A blood transfusion is the transfer of blood or blood products from one person (donor) into another person's bloodstream (recipient). This is usually done as a life saving maneuver to replace blood cells or blood products lost through severe bleeding, during surgery when blood loss occurs or to increase the blood count in an anemic patient.
y IMPORTANT INFORMATION ABOUT BLOOD
The heart pumps blood through a network of arteries and veins throughout the body. Blood has many vital jobs. It carries oxygen and other nutrients to your body's organs and tissues. Having a healthy supply of blood is important to your overall health. Blood is made up of various parts, including red blood cells, white blood cells, platelets (PLATElets), and plasma. Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts. Blood Types Every person has one of the following blood types: A, B, AB, or O. Also, every person's blood is either Rh-positive or Rh-negative. So, if you have type A blood, it's either A positive or A negative. The blood used in a transfusion must work with your blood type. If it doesn't, antibodies (proteins) in your blood attack the new blood and make you sick. Type O blood is safe for almost everyone. About 40 percent of the population has type O blood. People who have this blood type are called universal donors. Type O blood is used for emergencies when there's no time to test a person's blood type. People who have type AB blood are called universal recipients. This means they can get any type of blood. If you have Rh-positive blood, you can get Rh-positive or Rh-negative blood. But if you have Rh-negative blood, you should only get Rh-negative blood. Rh-negative blood is used for emergencies when there's no time to test a person's Rh type.
y TYPES OF BLOOD TRANSFUSION
Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts. Red Blood Cell Transfusions Red blood cells are the most commonly transfused part of the blood. These cells carry oxygen from the lungs to your body's organs and tissues. They also help your body get rid of carbon dioxide and other waste products.
You may need a transfusion of red blood cells if you've lost blood due to an injury or surgery. You also may need this type of transfusion if you have severe anemia due to disease or blood loss. Anemia is a condition in which your blood has a lower than normal number of red blood cells. Anemia also can occur if your red blood cells don't have enough hemoglobin. Hemoglobin is an iron-rich protein that gives blood its red color. This protein carries oxygen from the lungs to the rest of the body. Platelets and Clotting Factor Transfusions Platelets and clotting factors help stop bleeding, including internal bleeding that you can't see. Some illnesses may cause your body to not make enough platelets or clotting factors. You may need regular transfusions of these parts of your blood to stay healthy. For example, if you have hemophilia , you may need a special clotting factor to replace the clotting factor you're lacking. Hemophilia is a rare, inherited bleeding disorder in which your blood doesn't clot normally. If you have hemophilia, you may bleed for a longer time than others after an injury or accident. You also may bleed internally, especially in the joints (knees, ankles, and elbows). Plasma Transfusions Plasma is the liquid part of your blood. It's mainly water, but also contains proteins, clotting factors, hormones, vitamins, cholesterol, sugar, sodium, potassium, calcium, and more. If you have been badly burned or have liver failure or a severe infection, you may need a plasma transfusion.
y BLOOD TRANSFUSION OPTIONS y Homologous transfusions - using the stored blood of others. These are often
called Allogeneic instead of homologous. y Autologous transfusions - using the patient's own stored blood
y RISKS OF A BLOOD TRANSFUSION
Most blood transfusions go very smoothly. However, mild problems and, very rarely, serious problems can occur. Allergic Reactions Some people have allergic reactions to the blood given during transfusions. This can happen even when the blood given is the right blood type. Allergic reactions can be mild or severe. Symptoms can include:
y y y y y
Chest and/or back pain Trouble breathing Fever, chills, flushing, and clammy skin A quick pulse or low blood pressure Nausea (feeling sick to the stomach)
Viruses and Infectious Diseases Some infectious agents, such as HIV, can survive in blood and infect the person receiving the blood transfusion. To keep blood safe, blood banks carefully screen donated blood. The risk of catching a virus from a blood transfusion is very low.
HIV. Your risk of getting HIV from a blood transfusion is lower than your risk of getting killed by lightning. Only about 1 in 2 million donations might carry HIV and transmit HIV if given to a patient. Hepatitis B and C. The risk of having a donation that carries hepatitis B is about 1 in 205,000. The risk for hepatitis C is 1 in 2 million. If you receive blood during a transfusion that contains hepatitis, you'll likely develop the virus. Variant Creutzfeldt-Jakob disease (vCJD). This disease is the human version of Mad Cow Disease. It's a very rare, yet fatal brain disorder. There is a possible risk of getting vCJD from a blood transfusion, although the risk is very low. Because of this, people who may have been exposed to vCJD aren't eligible blood donors.
Fever You may get a sudden fever during or within a day of your blood transfusion. This is usually your body's normal response to white blood cells in the donated blood. Iron Overload Getting many blood transfusions can cause too much iron to build up in your blood (iron overload). People who have a blood disorder like thalassemia, which requires multiple transfusions, are at risk for iron overload. Iron overload can damage your liver, heart, and other parts of your body. If you have iron overload, you may need iron chelation therapy. For this therapy, medicine is given through an injection or as a pill to remove the extra iron from your body. Lung Injury Although it's unlikely, blood transfusions can damage your lungs, making it hard to breathe. This usually occurs within about 6 hours of the procedure. Most patients recover. However, 5 to 25 percent of patients who develop lung injuries die from the injuries. These people usually were very ill before the transfusion.
