Blood Transfusion

It is the process of transferring blood or blood-based products from one person

into the circulatory system of another.

Blood transfusions can be life-saving in some situations, such as massive blood

loss due to trauma, or can be used to replace blood lost during surgery.

may also be used to treat a severe anaemia or thrombocytopenia caused by a blood

disease.

When red and white blood cells, platelets, or blood proteins are lost because of

hemorrhage or disease, it may be necessary to replace these components to restore the

blood’s ability to transport oxygen and carbon dioxide, to clot, to fight infection, and

to keep extracellular fluid within the intravascular compartment.

Blood Groups

Human blood is commonly classified into four main groups ( A, B, AB, and O).

The surface of an individual’s red blood cells contains a number of proteins

known as antigens that are unique for each person.

Many blood antigens have been identified, but the antigens A, B, and Rh are the

most important in determining blood group or type. Because antigens promote

agglutination or clumping of blood cells, they are also known as agglutinogens.

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 The A antigen or agglutinogen is present on the RBCs of people with blood group

A, the B antigen is present in people with blood group B, and both A and B

antigens are found on the RBC surface in people with AB blood. Neither antigen

is present in people with group O blood.

Preformed antibodies to RBC antigens are present in the plasma; these antibodies

are often called agglutinins.

People with blood group A have B antibodies (agglutinins); A antibodies are

present in people with blood group B; and people with blood group O have

antibodies to both A and B antigens. People with group AB blood do not have

antibodies to either A or B antigens.

When blood is transfused, the blood group of the donor and recipient must match

to avoid an antigen-antibody reaction and destruction (hemolysis) of RBCs.

Rhesus ( Rh) Factor

The RH factor antigen is present on the RBCs of approximately 85% of the people

in the United States.

Blood that contains the Rh factor is known as RH-positive (Rh+); when it is not

present the blood is said to be Rh- negative (Rh-).

In contrast to ABO blood groups, Rh- blood does not naturally contain Rh

antibodies.

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 However, on exposure to blood containing Rh factor (e.g., an Rh- mother carrying

a fetus with Rh+ blood, or transfusion of Rh+ blood into a client who is Rh-), Rh

antibodies develop.

Subsequent exposures to Rh+ blood place the client at risk for an antigen-antibody

reaction and hemolysis of RBCs.

Blood typing and Cross Matching

To avoid transfusing incompatible red blood cells, both blood donor and recipient

are typed and their blood crossmatched.

Blood typing is done to determine the ABO blood group and Rh factor status.

This test is also performed on pregnant women and neonates to assess for possible

intrauterine exposure of either to an incompatible blood type (particularly Rh

factor incompatibilities).

Because blood typing only determines the presence of the major ABO and Rh

antigens, crossmatching also is necessary prior to transfusion to identify possible

interactions of minor antigens with their corresponding antibodies.

RBCs from the donor blood are mixed with serum from the recipient; a reagent

(Coombs’ serum) is added, and the mixture is examined for visible agglutinations.

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 If no antibodies to the donated RBCs are present in the recipient’s serum,

agglutination does not occur and the risk of transfusion reaction is small.

Transfusion Reactions

Transfusion of ABO- or Rh- incompatible blood can result in a hemolytic

transfusion reaction with destruction of the transfused RBCs and subsequent risk

of kidney damage or failure.

Other forms of transfusion reaction also may occur, including febrile, allergic,

circulatory overload, and sepsis. Because the risk of an adverse reaction is high

when blood is transfused, clients must be frequently and carefully assessed before

and during transfusion .

Many reactions become evident within 30 minutes of initiating the transfusion;

clients are closely monitored during this period. Stop the transfusion immediately

if signs of a reaction develop.

Nursing Responsibilities

1. Verify the physician’s written order and make a treatment card according to

hospital policy

2. Observe the 10 Rs when preparing and administering any blood or blood

components

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3. Explain the procedure/rationale for giving blood transfusion to reassure patient and

significant others and secure consent. Get patient histories regarding previous

transfusion.

4. Explain the importance of the benefits on Voluntary Blood Donation (RA 7719-

National Blood Service Act of 1994).

5. Request prescribed blood/blood components from blood bank to include blood

typing and cross matching and blood result of transmissible Disease.

6. Using a clean lined tray, get compatible blood from hospital blood bank.

7. Wrap blood bag with clean towel and keep it at room temperature.

8. Have a doctor and a nurse assess patient’s condition. Countercheck the compatible

blood to be transfused against the crossmatching sheet noting the ABO grouping

and RH, serial number of each blood unit, and expiry date with the blood bag label

and other laboratory blood exams as required before transfusion.

9. Get the baseline vital signs- BP, RR, and Temperature before transfusion. Refer to

MD accordingly.

10. Give pre-meds 30 minutes before transfusion as prescribed.

11. Do hand hygiene before and after the procedure

12. Prepare equipment needed for BT (IV injection tray, compatible BT set, IV

catheter/ needle G 19/19, plaster, torniquet, blood, blood components to be

transfused, Plain NSS 500cc, IV set, needle gauge 18 (only if needed), IV hook,

gloves, sterile 2×2 gauze or transplant dressing, etc.

13. 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.

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14. Open compatible blood set aseptically and close the roller clamp. Spike blood bag

carefully; fill the drip chamber at least half full; prime tubing and remove air

bubbles (if any). Use needle g.18 or 19 for side drip (for adults) or g.22 for pedia

(if blood is given to the Y-injection port, the gauge of the needle is disregarded).

15. Disinfect the Y-injection port of IV tubing (Plain NSS) and insert the needle, from

BT administration ser and secure with adhesive tape.

16. Close the roller clamp of IV fluid of Plain NSS and regulate to KVO while

transfusion is going on.

17. Transfuse the blood via the injection port and regulate at 10-15gtts/min initially for

the first 15 minutes of transfusion and refer immediately to the MD for any

adverse reaction.

18. Observe/Assess patient on an on-going basis for any untoward signs and

symptoms such as flushed skin, chills, elevated temperature, itchiness, urticaria,

and dyspnea. If any of these symptoms occur, stop the transfusion, open the IV

line with Plain NSS and regulate accordingly, and report to the doctor

immediately.

19. Swirl the bag gently from time to time to mix the solid with the plasma N.B one

B.T 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-check Hgb and Hct, bleeding time, serial platelet count within specified hours

as prescribed and/or per institution’s policy.

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23. Discard blood bag and BT set and sharps according to Health Care Waste

Management (DOH/DENR).

24. Fill-out adverse reaction sheet as per institutional policy.

25. Remind the doctor about the administration of Calcium Gluconate if patient has

several units of blood transfusion (3-5 more units of blood).

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Reference:

 Fundamentals of Nursing Concepts, Process, and Practice by Barbara

Kozier, GlenoraErb, Audrey Berman, and Shirlee Snyder 7th Edition

 http://www.news-medical.net/health/What-is-a-Blood-Transfusion.aspx

 http://nurseslabs.com/blood-transfusion-nursing-responsibilities/