30 – 40% volume loss
with adequate crystalloid replacement alone
- Weiskopf et al (1988) – Euvolaemic anaemia in
healthy volunteers (and patients) down to Hb
≥5g/dL (!) – No demonstrable inadequate tissue
oxygenation
- I.e. Only for symptomatic hypovolaemia
‘Keep the Hb ≥ 10 g/ dL’
(2) Peri -operative
• Much quoted by Surgeons still - ‘Keep the Hb ≥ 10 g/
dL
BUT
• Carson et al (1988); Stehling & Simon (1994)
Patients tolerated Hb 8 – 10 g/dL
No patients died with Hb ≥ 8g /dL and ≤ 500ml blood
loss
No data on morbidity ? Healing / recovery etc
Severe illness – Expensive Scare
(3) Severe and critical illness
• Oxygen delivery is dependent on:
(a) Cardiac output (c.o.)
(b) Oxygen content of blood
• However there is very little change in C.O. until Hb ≤
7 g/dL.
• Herbert et al, 1999 – recommended this was the level
taken for transfusion in the critically ill unless other
factors were present.
Recommendations for Transfusion
• Bracey et al, 1999
≤ 9 g/dL – CABG operation
≤ 8 g/ dL – Symptomatic anaemia and blood
loss
≤ 7g/dL – Critically ill (Herbert et al)
But: on-going and further blood loss must be
taken into consideration as must the clinical
situation and co-morbidity!
Pale Mrs McPale – Hb ‘Unmeasurable’
Chronic Anaemia
• Transfuse according to
- Symptoms
- Co-morbidities
- Level of Activity
• Correct underlying cause and deficiencies
• ‘Beware the ‘well patient’ with the macrocytic
anaemia, Hb of 2g/dL – ‘Slowly down – Slowly up’;
Remember their blood may be ‘see through’ but they
are essentially euvolaemic. A large, rapid transfusion
will cause fluid overload and pulmonary oedema.
Conclusions
Acute Anaemia
• Treat Patient according to situation
- Co-morbidities
- Symptoms
- Cause of the Anaemia
- Severity and likelihood of re-bleed
Red Cell Transfusion SHOULD not be solely used as a
‘plasma expander’ – but primarily as a method to
increase oxygen carrying capacity.
Pre – Transfusion Considerations
• Does the patient need the transfusion?
• Does the patient want the transfusion?
- Verbal consent
- ? Soon to be written consent
• Cross match vs Group and Save?
• How many units to Cross? (As opposed to
many rivers to cross (ho ho))
• When to re-cross in active bleeding
• Local haematology policies
Does the patient need the transfusion?
Yes:
• Symptomatic anaemia
• Significant blood loss
• Anaemia / severe illness
• Improving Oxygen capacity of the blood
No:
• Asymptomatic Hb ≥ 8 g/dL
• ‘Well’ patient receiving alternative therapies –
EPO or Iron
• ‘Euvolaemic’ Anaemia secondary to B12 and
folate deficiencies
Does the patient want the transfusion?
• Consent
- Recommended to obtain verbal consent from every
patient; ?Soon to be written.
• Need to discuss:
- Indication; Benefits
- Risks - Infectious incidence HIV
-
1per 3x 106
HBV 1per2 x 105
Non Infectious e.g. Transfusion reaction
- Patient’s right to refuse transfusion e.g. Jehovah’s
witnesses, has to be respected if decision made when
competent.
- Most hospitals now have Blood Transfusion nurse
specialist to assist with these issues.
Requesting Blood and Blood Products
• Bureaucratic errors are the commonest
cause of blood transfusion problems –
DON’T BE A STASTISTIC!
• Requests will not (and should not) be processed if any of
the following stages are missed or are wrong.
(a) Request Form details
(b) Blood bottle details
(c) No patient wrist band or missed details on the band (If
phlebotomist is taking the blood).
Write up the Blood Transfusion Cross match
request using the form provided
Mrs Kathy Lawrence is a 79yo woman with
myelodysplasia. She has been re-admitted with
a symptomatic anaemia, Hb 4.9 g/dl, MCV 87.
Please write a request form for her cross match
using the form provided.
Hospital number 213436; DOB 13/09/24; Turner
ward; Multiple transfusions over the last 6
months; Blood group A Rh +; No known
antibodies; Four pregnancies
Patient Details required – apply within
Patient Details required on form
• Full names
• DOB
• Hospital Number
• Location
• Blood Group (if known)
• Previous transfusion and obstetric history
Transfusion details
• Reason for request; Present Hb (if known)
• Location, Date and Time of expected transfusion
• Date of request
• Type of blood (Packed cells, whole blood, G&S only); Number of units.
