NAME: DIZON, DEXIE

SECTION: MIXED GROUP

BLOOD TRANSFUSION ACTIVITY

1. What are the components of Blood (draw and discuss each component)

ABO Compatibilities for Transfusion Therapy

Component Compatibilities
Whole Blood Give Type-Specific Blood Only
Donor Recipient
O O, A, B, AB
Packed red cells (stored, washed, or frozen/washed) A A, AB
B B, AB
AB AB
Donor Recipient
O O
A A, O
Fresh-frozen plasma B B, O

AB AB, B, A, O
RBC: ABO and Rh compatible
preferred
Donor Recipient
Platelets O O, A, B, AB
A A, AB
B B, AB
AB AB
2. What are the different blood products used for blood transfusion?

Blood Products for Transfusion

Product Use

Whole blood Not commonly used except for extreme cases of acute hemorrhage. Replaces
blood volume and all blood products: RBCs, plasma, plasma proteins, fresh
platelets, and other clotting factors.

Packed red blood cells Used to increase the oxygen-carrying capacity of blood in anemias, surgery,
(PRBCs) and disorders with slow bleeding. One unit of PRBCs has the same amount of
oxygen-carrying RBCs as a unit of whole blood. One unit raises hematocrit by
approximately 2% to 3%.

Autologous RBCs Used for blood replacement following planned elective surgery. Client donates
blood for autologous transfusion 4–5 weeks prior to surgery.

Platelets Replaces platelets in clients with bleeding disorders or platelet deficiency.

Fresh platelets are most effective. Each unit should increase the average adult
client’s platelet count by about 5,000 platelets/microliter.

Fresh frozen plasma Does not need to be typed and cross-matched (contains no RBCs).
Provides clotting
factors.

Albumin and plasma Blood volume expander; provides plasma proteins.

protein fraction

Clotting factors and Used for clients with clotting factor deficiencies. Each provides different
cryoprecipitate factors involved in the clotting pathway; cryoprecipitate also contains
fibrinogen.
 3. What is blood transfusion? What are the goals/purpose?

 IV fluids can be effective in restoring intravascular (blood) volume; however, they do not affect the
oxygen-carrying capacity of the blood. When red or 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, clot, fight infection, and keep extracellular fluid
within the intravascular compartment. A blood transfusion is the introduction of whole blood or blood
components into venous circulation.

 Blood transfusion, or blood component therapy, is the IV administration of whole blood or a blood
component such as packed red blood cells (RBCs), platelets, or plasma. Objectives for administering
blood transfusions include (1) increasing circulating blood volume after surgery, trauma, or
hemorrhage; (2) increasing the number of RBCs and maintaining hemoglobin levels in patients with
severe anemia; and (3) providing selected cellular components as replacement therapy (e.g., clotting
factors, platelets, albumin).

4. Nursing responsibilities in blood transfusion

 Caring for patients receiving blood or blood-product transfusion is a nursing responsibility. You must be
thorough in patient assessment, checking the blood product against prescriber's orders, checking it
against patient identifiers, and monitoring for any adverse reactions. Blood transfusions are never
regarded as routine; overlooking any minor detail can have dangerous and life-threatening events for a
patient (AABB, 2014a,b).

CRITICAL THINKING:

Basic knowledge:
1. What are the functions of red cells, Fresh Frozen Plasma (FFP) and platelets and when should they be
transfused?

Blood Products for Transfusion

Product Use

Packed red Used to increase the oxygen-carrying capacity of blood in anemias, surgery, and
blood cells disorders with slow bleeding. One unit of PRBCs has the same amount of oxygen-
(PRBCs) carrying RBCs as a unit of whole blood. One unit raises hematocrit by
approximately 2% to 3%.

Platelets Replaces platelets in clients with bleeding disorders or platelet deficiency. Fresh
platelets are most effective. Each unit should increase the average adult client’s
platelet count by about 5,000 platelets/microliter.
 Fresh frozen Does not need to be typed and cross-matched (contains no RBCs).
plasma
Provides
clotting
factors

2. When discussing Rh D factor in relation to blood, what does it refer to and can a person with a
negative Rh D factor be transfused positive blood?
 In contrast to the ABO blood groups, Rh− blood does not naturally contain Rh antibodies. However,
after 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 exposure to Rh+
blood places the client at risk for an antigen–antibody reaction and hemolysis of RBCs. Transfusion of
ABO- or Rh- incompatible blood can result in a haemolytic transfusion reaction, which causes
destruction of the transfused RBCs and subsequent risk of kidney damage or failure. To avoid hemolytic
transfusion reactions, blood from the donor and from the recipient is tested for compatibility. This is
referred to as a type and crossmatch.

 Blood transfusions must be matched to each patient to avoid incompatibility. RBCs have antigens in
their membranes; the plasma contains antibodies against specific RBC antigens. If incompatible blood is
transfused (i.e., a patient's RBC antigens differ from those transfused), the patient's antibodies trigger
RBC destruction in a potentially dangerous transfusion reaction (i.e., an immune response to the
transfused blood components).

Rh D blood group:
1. How many types of Rh D are there? Name them.
 Blood that contains the Rh factor is known as Rh positive (Rh+); blood that does not contain the Rh
factor is known as Rh negative (Rh−). There are 4 main blood groups (types of blood) – A, B, AB and O.
Your blood group is determined by the genes you inherit from your parents. Each group can be either
RhD positive or RhD negative, which means in total there are 8 blood groups.

