→ Is the introduction of whole blood or blood components into
venous circulation.
---------------------------HISTORY------------------------------
→ Where blood transfused in humans started.
→ Physician William Harvey fully described circulation and
properties of blood.
→ The first successful blood transfusion was done by physician
Richard Lower in England on a dog.
→ The first human blood transfusion was performed by Dr.
Philip Syng Physick.
→ The first transfusion of human blood for the treatment of
hemorrhage was performed by Dr. James Blundell in
London.
→ Landsteiner described ABO groups.
→ The Kimpton-Brown transfusion apparatus was commonly
used before citration.
→ First use of blood storage.
→ Levine described the Rh factor.
-----------------------------BLOOD------------------------------
→ Is a familiar red fluid in the body that contain white blood
cells, red blood cells, platelet, proteins, and other elements.
→ Each part of the blood has special function and can be
separated from each other.
→ Donor blood is converted into various products, including:
• Packed red blood cells (RBCs)
• Whole blood
• Platelets
• Fresh frozen plasma
• Albumin
• Cryoprecipitates
→ Also known as an erythrocyte, this cell contains hemoglobin,
which binds to oxygen in the lungs, and carries the oxygen
throughout the body by way of the circulatory system.
→ A type of blood product that are used to replace erythrocytes
lost as a result of trauma or surgical intervention or in clients
with bone marrow suppression.
→ Used to increase the oxygen-carrying of blood in anemias,
surgery, and disorders with slow bleeding.
→ 1 unit of PRBCs has the same amount of oxygen-carrying
RBCs as a unit of whole blood.
→ 1 unit raises hematocrit by approximately 2% to 3%.
→ Blood unaltered, as it is taken from the donor.
→ Composed of RBCs, plasma, and plasma proteins.
→ It is administered primarily to treat hypovolemic shock
resulting from hemorrhage.
→ 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.
→ A type of blood cell that is involved in the clotting process.
→ Platelets are administered to clients with low platelet counts
as a means of preventing hemorrhage and to
thrombocytopenic clients who are actively bleeding or
scheduled for invasive procedures.
→ 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.
→ A type of blood component administered to augment clotting
factors in clients who are deficient in such factors.
→ Provides clotting factors.
→ Does not need to be typed and crossmatched (contains no
RBCs).
→ A type of blood component administered to augment clotting
factors in clients who are deficient in such factors.
→ A type of plasma protein that is used to treat hypovolemic
shock or hypoalbuminemia.
→ Albumin and plasma protein fraction are used as blood
volume expander and provides plasma proteins.
→ Various blood components used to remedy deficiencies of
clotting factors in conditions such as hemophilia or von
Willebrand disease.
→ Used for clients with clotting factor deficiencies.
→ Each provides different factor involved in the clotting
pathway; cryoprecipitate also contains fibrinogen.
ABO
- A type of antigen system.
- The ABO type of the
donor should be compatible with the recipient's.
Human blood is commonly classified into four
main groups: A, B, AB, and O.
→ The surface membrane of the red blood cell (RBC) is
characterized by glycoproteins known as antigens.
→ More than 400 different antigens have been identified on the
RBC membrane.
→ Yet, A, B, and Rh antigens are the most important in
determining blood group or type.
compared with the name on the client's identification band
or bracelet.
→ The recipient’s ABO and Rh types are identified.
→ An antibody screen is performed to determine whether
antibodies other than anti-A and anti-B are present.
Crossmatching
- Is performed:
✓ Donor red blood cells (RBCs) are combined with the
recipient’s serum and Coombs’ serum.
✓ The crossmatch is compatible if no RBC
agglutination occurs = no antibodies are present.
→ The universal RBC donor is O-negative; the universal
recipient is AB-positive.

→ These are proteins produced by B lymphocytes; they consist

of two light and two heavy chains that form a Y shape.
→ These antibodies are often called agglutinins.

• Rh positive (Rh+) blood that contains the Rh factor.
• Rh negative (Rh-) blood that does not contains the Rh
factor.
→ Unlike the ABO system, Rh blood does not naturally contain
Rh antibodies.
→ Transfusion of ABO- or Rh- incompatible blood can result
in a hemolytic transfusion reaction, which causes
destruction of the transfused RBCs and subsequent risk of
kidney damage or failure.

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

→ Client blood samples are drawn and labeled at the bedside;

the client is asked to state his or her name, which is
 → A type of autologous donation in which blood is suctioned
from a client’s body cavities, joint spaces, and other closed
body sites during a procedure.
→ Blood obtained through blood salvage may need to undergo
“washing”, a process that removes tissue debris, before
being infused.

