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to alleviate anemia or when the blood is low (e.g. after a severe hemorrhage) - in an incompatible blood transfusion, the normal components of one’s person plasma membrane can trigger damaging antigen-antibody responses in a transfusion recipient (when you administer incompatible blood, the recipient antibody will destroy the antigen of the blood causing potential complications such as blood transfusion reactions or antibody-antigen reactions) Purposes: 1. to restore blood volume after severe hemorrhage (e.g. whole blood to replace blood volume) 2. to restore the capacity of the blood to carry oxygen (e.g. PRBC for anemic patients) 3. to provide plasma factors which prevent or treat bleeding (e.g. platelets, CHON’s, cryoprecipitate for bleeding disorders)
Blood Typing: A. ABO Groups Summary of ABO Blood Groups Interactions Characteristics A B AB O 1. Antigen A B Both A & B Neither A nor (RBC) B 2. Antibody Anti-B Anti-A Neither AntiBoth Anti-A & (Plasma) A nor Anti-B Anti-B 3. Compatible A, O B, O A, B, AB, O O donor blood types (no hemolysis) 4. Incompatible B, AB A, AB ____ A, B, AB donor blood types (hemolysis) (In practice, the used of the terms universal recipient and universal donor is misleading and dangerous. Blood contains antigens and antibodies other than those associated with the ABO system that can cause transfusion problems.)
B. RH Factor - people whose RBC have Rh antigens are designated Rh+ (Rh positive) - those who lack Rh antigens are designated Rh- (Rh negative) - in blood transfusion reaction - if an Rh- person receives an Rh+ blood. - Its immune system starts to develop an Anti-Rh antibodies that will remain in the blood. - The first transfusion is not affected however, during second transfusion of Rh+ blood; the previously formed Anti-Rh antibody will cause hemolysis (rupture of RBC) in the donated blood. - In Hemolytic Disease of the Newborn - may arise during pregnancy - results when the mother is Rh- while the fetus is Rh+
- the first born baby is not usually affected - the mother develops anti-Rh antibody so that during the second pregnancy when the fetus is Rh+ again, it destroy fetal RBC causing hemolysis Pathophysiology - Normally there is no direct contact between maternal and fetal blood - Mother is Rh- and the fetus is Rh+ - Small amount of Rh+ fetal blood leaks across the placenta - It will go to the bloodstream of an Rh- mother - The mother will start to make anti-Rh antibodies - First pregnancy is not usually affected - An injection of Anti-Rh antobidies called Anti-Rh gamma globulin (Rhogam) should be given as soon as 72 hours after delivery to prevent HDN - During second pregnancy, if fetus is Rh+ again - The anti-Rh antibodies of the mother crosses the placenta - It enters the blood strem of the fetus - Ensuing antigen-antibody reaction - Hemolysis of the fetal blood (fetal RBC) - Hemolytic disease of the newborn - If the fetus is Rh- there is no problem, because Rh- blood does not have the Rh antigen
Blood Typing - Lab. Technicians type the patient’s blood and then either cross match it to potential donor’s blood or screen it for the presence of antibody - is done to determine the ABO blood groups and Rh factor status - a drop of blood is mixed with different anti-sera, that contains antibody ABO Procedure: 1. one drop of blood is mixed with Anti-A serum, contains Anti-A antibody that will agglutinate RBC of A Antigens 2. another drop of blood is mixed with Anti-B serum, contains Anti-B antibody that will agglutinate RBC of B antigens 3. if RBC agglutinate only when mixed with Anti-A serum, the blood type is A 4. if RBC agglutinate only when mixed with Anti-B serum, the blood type is B 5. if both drops agglutinate, the blood type is AB 6. if neither drop agglutinate, the blood type is O Agglutination – means “clumping of blood” specifically the clumping of RBC that is visible to the naked eye - it is an antigen-antibody response whereby RBC’s becomes cross linked to one another - mixing of incompatible blood causes agglutination Rh factor Procedure: 1. the RBC’s from the donor blood (drop of blood) are mixed with serum from the recipient
2. a reagent is added (Coomb’s serum) that contains antibody will
agglutinate donor’s RBC 3. if the blood agglutinates, it is Rh+ 4. no agglutination indicates Rh-
Cross-Matching - it is done to identify possible interactions of minor antigens with their corresponding antibodies - once the patient’s blood type is known, donor blood of the same ABO and Rh is selected - in cross match, the possible donor’s RBC are mixed with recipient serum
