ASSIGNMENT ON BLOOD

TRANSFUSION

SUMBITTED TO: SUMBITTED BY:

MRS.LITTERSHIA BALIN.MSC (N), S.VISHNU PRIYA,
ASSOCIATE PROFESSOR, MSC (N) ST YEAR,
TEXCITY COLLEGE OF TXCITY COLLEGE OF
NURSING. NURSING
 BLOOD TRANFUSION:

INTRODUCTION :

A blood transfusion is a procedure that restores blood to the body. A healthcare

professional will pass blood through a rubber tube into a vein using a needle or
thin tube. The sections below will cover the different types of blood transfusion
procedures available, as well as the different types of blood.

DEFINITION:

A blood transfusion is a common procedure in which donated blood or blood

components are given to you through an intravenous line (IV). A blood
transfusion is given to replace blood and blood components that may be too low

Principles:

Whole blood transfusion:

Generally indicated only for patients who need both increased oxygen-carrying
capacity and restoration of blood volume when there is no time to prepare or
obtain the specific blood components needed.

Packed RBCs:

Should be transfused over 2 to 3 hours; if patient cannot tolerate volume over a

maximum of 4 hours, it may be necessary for the blood bank to divide a unit
into smaller volumes, providing proper refrigeration of remaining blood until
needed. One unit of packed red cells should raise hemoglobin approximately
1%, hemactocrit 3%.

Platelets:

Administer as rapidly as tolerated (usually 4 units every 30 to 60 minutes). Each

unit of platelets should raise the recipient’s platelet count by 6000 to
10,000/mm3: however, poor incremental increases occur with alloimmunization
from previous transfusions, bleeding, fever, infection, autoimmune destruction,
and hypertension.

Granulocytes:
May be beneficial in selected population of infected, severely granulocytopenic
patients (less than 500/mm3) not responding to antibiotic therapy and who are
expected to experienced prolonged suppressed granulocyte production.

Plasma:

Because plasma carries a risk of hepatitis equal to that of whole blood, if only

volume expansion is required, other colloids (e.g., albumin) or electrolyte
solutions (e.g., Ringer’s lactate) are preferred. Fresh frozen plasma should be
administered as rapidly as tolerated because coagulation factors become
unstable after thawing.

Albumin:

Indicated to expand to blood volume of patients in hypovolemic shock and to

elevate level of circulating albumin in patients with hypoalbuminemia. The
large protein molecule is a major contributor to plasma oncotic pressure.

Cryoprecipitate:

Indicated for treatment of hemophilia A, Von Willebrand’s

disease, disseminated intravascular coagulation (DIC), and uremic bleeding.

Factor IX concentrate:

Indicated for treatment of hemophilia B; carries a high risk of hepatitis because

it requires pooling from many donors.

Factor VIII concentrate:

Indicated for treatment of hemophilia A; heat-treated product decreases the risk

of hepatitis and HIV transmission.

Prothrombin complex:

Indicated in congenital or acquired deficiencies of these factors

Blood Components:

Component Additional Information

Packed RBCs 100% of erythrocyte, 100% of
leukocytes, and 20% of plasma
originally present in one unit of
whole blood
Leukocyte-poor packed RBCs Indicated for patients who have
experience previous febrile no
hemolytic reactions
Platelets either HLA (human leukocyte
antigen) matched or unmatched
Fresh frozen plasma Contains all coagulation factors,
including factors V and VIII
Granulocytes Contains basophils, eosinophils, and
neutrophils
Albumin A plasma protein.

Cryoprecipitate A plasma derivative rich in factor

Factor IX concentrate
Factor VIII concentrate
Prothrombin complex
VIII, fibrinogen, factor XIII, and
fibronectin
A concentrated form of factor IX
prepared by pooling, fractionating,
and freeze-drying large volumes of
plasma.
A concentrated form of factor IX
prepared by pooling, fractionating,
and freeze-drying large volumes of
plasma.
Contains prothrombin and factors
VII, IX, X, and some factor XI.