Acute Immune Hemolytic Reaction Acute immune hemolytic reaction is very serious, but also very rare. It occurs if the blood type you get during a transfusion doesn't match or work with your blood type. Your body attacks the new red blood cells, which then produce substances that harm your kidneys. The symptoms include chills, fever, and nausea, pain in the chest or back, and dark urine. Delayed Hemolytic Reaction This is a much slower version of acute immune hemolytic reaction. Your body destroys red blood cells so slowly that the problem can go unnoticed until your red blood cell level is very low. Both acute and delayed hemolytic reactions are most common in patients who have had a previous transfusion. Graft-Versus-Host Disease Graft-versus-host disease (GVHD) is a condition in which white blood cells in the new blood attack your tissues. GVHD usually is fatal. People who have weakened immune systems are the most likely to get GVHD. Symptoms start within a month of the blood transfusion. They include fever, rash, and diarrhea. To protect against GVHD, people who have weakened immune systems should receive blood that has been treated so the white blood cells can't cause GVHD.
ADMINISTERING BLOOD AND BLOOD COMPONENTS
y y y y y y y
Tourniquet Iodine-containing skin antiseptic Needle or venous catheter Y-type blood infusion set 170-Âµ filter Normal saline Blood product as described
PROCEDURE Before a blood transfusion, a technician tests your blood to find out what blood type you have (that is, A, B, AB, or O and Rh-positive or Rh-negative). He or she pricks your finger with a needle to get a few drops of blood or draws blood from one of your veins. The blood type used in your transfusion must work with your blood type. If it doesn't, antibodies (proteins) in your blood attack the new blood and make you sick.
Nursing Action Preparatory phase 1. Inform the patient of the procedure, blood product to be given, approximate length of time, and desired outcome. 2. Obtain and record baseline vital signs.
Rationale 1. Instruct the patient to report unusual symptoms immediately.
2. If the patient's clinical status permits, delay transfusion if baseline temperature is greater than 101.7Â° F (38.7Â°C). 3. Prepare infusion site. Select a large 3. Antecubital veins are not recommended for vein that allows patient some lengthy infusions. Prolonged restriction of arm degree of mobility. Start the movement is uncomfortable and inconvenient prescribed I.V. infusion. for the patient. In the event of an acute reaction, the I.V. catheter should be maintained with normal saline. DRUG ALERT Crystalloid solutions other than 0.9% saline and all medications are incompatible with blood products. They may cause agglutination or hemolysis. 4. Obtain blood product from blood 4. Platelets are normally cloudy. If the transfusion bank. Inspect for abnormal color, cannot begin immediately, return product to cloudiness, clots, and excess air. blood bank. Blood out of proper storage (above Read instructions on the product 50Â° F [10Â° C]) for more than 30 minutes label regarding storage and infusion. cannot be reissued. Never store blood in unauthorized refrigerators, such as those on the Check expiration date. nursing unit. 5. Verify patient identification. 5. The majority of acute fatal transfusion reactions are caused by clerical errors. Patient and a. Ask the patient to state his or product verification is the single most important her full name and compare with function of the nurse. It is strongly name on the wrist band. If the recommended that two qualified individuals patient is unable to state his or perform this task. Do not proceed with the her name, verify identity with an transfusion if there is a discrepancy. Contact the individual familiar with the blood bank immediately. patient. b. Compare the name and ID number on the wristband with the bag tag, transfusion form, and medical order. c. Confirm ABO and Rh compatibility by comparing the bag label, bag tag, medical record, and transfusion form. d. Check bag labels for expiration date and satisfactory serologic testing.
Performance phase 1. Start infusion slowly (ie, 2 mL/minute). Remain at bedside 1530 minutes. If there are no signs of adverse effect, increase flow to the prescribed rate. 2. Observe the patient closely and check vital signs at least hourly until 1 hour after transfusion. Report signs of adverse effect to health care provider immediately. 3. Record the following information on the patient's chart: a. Time and names of persons starting and ending the transfusion. b. Names of individuals verifying patient ID. c. Unique product identification number. d. Product and volume infused. e. Immediate response
1. Institutional policy may vary regarding flow rates and patient monitoring. Signs of a severe transfusion reaction (ie, acute hemolytic, anaphylactic) are usually manifested during infusion of the initial 50-100 mL. 2. Acute reactions may occur at any time during the transfusion
3. Facts relating to the transfusion should be charted exactly.
It must be possible to trace each transfusion product to the original blood donor.
Nursing and Patient Care Considerations
y y y
Infuse at the prescribed rate. Generally, a unit can be given to an adult in 90 to 120 minutes. Pediatric patients are usually transfused at a rate of 2 to 5 mL/kg per hour. To reduce the risk of bacterial contamination and sepsis, RBCs must be transfused within 4 hours of leaving the blood bank. Observe closely (particularly during first 15 to 30 minutes) for the most common acute complications associated with packed RBCs, allergic and febrile transfusion reactions. Signs and symptoms of the more serious, but rare, hemolytic transfusion reactions are usually manifested during infusion of the first 50 mL.