2. Is the RhD blood group relevant to all blood components? Name the relevant components……………
 It is the antigens of the ABO and Rh blood groups that cause the most vigorous transfusion reactions.
The ABO blood groups are based on which of two antigens, type A or type B, a person inherits. Absence
of both antigens results in type O blood, presence of both antigens leads to type AB, and the presence
of either A or B antigen yields type A or B blood, respectively. In the ABO blood group, antibodies form
during infancy against the ABO antigens not present on your own RBCs. A baby with neither the A nor
the B antigen (group O) forms both anti-A and anti-B antibodies; those with type A antigens (group A)
form anti-B antibodies, and so on. To keep this idea straight, remember that antibodies against a
person’s own blood type will not be produced.
 Unlike the antibodies of the ABO system, anti-Rh antibodies are not automatically formed by Rh− (“Rh
negative”) individuals. However, if an Rh− person receives Rh+ blood, shortly after the transfusion his or
her immune system becomes sensitized and begins producing anti- Rh+ antibodies against the foreign
blood type. Hemolysis (rupture of RBCs) does not occur in an Rh− person with the first transfusion of
Rh+ blood because it takes time for the body to react and start making antibodies. However, the second
time and every time thereafter, a typical transfusion reaction occurs in which the patient’s antibodies
attack and rupture the donor’s Rh+ RBCs. An important Rh-related problem occurs in pregnant Rh−
women who are carrying Rh+ babies. The first such pregnancy usually results in the delivery of a healthy
baby. But because the mother is sensitized by Rh+ antigens that have passed through the placenta into
her bloodstream, she will form anti-Rh+ antibodies unless treated with RhoGAM in the 28th week of
pregnancy and again shortly after giving birth. RhoGAM is an immune serum that prevents this
sensitization and subsequent immune response. If she is not treated and becomes pregnant again with
an Rh+ baby, her antibodies will cross through the placenta and destroy the baby’s RBCs, producing a
condition known as hemolytic disease of the newborn. The baby is anemic and becomes hypoxic and
cyanotic (the skin takes on a blue cast). Brain damage and even death may result unless fetal
transfusions are done before birth to provide more RBCs for oxygen transport.

3. AJ is a 56 year old male who is Rh D negative but the Blood Transfusion Laboratory (BTL) has sent you
an Rh D positive component? Can you transfuse this component? Give a reason for your answer
 Yes. Though, as a general rule, RhD negative individuals should not be transfused with RhD positive red
cells, especially RhD negative girls and women of childbearing age. When it comes to blood transfusion,
anyone who is Rh positive can receive blood from someone who is Rh negative, but those with negative
blood types cannot receive from anyone with a positive blood type. Transfusion of ABO- or Rh-
incompatible blood can result in a haemolytic transfusion reaction, which causes destruction of the
transfused RBCs and subsequent risk of kidney damage or failure. However, if an Rh− person receives
Rh+ blood, shortly after the transfusion his or her immune system becomes sensitized and begins
producing anti- Rh+ antibodies against the foreign blood type. Hemolysis (rupture of RBCs) does not
occur in an Rh− person with the first transfusion of Rh+ blood because it takes time for the body to
react and start making antibodies

4. John, 28 years old, road traffic accident, post severed artery repair has lost a lot of blood before
surgery and continues to ooze. He is Rh D negative and the BTL has issued Rh D positive components?
What must you consider?
 We must consider that this is the first time that John will be transfused with an Rh D positive
component. Hence, Hemolysis (rupture of RBCs) does not occur in an Rh− person with the first
transfusion of Rh+ blood because it takes time for the body to react and start making antibodies.
However, the second time and every time thereafter, a typical transfusion reaction occurs in which the
patient’s antibodies attack and rupture the donor’s Rh+ RBCs (in the case of the D antigen, individuals
who do not produce the D antigen will produce anti-D if they encounter the D antigen on transfused
RBCs causing a hemolytic transfusion reaction - HTR).
5. Rh D negative patients may receive Rh D positive components True/false. Give examples to support
your answer.

 TRUE. Unlike the antibodies of the ABO system, anti-Rh antibodies are not automatically formed by Rh−
(“Rh negative”) individuals. However, if an Rh− person receives Rh+ blood, shortly after the transfusion
his or her immune system becomes sensitized and begins producing anti- Rh+ antibodies against the
foreign blood type. Hemolysis (rupture of RBCs) does not occur in an Rh− person with the first
transfusion of Rh+ blood because it takes time for the body to react and start making antibodies.
However, the second time and every time thereafter, a typical transfusion reaction occurs in which the
patient’s antibodies attack and rupture the donor’s Rh+ RBCs.

 An important Rh-related problem occurs in pregnant Rh− women who are carrying Rh+ babies. The first
such pregnancy usually results in the delivery of a healthy baby. But because the mother is sensitized by
Rh+ antigens that have passed through the placenta into her bloodstream, she will form anti-Rh+
antibodies unless treated with RhoGAM in the 28th week of pregnancy and again shortly after giving
birth. RhoGAM is an immune serum that prevents this sensitization and subsequent immune response.
If she is not treated and becomes pregnant again with an Rh+ baby, her antibodies will cross through
the placenta and destroy the baby’s RBCs, producing a condition known as hemolytic disease of the
newborn. The baby is anemic and becomes hypoxic and cyanotic (the skin takes on a blue cast). Brain
damage and even death may result unless fetal transfusions are done before birth to provide more
RBCs for oxygen transport.