Blood Transfusion

Submitted by:

Maribel Belmonte

Justine De Jesus

Anne Malicay

Elisha Miranda

Karen Panganiban
Definition:

 Blood transfusion (BT) therapy involves transfusing whole blood or blood

components (specific portion or fraction of blood lacking in patient).

 This potentially life-saving procedure can help replace blood lost due to surgery

or injury.

 A blood transfusion also can help if an illness prevents your body from making

blood or some of your blood's components correctly.

Types of blood products and its indications

1. Fresh Whole Blood - contains all the components blood which are RBC, WBC,

Platelets, and Plasma. It is usually being given in patients with massive bleeding.

2. Packed RBC - This type of transfusion increases the patient’s hemoglobin and

iron levels, while improving the amount of oxygen in the body. It is given in patients

with active bleeding and conditions where the body does not have enough red blood

cells such as anemia.

3. Fresh Frozen Plasma

- Consists of proteins, carbohydrates, fats and vitamins present in the blood along

with water and contains many factors necessary for blood clotting.

- Usually used in patients with low protein content in the blood or where there is an

insufficient number of blood clotting factors present in blood.

- Plasma transfusion is recommended in patients with active bleeding and with an

- INR (International Normalized Ration) greater than 1.6, or before an invasive

procedure or surgery if a patient has been anticoagulated. INR is a calculation based

on results of a Prothrombin Time that is used to monitor individuals who are being

treated with the blood-thinning medication (anticoagulant) such as warfarin

(Coumadin).
4. Platelets - to treat bleeding caused by decreased circulating platelets. Usually

given to patients who are extremely thrombocytopenic (low platelet count).

Blood Types

 Blood types are determined by the presence or absence of certain antigens –

substances that can trigger an immune response if they are foreign to the body. 

Since some antigens can trigger a patient's immune system to attack the

transfused blood, safe blood transfusions depend on careful blood typing and

cross-matching

 There are four major blood groups determined by the presence or absence of

two antigens – A and B – on the surface of red blood cells. In addition to the A

and B antigens, there is a protein called the Rh factor, which can be either

present (+) or absent (–), creating the 8 most common blood types (A+, A-,  B+,

B-,  O+, O-,  AB+, AB-).

Group A

 Has only the A antigen on red cells (and B antibody in the plasma)

 can donate red blood cells to A's and AB's

Group B

 Has only the B antigen on red cells (and A antibody in the plasma)

 Group B can donate red blood cells to B's and AB's

Group AB

 Has only the A and B antigen on red cells (but neither A nor B antibody in the

plasma)

 can donate to other AB's but can receive from all others

Group O

 Has neither A nor B antigen on red cells (but both A nor B antibody in the

plasma)

 can donate red blood cells to anybody. It's the universal color.

Blood Typing

 It determines the ABO and Rh blood groups of a blood sample

 The cells are separated from the serum and then tested with known antibodies to

determine the type of antigen on the cell surface

Crossmatch

 It is the final check of ABO compatibility between the donor and patient

 It tests for agglutination reactions between donor and recipient blood.

 Technique used is immediate spin method

Assessment

 Assess the status of the infusion site

 Check for any unusual symptomps like hypervolemia or fever

 Check vital signs for baseline data

Determine

 Informed Consent

 Any known allergies or previous adverse reactions

Assemble Equipment

 Unit of blood products

 Blood transfusion set

 Normal Saline Solution

 Gloves

 IV pole

 #19 gauge needle

 Alcohol Swabs

Prepare the client

 Instruct the client to report promptly any sudden chills, nausea, itching, rash,

dyspnea, back pain

 Check whether needle and solution are appropriate to administer blood

Procedure

1. Obtain the correct blood component for the client.

A. Check the physician’s order with the requisition.

B. Check the requisition form and the blood bag label.

C. Observe the blood for abnormal color, clumping, gas bubbles, and extraneous

material.

D.With another nurse, compare the laboratory blood record with:

 Client's name and identification number

 Serial Number

 ABO group and Rh type

2. Verify the client’s identity (ask the client’s full name and check the arm band)

3. Explain to the client what you’re going to do, why it is necessary and how he/she

can cooperate.

4. Provide for client privacy.

5. Wash hands and observe appropriate infection control.

6. Set up the infusion equipment

- Start infusing the Saline solution in KVO (5-10gtts/min.)

- Mix the blood by inverting the blood bag gently to mix the blood components, then

connect it to the IV line.

7. The blood transfusion should be in KVO for the first 15 mins.

8. Monitor the patient’s status for the first 5-10 mins. And observe for the presence of

adverse reactions such as chills, dizziness or fainting, Skin flushing, itching,

shortness of breath and fever

9. Document:

> Date and Time of transfusion.

> Hours to run.

> Vital signs of the patient.

> Premedications given such as Benadryl IM/Dipenhydramine.

> Type of Blood, blood unit number, and the sequence number.

> Typing and Crossmatching.

11. Monitor the client every 15 minutes for the first hour, 30 minutes for the second

hour and every hour until the desired running time

12. Terminate the transfusion

13. Monitor vital signs

14. Return the blood bag to the blood bank with requisition

15. Document relevant data. Record

> Completions of the transfusion

> Amount of blood absorbed

> Vital Signs

THINGS TO DO IF REACTION OCCURS

1. If blood transfusion reaction occurs:  STOP THE TRANSFUSION.

2. Start IV line (0.9% NaCl)

3.Place the client in Fowler’s position if with Shortness of Breath and administer O2

therapy.

4.The nurse remains with the client, observing signs and symptoms and monitoring

vital signs as often as every 5 minutes.

5.Notify the physician immediately.

6.The nurse prepares to administer emergency drugs such as antihistamines,

vasopressor, fluids, and steroids as per physician’s order or protocol.

7.Obtain a urine specimen and blood from the blood bag for coomb’s test to

determine if there is a presence of hemoglobin as a result of RBC hemolysis.

8.Blood container, tubing, attached label, and transfusion record are saved and

returned to the laboratory for analysis.

NURSING RESPONSIBILITIES

1.The patient should be fully informed about the procedure.

2.Get patient histories regarding previous blood transfusion.

3.The consent should be explained and signed prior to administration.

4.Ensure patient comfort.

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

compatible blood to be transfused against the cross matching 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.

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

MD accordingly.

7.Continue to observe and monitor patient post transfusion, for delayed reaction

could still occur.

8.Re-check Hgb and Hct, bleeding time, serial platelet count within specified hours as

prescribed and/or per institution’s policy.

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

Management (DOH/DENR).

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

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

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