Doctor Details
• Name, Bleep number and Signature of person requesting the blood
LABELS ARE NEVER ALLOWED ON THE
FORMS OR THE BOTTLES
Sample Collection – No magazines available
• Check patient details on wrist band vs form.
• Use Pink cross match bottle (In use nationally)
• Details required on Blood bottle
- Full names of patient
- DOB; Gender; Hospital number
- Signature of person taking blood
- Date and Location
• Take blood bottle down to the blood bank if required
urgently – you will also meet the cross match team
(essential when you need a favour) and where the blood
fridge is situated.
PATIENT LABELS WILL NOT BE ACCEPTED!
Setting up the Transfusion
• Units of blood are stored in the ‘blood
bank’ fridge or theatre fridge.
• You will need all the patient’s details
prior to going to collect any blood
products
• Check details of blood report form
against unit of blood.
[Do not accept any wrong or missing
details]
• You will need to sign for the unit in
blood bank register; The responsibility is
therefore yours!
• Start transfusion within 30 minutes of
blood being removed from the fridge.
• This picture is for those that have never
seen a fridge!
The Ian Wright,
Wright ,Wright
Rule
The Right Blood,
The Right Patient,
The Right Time!
Why can’t you use
this unit of blood
unless you are a Vet?
Cross Match or Group and Save
(G&S)
• Guides (particularly for major surgical
procedures) are available in most hospitals.
• Most haematology labs can cross match
blood in 20 minutes.
• Cross match when
(a) Significant, on-going or potential
significant blood loss
(b) Severe symptomatic anaemia or illness
Prescribing Blood Transfusion
Please write up the a four unit blood transfusion
for Mrs Lawrence using the fluid chart supplied.
The correct format is shown on the next slide.
Why do we give frusemide?
What is the slowest rate of transfusing a unit of
blood?
Ward: Turner
Hospital No:213436
Consultant: Feather
Name; Kathy Lawrence
DOB: 13/09/24
Weight
Date
Central or
peripheral
line
Type of
Infusion Fluid
Volume of
Infusion Fluid
(ml)
Drug to be
added
Total dose
in bag
Infusion
Rate
04.06.04
P
Blood
1 unit
4 hours
P
Blood
1 unit
4 hours
P
Frusemide
IV 40mg
P
Blood
1 unit
4 hours
P
Blood
1 unit
4 hours
P
Frusemide
IV 40mg
After fourth
unit
P
N. Saline
100ml
To flush the
line
After second
unit
20
minutes
Doctor’s
signature
Setting up a transfusion
• Prescribe Transfusion on IV chart
- State units to be given
- Rate of each unit (slowest approx 4 hours)
- Give saline (100ml+) before (to keep
cannula ‘open’) and after transfused units to
‘wash through’ the line.
- Frusemide (40mg) is often given with each
or every other unit (IV or PO) to stop
potential fluid overload. Not required when
patient is hypovolaemic
- All patient details MUST be correctly
charted.
Blood Transfusion
• It takes TWO to check details of blood unit
• Check details on the unit of blood against
those written on the form against patient’s
wrist band. ALL MUST BE CORRECT!
(Recent advance = bar code devices)
• DO NOT PUT UP UNITS WHICH YOU
ARE NOT HAPPY ABOUT!
• Check any queries with the laboratory or the
haematologist on-call.
Blood Transfusion - Procedure
• Introduce yourself to the patient
• Check patient understanding and ensure they are happy to receive
blood transfusion
• Gain verbal consent
• Ensure patient has venous access – will need to site cannula if no
access present!
• Check equipment – Correct unit of blood and blood giving set
• With a partner – check unit of blood details against transfusion slip
• Check patient details against blood unit.
• Puts on gloves
• Attach unit of blood to giving set and run through blood correctly
• Aseptically attach blood giving set to cannula; Secure the giving set
and cannula with bandaging.
• Ensure blood is flowing and set at correct rate
• Inform nurses blood is running and to make sure routine observations
are made.
Setting up the transfusion
To set up a transfusion
(1) Two people to check
details
(2) Blood transfusion report
form; Unit(s) of blood
(3) Patient with IV access (!)
and wrist id band
(4) Sterile blood giving set
Blood Transfusion - Acute Complications I
Complication
Cause
Incidence / Likely timing with
regard transfusion
Treatment
Acute Intravascular
haemolysis
ABO incompatibility
(Commonest cause is administrative!)