Selection of Blood Donors: - criteria has been established to protect the donor from possible illeffects of donation and to protect the recipient from exposure to diseases transmitted through the blood or blood borne diseases. - Potential donors must be screened for the following conditions: a. history of hepatitis b. HIV infection c. Heart diseases d. Severe asthma e. Most cancers f. Bleeding disorders - donation of blood may be deferred on the following conditions: a. people with malaria b. has been exposed to malaria/Hepatitis c. pregnancy d. surgery e. anemia f. high or low blood pressure g. certain drugs such as amphetamines Blood and Blood Products: - most client do not require transfusion of whole blood. Most often transfusion of a particular blood component is more appropriate
Blood Products for Transfusion Products Use 1. Whole Blood - not commonly used except for extreme - to be infused within 4 hours cases of acute hemorrhage - volume: 500ml/unit - replaces blood volume and all blood - must be ABO and Rh compatible products such as RBC, plasma, plasma proteins, fresh platelets and other clotting factors 2. Red Blood Cells - also known as PRBC - should be infused within 1 ½ to 4 hours -volume: 300-350ml/unit 3. Platelets - used to increase the oxygen-carrying capacity of blood in anemia, surgery. - one unit raises hematocrit by approximately 4% - replaces platelets in clients with
- rapid infusion or within 20 minutes bleeding disorders or platelet deficiency (because it is easily destroyed) - volume: 60-70 ml/unit 4. Fresh Frozen Plasma - Expands blood volume and provides - should be infused within 15-20 minutes clotting factors when given for bleeding or clotting - does not need to be typed and cross factor replacement matched (contains no RBC) - volume: 175-225 ml/unit 5. Albumin and Plasma proteins - blood volume expander and provides - infused within 1 hour plasma proteins - volume: 12.5 g/50 ml 6. Cryoprecipitate and Clotting factors - used for clients with clotting factor - rapid infusion within 20 minutes deficiencies - volume: 5-10 ml/unit Hematocrit – male: 47-54% - Female: 42-47% Hemoglobin – Male: 13-18 g/dl - Female 12-16 g/dl Patient is recommended to undergo BT if the Hgb is 8-10g/dl.
Blood Transfusion Reactions: Transfusion Reactions Reaction Cause Clinical Signs 1. Hemolytic reaction Chills, fever, headache, - incompatibility between backache, dyspnea, client’s blood and donor’s cyanosis, chest pain, blood tachycardia and - infusion of incompatible hypotension blood products
2. Febrile Reaction: - sensitivity of the client’s blood to white blood cells, platelets or plasma proteins - the most symptomatic complication of BT
Nursing Intervention 1. Discontinue the transfusion immediately. NOTE: when the transfusion is discontinued, the blood tubing must be removed as well. use new tubing for the normal saline infusion 2. keep vein open with normal saline or according to agency protocol 3. send the remaining blood, a sample of the client’s blood and an urine sample to the laboratory 4. notify the physician immediately 5. monitor vital signs 6. monitor fluid intake and output Fever, chills, warm, 1. discontinue the flushed skin, headache, transfusion immediately anxiety and muscle pain 2. give antipyretics as ordered 3. notify the physician 4. keep the vein open with a normal saline infusion
3. Allergic reaction(mild): Flushing, itching, urticaria 1. stop or slow the infusion - sensitivity to infused and bronchial wheezing 2. notify the physician plasma proteins 3. administer medication (antihistamines) as ordered 4. Allergic reaction Dyspnea, chest pain, 1. stop the transfusion (severe): antibody-antigen circulatory collapse and 2. keep vein open with reaction cardiac arrest open normal saline 3. notify the physician immediately 4. monitor vital signs, administer cardiopulmonary resuscitation if needed 5. administer medications and/ or oxygen as ordered 5. Circulatory overload: Cough, dyspnea, crackles 1. place the client upright, blood administered (rales), distended neck with feet dependent faster than the veins, tachycardia and 2. administer diuretics circulation can hypertension and oxygen as ordered accommodate 3. notify the physician 4. stop or slow the transfusion 6. Sepsis: High fever, chills, 1. stop the transfusion contaminated blood vomiting, diarrhea and 2. send the remaining administered hypotension blood to laboratory - expired blood and not 3. notify the physician properly cross matched 4. obtain a blood specimen form the client for culture 5. administer IV fluids, antibiotics 6. keep the vein open with a normal saline infusion
