to stimulate the production of mature red blood cells, to

BLOOD TRANSFUSION maintain healthy oxygen levels in our tissues.

Course Outline
ETIOLOGY OF BLOOD CELL
DEFINITION OF BLOOD Blood cells do not originate in the bloodstream itself but in
PORTIONS OF THE BLOOD specific blood-forming organs, notably the marrow of certain
ETIOLOGY OF BLOOD CELL
bones. In the human adult, the bone marrow produces all the
UNDERSTANDING BLOOD TRANSFUSION THERAPY
ELIGIBLE & INELIGIBLE TO BLOOD DONATION red blood cells.
BLOOD CLOTTING FACTORS
NURSE’S RESPONSIBILITY The lymphatic tissues, particularly the thymus, the spleen, and
TRANSFUSION PRECAUTIONS the lymph nodes, produce the lymphocytes. And then, the
DOCUMENTATION reticuloendothelial tissues of the spleen, liver, lymph nodes,
BLOOD PRODUCTS and other organs produce the monocytes.
BLOOD TRANSFUSION
TRANSFUSION REACTIONS UNDERSTANDING BLOOD TRANSFUSION THERAPY

BLOOD is a mixture of cells and a complex TRANSPORT BLOOD TRANSFUSION

mechanism
▪ The infusion of whole blood or blood component into
T – transports hormones the patient’s venous circulation.
▪ Lifesaving therapy for patients with medical or surgical
R – removes waste products conditions that need blood.
▪ RA 7719 [National Blood Services Act of 1994] – an act
R – regulates body temperature of promoting voluntary blood donation.
▪ The volume of fluids will adjust within a few hours
P – protects the body
after your donation. The RBC will be replaced within a
P – promotes hemostasis few weeks.
▪ The minimum interval between 2 donations is 12
S – supplies oxygen weeks or 3 months.

PORTIONS OF THE BLOOD Indications of blood transfusion:

Blood is composed of 55% of plasma and 45% cellular (a) Hemorrhage caused by trauma
components. The body contains 10-12 pints (5-6 L) of blood, (b) High blood loss surgery
your whole blood donation approximately 1 pint or equivalent (c) Hemolysis
to 450-500 ml. (d) Anemia

Plasma is the main component of blood and consists mostly of Purposes:

water with CHON, ions, nutrients, lipids, glucose, and salt mixed
in.  To restore and maintain blood volume.
 To improve the oxygen-carrying capacity of the blood.
Platelets is a blood cell that is responsible for blood clotting. It  To replace deficient blood components.
stops the bleeding and promote blood clotting.
WHO CAN & WHO CAN’T GIVE BLOOD
White blood cells are cells that play a major role in defense in
microorganisms, so they fight viruses, bacteria, and other ▪ Eligible donors must:
foreign invaders that threaten your health.  18 and above
 Weigh at least 110lb
Red blood cells are responsible for carrying and transportation  Skin disease free
of oxygen and carbon dioxide.  Not donated in the past 56 days
 Hgb level is at least 12.5g/dl [women] or
Erythropoietin is a hormone that is produced by the kidneys
13.5g/dl [men]
when oxygen levels in the blood are low. It acts in bone marrow
 Normal VS
  Blood volume collected will depend mainly on  Gently suspend the RBC within the plasma
your body weight.  Observe signs of hemolytic reaction that generally
▪ Ineligible donors include: occurs within first 10-15 minutes.
 HIV, AIDS, STD
 Took illegal drugs Shivering, headache, low back pain, increased RR & PR,
hemoglobinuria, oliguria, and hypotension
 Had sex with prostitutes in the past 12
months  Observe signs of febrile reaction that usually occurs
 Had sex with anyone above categories withing 30 minutes
 Pregnant
Shaking, headache, elevated temperature, back pain,
 Hepatitis B/C
confusion, and hematemesis.
 Certain types of cancer
 Hemophilia  Act promptly if the patient develops bronchospasm
 Who have receive clotting factor and wheezing. This may indicate allergic reaction or
concentration anaphylaxis.
 Chronic alcoholism
INTERVENTIONS PRIOR BLOOD TRANSFUSION
 Body piercing and tattooing
✓ Proper cross-matching of donor’s and recipient’s blood
BLOOD CLOTTING FACTORS to assure compatibility.
I Fibrinogen ✓ After receiving delivery from blood bank, check if you
II Prothrombin receive both the product and the transfusion record
III Thromboplastin that corresponds to it.
IV Calcium ✓ Inspect the label, integrity of unit, and the appearance.
V Proaccelerin
VII Proconvertin (stable factor) SAFETY PRECAUTIONS
VIII Antihemophilic Factor A
IX Antihemophilic Factor B ❖ PPE
X Stuart-Prower Factor ❖ Hand hygiene or hand washing.
XI Plasma thromblastin antecedent ❖ If possible, use needleless system.
XII Hageman factor ❖ Do not recap the needle.
XIII Fibrin stabilizing factor
❖ Observe proper waste disposal.
NURSE’S RESPONSIBILITY ❖ Don’t touch blood with bare hands.
❖ Secure blood bag.
NURSES MUST: ❖ Always double or triple check.
❖ Perform disinfection technique.
 Assure that informed consent has been obtained prior
starting transfusion.
TRANSFUSION PRECAUTIONS
 Patient education regarding benefits, risks,
alternatives to transfusion [iron/ ESAs] 1 Don’t add medications to the blood.
2 Don’t transfuse if you suspect or discover discrepancy
RESPONSIBILITIES:
in blood number, blood type or pt identification
 Check blood or blood components have been typed & number.
cross-matched for compatibility. Two nurses verify the 3 Don’t piggyback blood into the port of an existing
blood type, Rh factor, serial number, extraction date infusion set.
and expiration date.
 Don’t administer blood without warming it. DOCUMENTATION
 Obtain VS before and 15 minutes after transfusion. □ Date and time of transfusion was started and
 Always have an isotonic solution set up as a primary completed.
line along with the transfusion.
□ Name of HCW who verified information of the patient
 Maintain standard precaution in handling blood or IV
and the blood.
equipment
□ Type of catheter and gauge.
 Inform the client or assure them that risk for AIDS is
□ Total amount of transfusion.
minimal because the blood is screened.
□ Pt vital signs before and after transfusion
 □ Infusion device It is made from 1 unit partially thawed FFP and the amount is
□ Flow rate and blood warmer if used 15mL. It is very rich in fibrinogen and Factor VIII.
□ Name of component, unit number Indications: it helps control bleeding or immediately prior to an
□ Evidence of possible transfusion reaction and the invasive procedure in patients with significant
interventions done. hypofibrinogenemia. It contains specific proteins for clotting.
□ Patient’s outcome. Indicated clients with missing factor VIII and factor XIII this
helps platelets stick together.

RISKS OF BLOOD TRANSFUSION Nursing Considerations: crossmatching is not required but it

should be ABO compatible. It must not store in ward fridges if
(1) HIV stored in fridge, require re-thawing by blood bank.
(2) Hepatitis B Administered at a rate of 5-10 minutes per unit. Faster
(3) Hepatitis C administration is for acute bleeding situations only.
(4) BT reactions
BLOOD TRANSFUSION
BLOOD PRODUCTS
EQUIPMENT NEEDED FOR BLOOD TRANSFUSION
WHOLE BLOOD
1) Blood product
Indications: to restore blood volume from hemorrhaging, 2) Blood transfusion set
trauma, or burn patients. One unit is given over 2-3 hours or 4- 3) IVF = 0.9 NaCl
6 hours. The total volume is approximately 450-500mL.
4) IV pole
Nursing Considerations: do not infuse more than 4 hours, warm 5) IV catheter
the blood if giving large quantity, and stop when the patient 6) Disposable gloves
can’t tolerate the circulating volume. 7) Micropore tape