1:6x105
Occurs within a few mls of
starting transfusion
(Mortality 10%)
Shouldn’t happen!
STOP THE BLOOD!
Supportive treatment
Treat complications – ARF and
DIC
Febrile Non-haemolytic
reactions
Anti –Leucocyte Ig or
Cytokines in platelet transfusions
Commonest in patients receiving
multiple transfusions or
previously pregnant
Becoming rarer because of
leucocyte depletion in many
transfusion practices.
Occurs towards the end of or up to
hours after transfusion
Unpleasant – but not life
threatening
Paracetamol and cooling.
Urticaria
Transfusion contains plasma proteins
or allergens causing an acute IgE
mediated allergic response
Occurs with plasma and platelet
rather than red cell transfusions.
1 – 2% of all transfusions
Peri-transfusion
May occur recurrently
Unpleasant – but not life
threatening
Anti-histamines –
(can be given prophylactically
in known patients)
Infective shock
Bacterial contamination of transfused
blood
Rare; 1:5x 105
First 100mls of blood – ie early
Often fatal!
That of Septicaemia and shock
– fluids, IV antibiotics
Anaphylaxis
Anti-IgA antibodies ?others
Patients are often IgA deficient as
well!
Extremely rare
Life threatening
A.B.C / Crash team call
IV / IM adrenaline, steroids,
aHistamines, Oxygen
Nebulisers.
Blood Transfusion - Acute Complications II
Transfusion Related Acute Lung Injury (TRALI)
•
•
•
•
•
RHS Rare; Non-cardiogenic Pulmonary oedema
Caused by donor blood containing anti-Leucocyte antibodies
Occurs at the start of the transfusion
Can be life threatening
Treat for
(a) Acute transfusion reaction
(b) Respiratory failure (ARDS), Shock and Pulmonary oedema
(RHS – Rocking Horse Shit – Not Royal Horticultural Society)
As Dorothy parker once said – ‘You can lead a whore to culture but you can’t
make her think’)
Blood Transfusion – Delayed Complications
Complication
Cause
Incidence / Timing
Treatment
Delayed Red cell haemolysis
Recipient IgG vs Red cell
antigens
Occurs in previously
transfused or pregnant
patients; Initial cross match
will not contain IgG but
subsequent cross matches
should!
5 – 10 days after transfusion
No treatment per se but
Patient will receive less
benefit from
transfusion and once
present they will
cause problems for
future transfusions
Transfusion associated Graft
versus Host disease
(TA-GvHD)
Immune mediated donor Tcell reaction (often occurs in
immunodeficient patients)
Fever, Rash, MOF,
Pancytopaenia
Rare 1:750,000 units of
cellular blood components
transfused
4 – 30 days after transfusion
Usually fatal!
Haematology specialist care
required
In susceptible recipients –
blood is subjected to Gamma
irradiation
Post Transfusion Purpura
Anti-Platelet antibodies
(usually aHPA-1a)
Immune medicated TCP
Primarily during pregnancy
RHS Rare
5 -10 days after transfusion
Often severe TCP causing
bleeding
Use HPA-1a negative red cell
and platelet transfusions or
LDBlood
High dose IV
Immunoglobulins for 5 days
0.4g / kg
Post Transfusion Viral
Infection
Virus (and other infective
agents e.g. prions) undetected
by UK screening system
HIV <1: 3x 106
HBV and HCV < 1: 2 x 105
Counselling and specialist
advice required
Iron overload
Multiple transfusions
Only occurs after several
years of blood transfusions
e.g. Chronic haemolytic
disease
Desferrioxamine – increases
iron excretion
One unit of blood contains
250mg of iron
<1:500 red cell transfusions
Generic Management of Acute Transfusion Reaction
•
Most ‘reactions’ occur within the first fifteen minutes of blood being started – this is the most
important time for observations to be done. Do not hide the patient away during this time – let
the nurses know transfusions are running and that they should do formal observations for the
first fifteen minutes and then routinely.
If a reaction occurs:•
Stop the unit of blood being transfused!
•
Ensure patient is clinically well and no other pathology is present (why are they having
transfusion etc) - Treat the underlying cause of ‘reaction’; Once patient is deemed OK:-
•
•
•
•
Disconnect and take down entire transfusion giving set and blood unit.
Maintain venous access with normal saline
Check administrative details from transfusion forms and patient’s wrist band
Contact the haematology / transfusion lab and inform them you are returning the unit of blood
for testing.
