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Platelets

White blood cells

BLOOD
A mixture of cells A complex TRANSPORT mechanism

Transports hormones Removes waste products Regulates body temperature Protects the body Promotes hemostasis Supplies oxygen

BLOOD VOLUME
!" of total body weight = varies by age & body composition

Category Adult ! ale


Kilograms of Body Weight

mL/kg 70 mL/kg 70 mL/kg 80 mL/kg 8590 mL/kg

Blood Volume 90 kg = 6300 mL 60 kg = 4200 mL 30 kg = 2400 mL 3 kg = 255 270 mL

Adult emale Child N eonate

Blood Volume

#OMPOS$T$ON O% BLOOD
Temperature 38 !"##$%&' p( )$3* + )$%* ,pecific -ravity "$#%8 "$#.. /ody weight )0 * times the viscosity of water 1olume
2ale &emale * . 3iters % * 3iters

Portio&s o' the Blood


PLASM A
PLATELETS
GRANULOCYTES

Composed of: 55% plasma 45% cellular components


Plasma = fluid portion Coagulation factors Inorganic su stances !nti odies

"#$ %L&&$ C#LL'

Plasma
Li(uid )art of the blood onsists of serum and 'ibri&o*e& ontains plasma proteins such as4
Albumi& = regulates & maintains Serum *lobuli&s = for transportation %ibri&o*e&+ )rothrombi&+ )lasmi&o*e& = to stop the bleeding

#ellular #om)o&e&ts
%ormed eleme&ts o' blood
RB# = responsible for oxygen transport

WB# = play a ma5or role in defense against microorganisms

Platelets = function in hemostasis

Blood A& Emotio&al To)ic,-the s.ee)i&* stor/ o' a


substa&ce that has bee& 'eared+ re0ered+ m/tholo*i1ed+ a&d used i& ma*ic a&d medici&e 'rom earliest times2a substa&ce that has become the ce&ter o' a hu*e+ secreti0e+ a&d o'te& da&*erous .orld.ide commerce34
2%rom the )ublisher5s descri)tio& o' the boo6

TRANS%US$ON
6efers to the admi&istratio& of any of several blood products$

7s li'esa0i&* thera)/ for patients with a variety of medical and surgical conditions in need for blood$

BLOOD TRANS%US$ON

Blood Transfusion may be necessary for any of the following reasons:


7emorrha*e !blood loss' caused by trauma or high blood loss surgery Red cell destructio& Decreased red cell )roductio&

Natio&al Blood Ser0ices Act o' 899:


Also 6&o.& as the Re)ublic Act ;;89 AN A#T PROMOT$N< VOLUNTAR= BLOOD DONAT$ON PROV$D$N< %OR AN ADE>UATE SUPPL= O% SA%E BLOOD+ RE<ULAT$N< BLOOD BAN?S+ AND PROV$D$N< PENALT$ES %OR V$OLAT$ON T7EREO%3

Who #AN a&d #AN5T *i0e Blood


Eligible Donors Must:
/e at least age 8! 8eigh at least 88@ lb AB@ 6*C &ree from s6i& disease 9ot have donated in the past BD da/s (ave a hemoglobin level of at least 8E3B *Fdl A.ome&C or 8G3B *Fdl Ame&C

Ineligible Donors include those:


8ho have 7$V or A$DS 8ho have ta:en ille*al dru*s $3V3 8ho have had sex with )rostitutes in the )ast 8E mo&ths 8ho have had sex with anyone above categories 8ho have had he)atitis 8ith certain t/)es o' ca&cer Aother tha& mi&or s6i& ca&cerC 8ith hemo)hilia 8ho have recei0ed clotti&* 'actor co&ce&tratio&s

Blood #ollectio& Methods


G T/)es o' Blood Do&or Sources 'or Routi&e Blood #ollectio&
;nrelated <onor !Allogeneic' <irected <onor Autologous <onor !,elf'

NURSES MUST BE ?&o.led*eable about blood products


Sa'e admi&istratio&

(ow to mo&itor )atie&ts be'ore+ duri&* and a'ter therapy

Assure that i&'ormed co&se&t has been obtained be'ore starting a transfusion$ Appropriate i&'ormatio& to include in patient education includes4
Be&e'its Ris6s Alter&ati0es to tra&s'usio&

NURSES MUST BE

Docume&t all )atie&t educatio& re*ardi&* tra&s'usio& thera)/= and the responses of patients and family members after teaching$

Patie&t Educatio&
Pro0ide )atie&t a&d 'amil/ i&'ormatio& to blood tra&s'usio& thera)/
The &eed for blood transfusion Ad0a&ta*es of blood transfusion Possible reactio&s related to the blood transfusion therapy Volu&tar/ blood do&atio& act

Do&5t add medicatio&s to the blood$ Do&5t tra&s'use the blood product if you discover a discrepancy in the blood number= blood slip type= or patient identification number$

Tra&s'usio& Precautio&s

Do&5t piggybac: blood into the port of an existing infusion set$

Sto) tra&s'usio& i' /our )atie&t sho.s4

,hows cha&*es in vital signs 7s d/s)&eic or restless <evelops chills= hematuria= or )ai& in the flan:= chest or bac:

8hen assessing your patient before a transfusion4


>btain im)orta&t medical histor/ i&'ormatio& 6eview )erti&e&t laborator/ 0alues
Re0ie. the doctor5s order+ i&cludi&* a&/ s)ecial )rocessi&* re(uested