Types of blood transfusions:

According to the American Red Cross, there are four common types of blood
transfusions:

 Red blood cell transfusions: A person may receive a red blood cell
transfusion if they have experienced blood loss, if they have anemia (such
as iron deficiency anemia), or if they have a blood disorder.
  Platelet transfusions: A platelet transfusion can help those who have
lower platelet counts, such as from chemotherapy or a platelet disorder.
 Plasma transfusions: Plasma contains proteins important for health. A
person may receive a plasma transfusion if they have experienced severe
burns, infections, or liver failure.
 Whole blood transfusion: A person may receive a whole blood
transfusion if they have experienced a severe traumatic hemorrhage and
require red blood cells, white blood cells, and platelets.

Before a blood transfusion, a healthcare professional will remove the white

blood cells from the blood. This is because they can carry viruses.

That said, they may transfuse white blood cells called granulocytes to help a
person recover from an infection that has not responded to antibiotics.
Healthcare professionals can collect granulocytes using a process
called apheresis.

Blood types:

It is important that a healthcare professional uses the correct blood type during a
blood transfusion. Otherwise, the body might reject the new blood, which can
have severe consequences.

There are four types of blood:

 A
 B
 AB
 O

Each blood type can be positive or negative.

Blood type O is compatible with all other blood types. People with blood type O
are universal donors.
If someone is in a critical condition and bleeding heavily, a doctor may use
universal blood donor blood.

INDICATION:

Blood transfusions are necessary when the body lacks enough blood to function
properly. For example, a person may need a blood transfusion if they have
sustained a severe injury or if they have lost blood during surgery.

Some people need blood transfusions for certain conditions and disorders,
including:

 Anemia: This occurs when a person’s blood does not have enough red
blood cells. It can develop for a number of reasons, such as if a person
does not have enough iron in their body. This is known as iron deficiency
anemia.

 Hemophilia: This is a bleeding disorder wherein the blood is unable to

clot properly.
 Cancer: This occurs when cells in the body divide and spread to the
surrounding tissues.
 Sickle cell disease: This is a group of red blood cell disorders that change
the shape of red blood cells.
  Kidney disease: This occurs when the kidneys are damaged.
 Liver disease: This occurs when the liver stops functioning properly.

Necessary Equipment for a Blood Transfusion:

 IV access. Blood components may be provided through a number of central
venous access devices (CVAD) or peripheral intravenous catheters. ...
 Administration sets. ...
 Sets for blood components. ...
 Sets for PPPs. ...
 Infusion devices. ...
 Pressure infusion devices. ...
 Blood warmer devices
PREPARING FOR A BLOOD OR BLOOD PRODUCT TRANSFUSION:

STEPS ADDITIONAL INFORMATION

Verify the physician’s order for the
specific blood or blood product
Order must be verified for the type of
product; the amount, date, time, and
rate and duration of infusion; any
modifications to a blood component
(e.g., irradiation); specific transfusion
requirements; and possible sequence
in which multiple components are to
be transfused.

Verify the health care provider’s Some patients may require Benadryl
orders for any pre- or post-transfusionIV or Tylenol pretransfusion or Lasix
medications to be administered post-transfusion
Obtain the patient’s transfusion Past complications may require
history, and note any known allergies patient to have pre- and post-
and previous transfusion reactions. transfusion medications to prevent
further transfusion reactions
Verify that type and cross-match (also Verification allows for
known as a G & S) have been the identification of any newly
completed within the past 96 hours. developed antibodies, and ensures
current compatibility between donor