Take bloods – Blood film, FBC, Cultures, Clotting, Cross match sample (U&Es)
If blood transfusion is essential or serious reaction occurs need further advice from
haematologist
Nursing staff need to observe patient for signs of ‘shock’, DIC, acute renal failure
Thus ‘Regular’ observations of BP, Pulse, ToC, Urine output
•
•
•
Re-cap of Multidimensional analysis
Hopefully by now you will be familiar with
using multidimensional analysis. I have
included the example from module one. If
you are confident using other methods this
is fine but you must get the answers correct!
Dimensional Analysis
Dimensional analysis is commonly used by chemistry and physics
students to ensure they don’t make basic calculation errors when using
lots of values in an equation with different units; Each time one
converts one unit to another we use a conversion factor, which we will
call the dimensional analysis conversion factor (DACF) e.g 450g to kg
– the DACF = 1000g / 1 kg
Thus 450g / Xkg = 1000g / 1 Kg
XKg = 450g x 1 Kg
1000g
= 0.450 Kg
Dimensional analysis ensures that both sides of an equation are
‘singing from the same hymn sheet’. I.e. The units on both sides are
the same. By cancelling the units above and below the line, the units
yu are left with on one side should equal those of the value you are
seeking. If they don’t match, you have mucked up somewhere! It will
not ensure your maths is correct.
www.wine1.sb.fsu.edu/chm1045/notes/Intro/Dimanal/Dimanal.htm - Dr
Michael Baker – a teacher with a similar outlook on education!
Dimensional analysis for party planning…
If you have ever had a party you have used dimensional analysis. The amount of
beer (or soft drinks) and munchies you will need will depend on the number of
people you expect. For 30 people you may estimate you need to go and buy
120 bottles of beer and 10 large pizzas (obviously not a medic party!) How did
you guestimate these numbers? Here’s the dimensional analysis.
4 bottles / person and 1/3 of a pizza per person
30 persons x (4 beers) = 120 beers
person
30 persons x (0.333 pizza) = 10 pizzas
person
But should you buy beer in six packs or cases? – 1 case = 4 six packs = 24 Beers
120 beers x 1 six pack x 1case
= 5 cases
6 Beers
4 six packs
1 case / 4 six packs = 5 cases / x six packs = 20 six packs
To calculate drip rates / transfusion rates
• Blood transfusions are run through specific
giving sets with a filter included in the
chamber and wide bore tubing.
• You can NOT run them through a normal
giving set as without the filter the blood will
coagulate.
• Likewise you should NOT run fluids such
as saline and dextrose through a blood
giving set unless it is during or after a blood
transfusion.
To calculate drip rates / transfusion rates
• For any giving set the tubing will have its own
drop factor. This is the number of drops in 1ml.
• The drop factor is written on the packaging and is
dependent on the bore of the tubing.
• For reasons unbeknown to me the units of drop
factor is gtt / minute.
• Common drop factors are 10, 15 and 20 gtt / min
• Paediatric drips commonly have a drop factor of
60 gtt /min
• Saline and Dextrose are commonly run through 10
gtt / min tubing whereas blood is commonly run
through 20 gtt / minute tubing
To calculate drip rates / transfusion rates
To calculate the drip rate (drops / minute)
Drip Rate gtt = Volume to be infused (ml) x Drop Factor (gtt/ml)
min
Time (minutes)
1 unit of blood is approximately 400ml in volume
E.g. A unit of blood is prescribed to run over 2 hours; The giving set
has a drop factor of 20 gtt /ml. What is the drip rate (drops /min)?
(See next slide for answer and calculation)
The calculations used here are similar to those used for crystalloid
transfusions – see module (4)
Example one – Calculate the Transfusion rate
E.g. A unit of blood is prescribed to run over 4 hours; The giving set has a
drop factor of 20 gtt /ml. What is the drip rate (drops /min) ?
Drip rate = 400 ml x 20 gtt ; Drip Rate is drops / minute
4 hour 1ml
Thus Drip Rate = 400ml x 20 gtt x 1 hour
4 hour 1 ml 60 minutes
By multidimensional analysis units are correct (drops / minute)
Drip Rate = 100 / 3 = 33 drops / minute
• Drop rate is rounded up or down to the nearest drop
• In the clinical setting to be able to count drops / minute it is sensible to
have a number divisable by 4 - Thus you would set this drip at 32
drops per minute
Please try the following calculations – They
should be included in your folder
(1) A 71 yo man is receiving a blood transfusion after a
hemicolectomy. The transfusion is set at 30 drops per
minute with a giving set of 20 gtt / ml. The unit of blood
is prescribed for 4 hours as he has grade 1 heart failure.