→ A compatible donor who has been selected by the recipient

or, in a procedure also known as directed donation,
volunteers to donate on behalf of the client.
→ Infusion of blood taken from a designated donor does not
reduce the risk of bloodborne infection, but recipients often
feel more comfortable about taking blood from a donor they
know and approve of.

• Never store blood in a refrigerator other than those used in

blood banks (blood bank refrigerators are equipped with
controlled temperatures designed for blood storage).
• Make sure that the blood is left at room temperature for no
more than 30 minutes before starting the transfusion.
Blood must be returned to the blood bank if it has not been
started.
• A transfusion should be completed within 4 hours of
initiation. The maximum time for use of a blood filter is 4
hours (Phillips & Gorski, 2014).
• No fluid other than normal saline solution should be added
to blood components, nor should medications be added to
a blood transfusion.

• The recommended rate of infusion varies with the blood

component being transfused and the client's condition, but
generally blood is infused as quickly as the client's
condition will allow.
• Blood products containing few RBCs, such as platelets,
may be infused rapidly (over 15 to 30 minutes), but care
should be taken to avoid circulatory overload.
• Vital signs and lung sounds should be assessed before the
transfusion, again after the first 15 minutes of transfusion,
and every hour until 1 hour has passed since the
transfusion was completed.

→ Donation of the client's own blood before a scheduled

procedure or in anticipation of some other future need.
→ With another nurse (most agencies require an RN), verify
→ Reduces the risk of disease transmission and potential
the following before initiating the transfusion (Phillips &
transfusion complications but is not an option for a client
Gorski, 2014, p. 731):
with leukemia or bacteremia.
✓ Order: Check the blood or component against the
primary care provider’s written order.
✓ Transfusion consent form: Ensure the form is
completed per facility policy.
✓ Client identification: The name and identification
number on the client’s identification band must be
identical to the name and number attached to the unit
of blood.
✓ Unit identification: The unit identification number on
the blood container, the transfusion form, and the tag
attached to the unit must agree.
✓ Blood type: The ABO group and Rh type on the
primary label of the donor unit must agree with those
recorded on the transfusion form.
✓ Expiration: The expiration date and time of the donor
unit should be verified as acceptable.
✓ Compatibility: The interpretation of compatibility
testing must be recorded on the transfusion form and
on the tag attached to the unit.
✓ Appearance: There should be no discoloration,
foaming, bubbles, cloudiness, clots or clumps, or loss
of integrity of the container.

• To restore blood volume after severe hemorrhage.

• To restore the oxygen-carrying capacity of the blood.
• To provide plasma factors, such as antihemophilic factor
(AHF) or factor VIII, or platelet concentrates, which
prevent or treat bleeding

• Vital signs.
• Physical examination including fluid balance and heart
and lung sounds as manifestations of hypo- or
hypervolemia.
• Status of infusion site.
• Blood test results such as hemoglobin value or platelet
count.
• Any unusual symptoms.

• Prior to performing the procedure, introduce self and

verify the client’s identity using agency protocol. Explain
to the client what you are going to do, why it is necessary,
and how he or she can participate.
• Instruct the client to report promptly any sudden chills,
nausea, itching, rash, dyspnea, back pain, or other unusual
symptoms.
• Provide for client privacy and prepare the client.
• Perform hand hygiene and observe other appropriate
infection prevention procedures.
• Prepare the infusion equipment.
• Prime the tubing.
• Start the saline solution.
• Obtain the correct blood component for the client.
• Prepare the blood bag. Invert the blood bag gently several
times to mix the cells with the plasma.
• Establish the blood transfusion.
✓ Close the upper clamp below the IV saline solution
container.
✓ Open the upper clamp below the blood bag.
• Observe the client closely for the first 15 minutes.
✓ Phillips and Gorski (2014) report that the AABB
recommends that “transfusions of RBCs be started
at 1–2 mL/min for the first 15 minutes of the
transfusion” (p. 732).
• Document relevant data.
✓ Record starting the blood, including vital signs, type
of blood, blood unit number, sequence number (e.g.,
#1 of three ordered units), site of the venipuncture,
size of the catheter, and drip rate.
• Monitor the client.
✓ Fifteen minutes after initiating the transfusion (or
according to agency policy), check the vital signs.
✓ If there are no signs of a reaction, establish the
required flow rate.
• Follow agency protocol for appropriate disposition of the
used supplies.
• Document relevant data.
✓ Record completion of the transfusion, the amount of
blood absorbed, the blood unit number, and the vital
signs.
✓ If the primary IV infusion was continued, record
connecting it.
✓ Also record the transfusion on the IV flow sheet and
intake and output record.