Administering Blood Transfusion: Guidelines: 1. when transfusion is ordered, obtain blood from the blood bank just before starting the transfusion 2. do not store blood in the refrigerator on the nursery unit (lack of temperature control may damage the blood) 3. blood is administered through a #18 or #19 gauge intravenous needle or catheter (using a smaller needle may slow the infusion and may damage cells) 4. a Y-type blood transfusion set with in line filter is used 5. one arm of administration set connects to the blood while the normal saline (0.9% NaCl) is attached to the other arm of the Y-type set 6. saline is used to prime the set and flush the needle before administering blood (solution other than saline can cause damage to blood components) 7. transfusion of blood should be completed within 4 hours of initiation (the risk of sepsis increases if blood has transfused for a longer period) 8. blood tubing is changed after every 4-6 units per agency policy
The College of Maasin Nisi Dominus Frsutra College of Nursing Maasin City, Southern Leyte Performance Checklist BLOOD TRANSFUSION Instructions: Please check on the space provided for whether the participant is able to perform the procedure correctly or whether it is incorrectly done CD – Correctly done ID – Incorrectly done ND – Not done
PROCEDURE: Steps CD 1. verify doctor’s written prescription and make a treatment card according to hospital policy 2. observe ten (10) Rs when preparing and administering any blood or blood components 3. Explain the procedure/rationale for giving blood transfusion to reassure patient and significant others and secure consent. Get patient’s history regarding previous transfusion 4. request prescribed blood/blood components from blood bank to include blood typing and X-matching & blood result of transmissible disease 5. using a clean lined tray, get compatible blood from hospital blood bank 6. wrap blood bag with clean towel & keep it at room temperature 7. Have a doctor and a nurse assess patient’s condition. Countercheck the compatible blood to be transfused against the X-matching sheet noting ABO grouping and Rh, serial number of each blood unit and expiry date with the blood bag label and other laboratory blood exam as required before transfusion (Hgb & Hct) 8. get the baseline vital signs –BP, R, temperature before transfusion 9. give pre-med 30 minutes before transfusion as prescribed 10. do hand hygiene before and after the procedure 11. prepare equipment needed for BT (IV injection tray, compatible BT set, IV catheter/ needle G 18/19, plaster, tourniquet, blood component to be transfused, plain NSS 500cc, IV set, g 18 needle, IV hook, gloves, sterile 2x2 gauze or transparent dressing 12. if main IVF is with dextrose 5% initiate an IV line with appropriate IV catheter with plain NSS on another site, anchor catheter properly and regulate IV drops 13. Open compatible blood set aseptically and close roller clamp. Spike blood bag carefully, fill the drip chamber at
least half full; prime tubing and remove air bubbles (if any). Use needle g18 or 19 for side drip (for adults) or 22 for pedia (if blood is given through the Y injection port, the gauge of needle is disregarded 14. disinfect the Y-injection port of IV tubing (plain NSS) and insert the needle from BT administration set and secure with adhesive tape 15. close roller clamp of IV fluid of plain NSS and regulate to KVO while transfusing is going on 16. Transfuse the blood via the injection port and regulate at 10-15 gtts. Initially for 15 minutes and then at the prescribed rate 17. observe patient for 10-15 minutes for any immediate reaction 18. Observe patient on an ongoing basis for any untoward signs and symptoms such as flushed skin, chills, elevated temperature, itchiness, urticaria and dyspnea. If any of these symptoms occurs stop the transfusion, open the roller clamp of the IV line with plain NSS and report to doctor immediately 19. Swirl the bag hourly to mix the solid with the plasma. One BT set should be used for 1-2 units of blood 20. when blood is consumed, close the roller clamp of BT and disconnect from IV lines then regulate the IVF of plain NSS as prescribed 21. continue to observe and monitor patient post transfusion, for delayed reaction could still occur 22. Re-checked Hgb and Hct, bleeding time, serial platelet count within specified hours as prescribed 23. discard blood bag and BT set and sharps according to Health Care Waste Management 24. document the procedure, pertinent observations and nursing intervention and endorse accordingly Remarks: Pass___ Failed___ Name & Signature of the Student:______________ Name & Signature of the Instructor:____________
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