Verify patency of IV site.
Ensure appropriate patient
identification band is available and
legible
 Assess laboratory values, such as
hematocrit, coagulation values, and
platelet count
Check that the patient has properly
completed and signed the transfusion
consent form.
Assess patient’s understanding of the
procedure and its rationale. Consent
is required for the transfusion of
blood and blood components and
products.
red blood cells and recipient’s
plasma. If G & S is outdated or not
available, initiate process for new G
& S sample.
The patient’s IV cannula must be
patent and without complications,
such as infiltration or phlebitis. The
size of cannula (#18 to #20) must
match the guidelines set by Canadian
Blood Services.
To complete all safety identification
checks, proper identification must be
on the patient.
This ensures the transfusion is
appropriate for the patient.
All blood products must have a
consent form signed prior to the
transfusion.
Example of a consent form
Consent is mandatory for all blood
and blood product transfusions.
Follow agency policy if patient is
unable to sign or consent to blood or
blood product transfusions.
 Know the indications for the
transfusion.
Know why the patient is receiving the
transfusion.

Obtain and record the patient’s Pretransfusion vital signs are a

pretransfusion baseline vital signs, mandatory component of blood
including temperature, pulse, administration
respiration, blood pressure, and
oxygen saturation level. If the patient
is febrile, which means the patient’s
temperature is higher than 37.8°C
(100°F), notify the health care
provider before initiating the
transfusion.
 Have emergency equipment Be prepared for potential
available at the bedside (oxygen, complications, as prompt intervention
suction, etc.). may be required to prevent serious
complications
Complete all documentation as Proper documentation provides
required per agency policy evidence that all required procedures
have been followed to prepare for a
transfusion

Safety considerations::

 No medications may be added to blood units or through IV tubing.

 Specific blood administration tubing is required for all blood transfusions.
Blood tubing is changed every 4 hours or 4 units, whichever comes first.
 See agency policy for using EID for the administration of blood products.
 Intravenous immunoglobulin (IVIG) is only compatible with D5W.
 All blood products taken from the blood bank must be hung within 30 minutes
and administered (infused) within 4 hours due to the risk of bacterial
proliferation in the blood component at room temperature

PROCEDURE:
PROCEDURE
Verify physician orders
Assess or initiate venous access.
Initiate primary infusion at TKVO.
Complete and document
cardiovascular assessments and initial symptom that may be confused with a
vital signs.
Obtain products from the transfusion
areas within 30 minutes of planned
transfusion.
Complete visual inspection of
product.
Initial verification:
RATIONALE
Appropriate needle gauge is based on
clinical status of patient, urgency of
transfusion, and venous access:
#18 gauge for trauma/surgery
#20 to #22 for elective
medical/geriatric
Transfusion set must be Luer-locked
to a 2.0 ml maximum extension
tubing, either directly to cannula or
through a Max Plus positive pressure
cap.
Prime an IV line following Checklist
66.
0.9% NS for RBC
D5W for IVIG
Refer to blood product fact sheets for
all other products.
Document any clinical sign or
transfusion reaction (e.g., existing
fever).
Plan for pickup or delivery of blood
and blood products. Do not request
blood or blood products if Steps 1 to
4 are not complete.
Assess blood bag for any signs of
leaks or contamination, such as
clumping, clots, gas bubbles, or a
purplish discoloration. Return to
blood bank if blood bag contains any
of the above signs.
All verification numbers/information