PACKED RED BLOOD CELL (PRBC) PRE-ASSESSMENT

Indications: to restore or maintain the oxygen-carrying ▪ Secure BT consent

capacity, correct anemia or surgical blood loss and the total
volume of blood is 250mL.
Nursing Considerations: do not infuse for more than 6 hours.
RBCs have the same oxygen-carrying capacity as whole blood,
minimizing the hazard of volume overload.
PLATELETS
DOING BLOOD TRANSFUSION
Indications: to treat thrombocytopenia, acute leukemia, and
marrow aplasia. The total volume is approximately 50mL.
Nursing Considerations: RH type matching is compared to ABO
compatibility is preferable with repeated platelet transfusions.
100mL is infuse over 15 minutes. Administer at 150 to 200mL
per hour or as rapidly as the pt can tolerate and don’t exceed to
4 hours. Avoid administering platelets to febrile patients.
FRESH FROZEN PLASMA (FFP)
Indications: one unit is 200-250mL and this can treat
postsurgical hemorrhage/shock and correct an undetermined
coagulation factor deficiency.
Nursing Considerations: RH type matching is compared to ABO
compatibility is preferable with repeated platelet transfusions.
Large volume of FFP may require correction for hypocalcemia.
Citric acid in FFP binds in calcium.
CRYOPRECIPITATE
▪ Obtain baseline vital signs, lung sounds, and urinary
output.
▪ Review recent laboratory values.
▪ Ask for previous transfusion reactions.
▪ Inspect IV insertion site and check type of solution.
1) Determine whether patient knows reason for
transfusion.
2) Explain to patient what will happen. Check for signed
consent. Advise the patient to report any hemolytic or
febrile reactions.
3) Give pre-medications, if ordered by the physician.
4) Hang container of NSS with blood transfusion. Initiate
infusion.
5) Start IV with gauge 18 or 19. Run normal saline at KVO.
6) Obtain the blood product.
7) Complete identification and checks.
8) Take baseline VS.
9) Start infusion of blood [thawed].
✓ Prime in-line filter with blood.
✓ Start administration slowly.
✓ Stay with the patient for the first 5 to 15
minutes of transfusion.
✓ Check vital signs q15 for the first hour
 ✓ Observe for blood transfusion reactions.
10) Consume blood within 6 hours.
11) Assess frequently for transfusion reactions.
TERMINATING THE TRANSFUSION
➢ Flush the blood tubing with an adequate amount of
NSS according to patient’s condition.
➢ On a Y-type set, close the clamp on the bloodline and
open the clamp on the saline solution line.
➢ Discard tubing, filter, and blood bag according to
policy of institution.
➢ Reassess the patient’s condition and vital signs.
TRANSFUSION REACTIONS
DEFINITION
➢ Reaction of the body to transfusion of blood that’s not
compatible with its own blood.
➢ Usually attributed to major antigen-antibody
reactions.
➢ Acute transfusion reactions usually appear within the
first 5 to 15 minutes after transfusion started.
WHEN BT REACTION OCCURS… SPIN
S – stop the infusion
Nursing Interventions: administer antihistamines
Prevention: premedicate with antihistamine if pt has hx of
allergic reactions. Observe pt closely for the first 30 minutes
of the transfusion.
(iv) Plasma Protein Incompatibility
Nursing Interventions: treat shock by administering O2,
fluids, epinephrine, or steroid as ordered.
Prevention: transfuse only IgA-deficient blood or well
washed RBCs.
(v) Bacterial Contamination
Nursing Interventions: broad-spectrum antibiotics and
steroids treatment.
Prevention: inspect blood prior transfusion for gas, clot, &
dark purple color. Use air free, touch-free methods to draw
& deliver blood. Maintain strict storage control. Change the
blood tubing and filter q4h. Infuse each unit of blood over2-
4hrs; terminate the infusion if the time period exceeds
4hours. Maintain sterile technique when administering
blood products.
(vi) Circulation Overload
Nursing Interventions: stop infusion and maintain IV with
NSS. Administer O2 while the head is elevated. Administer
diuretics as ordered by the physician.
Prevention: transfuse blood slowly. Don’t exceed 2 units in
4 hours; less for elderly, infants or pt with cardiac
conditions.

P- pulse and other vital signs assessment

I – infuse NSS

N – notify the physician

TRANSFUSION REACTION MANAGEMENT

(i) Hemolytic
Nursing Interventions: keep track BP, treat shock as
indicated [IVF, O2, epinephrine, diuretic, and vasopressor].
Obtain post transfusion reaction, blood and urine sample
for evaluation. Observe signs of hemorrhage resulting from
DIC
Prevention: Before transfusion, check donor & recipient
blood types to ensure compatibility. Identify pt with
another nurse or doctor present. Transfuse the blood slowly
for the first 15 to 20 minutes closely observe the patient for
the first 30 minutes of the transfusion.
(ii) Febrile
Nursing Interventions: Administer antipyretic, antihistamine
or meperidine.
Prevention: premedicate with an antipyretic, antihistamine
or steroid. Use leukocyte-poor or washed RBCs. Use
leukocyte-poor removal filter specific to the component.
(iii) Allergic Reaction