BE%ORE TRANS%US$ON

?erform )h/sical assessme&t

8hen you received the delivery from the blood ban:= you should receive both the )roduct and the tra&s'usio& record that corresponds to it$ $&s)ect 'or the 'ollo.i&* Labels $&te*rit/ o' U&it A))eara&ce

?erform the verification process to ensure the correct blood is being given to the correct )atie&t$ T.o (uali'ied i&di0iduals should 0eri'/ the )atie&t a&d u&it ide&ti'icatio&3 Assess the )ate&c/ of the )atie&t5s 0ascular access3 #hec6 a&d rechec6 0ital si*&s 8B mi&utes after starting the transfusion$

DUR$N< TRANS%US$ON
Admi&ister the blood or component at the recomme&ded rate$ Sta/ with the patient for the first few minutes of the transfusion Re0ie. si*&s a&d s/m)toms of what the patient should report to you$

Disco&ti&ue tra&s'usio& immediatel/ o&ce the )atie&t ma&i'est s/m)toms o' tra&s'usio& reactio&+ assess the )atie&t a&d &oti'/ the doctor3 &inally= docume&t the tra&s'usio& i& the )atie&t5s chart$

A%TER TRANS%US$ON

ontinue to mo&itor )atie&t for any signs and symptoms of reaction for at least one hour after the transfusion$

>btain any ordered post+transfusion laboratory studies$

Blood Products Whole Blood

Indications

"ursing Considerations

To restore blood volume in hemorrhaging, trauma, or burn patients

Dont infuse over more than 4 hours. Warm blood if giving a large quantity. Avoid giving when the patient ant tolerate the ir ulating volume. Dont infuse over more than 4 hours. #$%s have the same o!ygen " arrying apa ity as whole blood, minimi&ing the ha&ard of volume overload.

P#BC

To restore or maintain o!ygen " arrying apa ity To orre t anemia and surgi al blood loss

Blood Products Platelets

Indications
To treat thrombo ytopenia To treat a ute leu'emia and marrow aplasia

"ursing Considerations
A$( ompatibility isnt ne essary but is preferable with repeated platelet transfusions) #h type mat h is preferred. *nfuse +,, ml over +- minutes. Administer at +-, to .,, ml / hour, or as rapidly as the patient an tolerate) dont e! eed 4 hours. Avoid administering platelets when the patient has a fever. %ross " mat hing0 A$( ompatibility isnt ne essary but is preferable with repeated plasma transfusions) #h type mat h is preferred. 1arge " volume transfusions of 223 may require orre tion for hypo al emia. %itri a id in 223 binds al ium.

$$P

To e!pand plasma volume To treat postsurgi al hemorrhage or sho ' To orre t an undetermined oagulation fa tor defi ien y

SA%ET= PRE#AUT$ONS
2a:e sure that =OU are protected too by4
8ear proper Perso&al Protecti0e E(ui)me&t APPEC Always )er'orm disi&'ectio& tech&i(ue$ 7f possible= use a needleless system$ 7f using sharps= do &ot reca) the &eedle$ Always obser0e )ro)er .aste dis)osal according to your institution@s policy$ 7f there are spills= &e0er touch the blood .ith bare ha&ds$ 2a:e sure that blood bag is secured$ Always double or triple chec:$ Al.a/s )er'orm 7AND 7=<$ENE

Acute Tra&s'usio& Reactio&s usually appear within the first *+"* minutes after the transfusion is started$ T/)es o' Acute Tra&s'usio& Reactio&s
Acute hemolytic Transfusion 6eaction &ebrile nonhemolytic Transfusion 6eaction 2ild allergic !;rticarial' Anapylactic Transfusion Associated irculatory >verload Transfusion 6elated Acute 3ung 7n5ury ,eptic Transfusion 6eaction

,ymptoms you might see during an acute tra&s'usio& reactio& include4


Temperature increase of more than "A /loody urine hills (ypotension ,evere low bac:= flan:= or chest pain 3ow or absent urine output 9ausea and vomiting <yspnea= wheeCing Anxiety= Dsense of impending doomD <iaphoresis or BA&

-eneraliCed bleeding= especially from punctures and surgical wounds$

W7AT TO DO $% TRANS%US$ON REA#T$ON O##URS 8hen they do occur= it is usually because of A/> incompatibility between patient and donor during transfusion of red cells$ Ensure that the intended recipient is getting the intended unit at the time of transfusion$

Should a&/ o' these s/m)toms occur+ disco&ti&ue the u&it immediatel/+ ha&* &ormal sali&e Ao& a &e. tubi&*C to mai&tai& 0ascular access+ a&d call 'or assista&ce3 #losel/ mo&itor the )atie&t5s 0ital si*&s a&d s/m)toms3 Noti'/ the )h/sicia& a&d obtai& 'urther orders to address the )atie&t5s s/m)toms3 Rechec6 the )atie&t5s ide&ti'/i&* i&'ormatio& a*ai&st the tra&s'usio& record a&d blood ba*3 All ba*s+ tubi&*s+ 'ilters+ a&d )a)er.or6 should be retai&ed a&d 'or.arded )er hos)ital )olic/3

DO#UMENT$N< BLOOD TRANS%US$ONS


<ate and time the transfusion was started and completed 9ame of the health care professional who verified the information of the patient and the blood atheter type and gauge Total amount of the transfusion ?atient@s vital signs before and after the transfusion

7nfusion device used &low rate and if blood warming was used 1ital signs obtain prior to= during= and after the transfusion 9ame of the component= unit number Evidence of possible transfusion reaction$
<ocument interventions done and to whom you notified$

?atient@s outcome$