a. Compare the transfusion medical
services (TMS) documentation with
the patient record to verify:
Patient first and last name and unique
identifier number
Physician order
Consent
Patient ABO grouping (G & S)
b. Compare the TMS documentation
with the product label attached to the
product tab and verify:
Patient first and last name and unique
identifier number
Type of blood product and ABO
blood grouping
11-digit serial number
Product expiry date and time
Special requirements (e.g., irradiated)
G & S expiry date
 Administer pre-medications as
ordered.
 Final verification (must be completed All verification numbers must match
by the same two staff members as
noted in Step 7).
Compare the patient’s first and last
name and unique identifier number
using all of the following:
Patient identification band or
equivalent ID process as approved by
the TMS (Ask the patient to spell first Spell first and last name
and last name and state date of birth.) State their date of birth
TMS documentation
must match exactly.
Must be completed by two trained
staff members competent in blood
transfusion administration process as
set out by the agency.
Confirm the patient blood type and
Rh are compatible with the donor
blood type and Rh.
If there are any discrepancies, stop
the process and contact the TMS for
resolution and direction. Do not
proceed.
Ensure the blood product matches the
physician’s orders (red blood cells or
platelets).
Medications must be administered
through an IV infusion set, and the IV
site cleared with 0.9% Ns
exactly. If there are any
discrepancies, stop the process and
contact the TMS for resolution and
direction. Do not proceed
Patients who are alert and oriented
should be asked to:
Compatibility tag and label attached
to blood product
Only after recipient identification and
product check is confirmed, invert
product 5 to 10 times and insert spike
of the blood administration set into
the blood product container.
 Perform hand hygiene. Prime the
blood product administration set:
Close clamp. Completely cover the
filter with product.
A straight blood administration set is
used for all transfusions.
A Y-type blood administration set
should only be considered in clinical
situations where additional fluid
volume may be required.
 Initiate transfusion:
Obtain vital signs immediately prior
to transfusion, then 15 minutes after
initiation, then every hour until
transfusion is complete.
Maintaining asepsis, disconnect the
NS infusion and connect blood
administration set and start
transfusion.
Advise patient on the signs and
symptoms of transfusion reaction and
what and when to report
All identifying information attached
to the blood bag must remain attached
at least until completion of
transfusion.
Do not remove the product from the
presence of the patient; prime at
bedside. If product is removed from
bedside, the final verification process
must be completed again.
Adults: Initiate red cells slowly (25
ml in the first 15 minutes). For all
other blood transfusions, refer to the
blood and product sheet as per your
agency policy.
Some agencies use an EID to
administer blood transfusions.
Always check agency policy prior to
transfusion.
For each and every unit:
Remain with the patient for the first 5
minutes and assess for clinical signs
of transfusion reaction.
Complete transfusion within 4 hours
of removal from the blood bank.
Most transfusion reactions occur
within first 15 minutes of a

Monitor:
Assess and observe for clinical signs
and symptoms of reactions up to 24
hours post-transfusion.
Complete all appropriate clinical
documentation
In the event of a transfusion reaction, Manage transfusion reactions as per
stop the infusion
For additional units, repeat steps 6 to
12.
 Flush administration set with
maximum of 50 ml of normal saline
and re-establish IV or SL as per
physician orders
 Discard waste in biohazard waste
container.
Complete all documentation as
required by agency.
transfusion. Infusing small amounts
of blood component initially
minimizes volume of blood to which
patient is exposed, thereby
minimizing severity of reaction.
Vital signs must be monitored:
Immediately prior to infusion
Within 10 to 15 minutes
Every hour until transfusion is
complete
protocol.
Complete required transfusion
reaction form.
Return remaining blood to blood bank
for further investigation.
Follow the same process to ensure
patient safety
Flushing displaces any blood or blood
product from the administration set. It
is not necessary to flush between
units of the same blood product.
This prevents the spread of biohazard
waste
Documentation may include:
Transfusion record form
All vital signs and reactions
Any significant findings, initiation
and termination of transfusion
Record of transfusion on the in-and-
out sheet
Nursing Interventions