Is the transfusion rate correct?
(2) A 31 yo woman is having a blood transfusion after
having a major upper GI bleed due to a peptic ulcer. The
unit of blood is running through a giving set with a drop
factor of 10 gtt/ ml. The rate of the infusion is set at 60
drops / minute. How long will it take the 6 units
prescribed to run through assuming there is 5 minutes to
change each unit?
A 71 yo man is receiving a blood transfusion after a hemicolectomy. The
transfusion is set at 30 drops per minute with a giving set of 20 gtt / ml.
The unit of blood is prescribed for 4 hours as he has grade 1 heart failure.
Is the transfusion rate correct?
Using Drip Rate = Volume to be Infused x Drop factor
Time in minutes
X gtt / min = 400ml x 20 gtt x 1 hour
4 Hr 1 ml 60 minutes
The drip should be running at 33 gtt/ min –
so it needs to be re-set.
A previously well 31 yo woman is having a blood transfusion after having
a major upper GI bleed due to a peptic ulcer. The unit of blood is running
through a giving set with a drop factor of 10 gtt/ ml. The rate of the
infusion is set at 60 drops / minute. How long will it take the 6 units
prescribed to run through assuming there is 5 minutes to change each
unit?
Using Drip Rate = Volume to be Infused x Drop factor
Time in minutes
60 gtt / min = 400 ml x 10 gtt x 1 hour
X hour 1 ml 60 minutes
X hours = 4000 = 1.11 hours / unit
3600
Thus for 6 units = 1.11 x 6 = 6.67 hours
Plus 5 minutes between units 1,2; 2,3; 3;4; 4,5; 5,6 =
25minutes = 0.42 hours
Total transfusion (or confusion) = 7.1 hours
Converting drip rate (gtt /min) to ml /hour
In high dependency areas caring for
critically ill patients it may be necessary to
know the infusion rate in ml/hour – this is
important in setting infusion pumps and in
calculating fluid balance.
E.g. What is the transfusion rate in ml /hour of
a blood transfusion being run at 40 drops /
minute through a giving set with drop factor
of 20 gtt / ml?
E.g. What is the transfusion rate in ml /hour of a blood
transfusion being run at 40 drops / minute through a giving
set with drop factor of 20 gtt / ml?
If there are 40 drops in one minute then in 1 hour
40 drops = X drops thus X = 40 x 60 = 2400 drops / hour
1 minute 60 minutes
If the giving set has drop factor of 20 drops/ 1 ml
20 drops = 2400 drops thus Xml = 2400 = 120 ml / hour
1 ml
X ml
20
Therefore one could set an infusion pump to deliver this
volume or it can be factored into the fluid input /hour.
Calculate the Transfusion rate in ml/hour
A 94 yo woman is receiving a ‘slow blood
transfusion for myelodysplasia. The unit of
blood is being run at 60 drops / minute
through a 20 gtt / ml giving set. Calculate
the rate of the transfusion and comment on
whether the rate is appropriate
Too Much – Too Quickly
If there are 60 drops in one minute then in 1 hour
60 drops = X drops thus X = 30 x 60 = 3600 drops / hour
1 minute 60 minutes
If the giving set has drop factor of 10 drops/ 1 ml
20 drops = 3600 drops thus Xml = 3600 = 180 ml / hour
1 ml
X ml
20
Thus the unit of blood (400ml) will run
through in 400 / 180 = 2.22 hours
I.e. Too quickly for an 94 yo with myelodysplasia
Learning Outcomes
At this point you should
• Have read and made notes regarding the ‘who, why, where
and when’ of blood transfusion
• Be aware of the acute and chronic complications of
transfusion
• Be aware of the steps regarding ordering and setting up a
blood transfusion
• Be able to order a cross match for a patient
• Be able to prescribe a blood transfusion
• Be able to calculate the correct infusion rate in drops/min
and ml / hour
If you are unable to achieve all of these outcomes at this point
you will need to continue to practice the skills and re-visit
the webpages to refresh your knowledge
Recommended websites and References
www.wine1.sb.fsu.edu/chm1045/notes/Intro/Dimanal/Dimanal.html
www.-isu.indstate.edu/nurs/mary/mathprac.html
www.classes.kumc.edu/son/nurs420/CalculatingDrugDosages.html
www.cs.jcu.edu.au/~michael/web/Sections6.html
References to follow