1. Verify doctor’s order. Inform the client and explain the purpose of the
procedure.
2. Check for cross matching and typing. To ensure compatibility
3. Obtain and record baseline vital signs
4. Practice strict asepsis
5. At least 2 licensed nurse check the label of the blood transfusion. Check
the following:
 Serial number
 Blood component
 Blood type
 Rh factor
 Expiration date
 Screening test (VDRL, HBsAg, malarial smear) – this is to ensure that
the blood is free from blood-carried diseases and therefore, safe from
transfusion.
6. Warm blood at room temperature before transfusion to prevent chills.
7. Identify client properly. Two Nurses check the client’s identification.
8. Use needle gauge 18 to 19 to allow easy flow of blood.
9. Use BT set with special micron mesh filter to prevent administration of
blood clots and particles.
10.Start infusion slowly at 10 gtts/min. Remain at bedside for 15 to 30
minutes. Adverse reaction usually occurs during the first 15 to 20
minutes.
11.Monitor vital signs. Altered vital signs indicate adverse reaction (increase
in temp, increase in respiratory rate)
12.Do not mix medications with blood transfusion to prevent adverse effects.
Do not incorporate medication into the blood transfusion. Do not use
blood transfusion lines for IV push of medication.
13.Administer 0.9% NaCl before; during or after BT. Never administer IV
fluids with dextrose. Dextrose based IV fluids cause hemolysis.
14.Administer BT for 4 hours (whole blood, packed RBC). For plasma,
platelets, cryoprecipitate, transfuse quickly (20 minutes) clotting factor
can easily be destroyed.
15.Observe for potential complications. Notify physician.

COMPLICATION:

1. Allergic Reaction – it is caused by sensitivity to plasma protein of donor

antibody, which reacts with recipient antigen.
Assess for:

 Flushing
 Rash, hives
 Pruritus
 Laryngeal edema, difficulty of breathing
2. Febrile, Non-Hemolytic – it is caused by hypersensitivity to donor white
cells, platelets or plasma proteins. This is the most symptomatic complication of
blood transfusion

Assess for:

 Sudden chills and fever

 Flushing
 Headache
 Anxiety
3. Septic Reaction – it is caused by the transfusion of blood or components
contaminated with bacteria.

Assess for:

 Rapid onset of chills

 Vomiting
 Marked Hypotension
 High fever
4. Circulatory Overload – it is caused by administration of blood volume at a
rate greater than the circulatory system can accommodate.

Assess for:

 Dyspnea
 Crackles or rales
 Distended neck vein
 Cough
 Elevated BP

Hemolytic reaction – it is caused by infusion of incompatible blood

products.Assess for:

 Low back pain (first sign). This is due to inflammatory response of the

kidneys to incompatible blood.
 Chills
  Feeling of fullness
 Tachycardia
 Flushing
 Tachypnea
 Hypotension
 Bleeding
 Vascular collapse
 Acute renal failure

SUMMARY:

Till now we had seen about the introduction , definition, indication ,contra
indication , equipment , position , preparation , procedure , side effects ,
aftercare , nurse responsibility , complication of “BLOOD TRANSFUSION

CONCLUSION:

A blood transfusion is a safe procedure that replaces blood lost to injury or

surgery. It can also help treat certain medical conditions.Blood transfusions can
be lifesaving, but they can cause some mild side effects.Although infections are
very rare, it is possible for the body to react to the new blood. In most cases,
however, these reactions are mild.

BIBLIOGRAPHY:

 Adams KW, Tolich D. Blood transfusion: the patient's

experience. American Journal of Nursing. 2011;111(9):24–
2. [PubMed]
 JOYCE M BLACK,JANCE HAKANSON HAWLAS “MEDICAL
SURGICAL NURSING “ 1st volume published by Bangladesh,
publishers elsevie.
 BT BASAVANTHAPPA “MEDICAL SURGICAL NURSING “1ST
volume published by newdelhi,publishers jaypee brothers.
 LEWIS”MEDICAL SURICAL NURSING “ 1 volume,2ND south asia
edition, published by Elsevier publishers,
 BRUNNER @SIDDARTH’S “ TEXT BOOK OF MEDICAL
SURGICAL NURSING “ 10 th edition published by suzame c . smellizel
Brenda
NET REFERENCE:

https://opentextbc.ca/clinicalskills/chapter/blood-and-blood-product-
administration/

https://nurseslabs.com/blood-transfusion-therapy-nursing-management/

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