Platelets

White blood cells

 BLOOD
• A mixture of cells
• A complex TRANSPORT mechanism
• Transports hormones
• Removes waste products
• Regulates body temperature
• Protects the body
• Promotes hemostasis
• Supplies oxygen
• BLOOD VOLUME:
– 8%of total body weight = varies by age & body composition

Categor Blood
mL/kg
y Volume
Adult 90 kg =
70 mL/kg
Male 6300 mL
Adult 60 kg =
70 mL/kg
Kilograms of Female 4200 mL
Blood Body Weight
30 kg =
Volume Child 80 mL/kg
2400 mL

85–90 mL/ 3 kg = 255

Neonate
kg – 270 mL
COMPOSITION OF BLOOD
Portions of the Blood
•Composed of:
•55% plasma
PLASM
A
•45% cellular
PLATELET components
S
GRANULOCYTES •Plasma = fluid portion
RED BLOOD CELLS
•Coagulation factors
•Inorganic substances
•Antibodies
 Plasma
• Liquid part of the blood

• Consists of serum and fibrinogen

• Contains plasma proteins such as:

– Albumin = regulates & maintains
– Serum globulins = for transportation
– Fibrinogen, prothrombin, plasminogen = to stop the
bleeding
 Cellular Components
• Formed elements of blood
– RBC = responsible for oxygen
transport

– WBC = play a major role in defense against

microorganism
s

– Platelets = function in
hemostasis
Blood: An Emotional Topic
“…the sweeping story of a
substance that has been feared,
revered, mythologized, and
used in magic and medicine
from earliest times—a
substance that has become the
center of a huge, secretive, and
often dangerous worldwide
commerce.”
—From the publisher’s description of the book
 TRANSFUSION
• Refers to the administration of any of
several blood products.
 BLOOD TRANSFUSION
• Is lifesaving therapy for patients with a variety of
medical and surgical conditions in need for blood.
Blood Transfusion may be necessary for any
of the following
reasons:
• Hemorrhage (blood loss) caused by trauma or
high blood loss surgery
• Red cell destruction
• Decreased red cell production
National Blood Services Act of 1994
• Also known as the Republic Act 7719
• AN ACT PROMOTING VOLUNTARY BLOOD DONATION
PROVIDING FOR AN ADEQUATE SUPPLY OF SAFE BLOOD,
REGULATING BLOOD BANKS, AND PROVIDING PENALTIES FOR
VIOLATION THEREOF.
Who CAN and CAN’T give Blood
• Eligible Donors
Must:
– Be at least age 18
– Weigh at least 110 lb (50 kg)
– Free from skin disease
– Not have donated in the past 56 days
– Have a hemoglobin level of at least 12.5 g/dl
(women) or 13.5 g/dl (men)
• Ineligible Donors include
those:
– Who have HIV or AIDS
– Who have taken illegal drugs I.V.
– Who have had sex with prostitutes in the past
12 months
– Who have had sex with anyone above
categories
– Who have had hepatitis
– With certain types of cancer (other than
minor skin cancer)
– With hemophilia
– Who have received clotting factor
concentrations
 Blood Collection Methods
• 3 Types of Blood Donor Sources for Routine
Blood Collection:
– Unrelated Donor (Allogeneic)

– Directed Donor

– Autologous Donor (Self)

 NURSES MUST BE:
– Knowledgeable about blood products

– Safe administration

– How to monitor patients before, during and

after therapy
 NURSES MUST BE:
• Assure that informed consent has been obtained
before starting a transfusion.

• Appropriate information to include in patient education

includes:
– Benefits
– Risks
– Alternatives to transfusion

• Document all patient education regarding transfusion

therapy, and the responses of patients and family
members after teaching.
 Patient Education
• Provide patient and family information to blood transfusion
therapy:
– The need for blood transfusion
– Advantages of blood transfusion
– Possible reactions related to the blood transfusion therapy
– Voluntary blood donation act
Transfusion Precautions
• Don’t add medications to the blood.

• Don’t transfuse the blood product if you discover a

discrepancy in the blood number, blood slip type, or
patient identification number.
• Don’t piggyback blood into the port of an existing
infusion set.
Stop transfusion if your patient shows:

– Shows changes in vital signs

– Is dyspneic or restless

– Develops chills, hematuria, or pain in the

flank, chest or back
BEFORE TRANSFUSION
• When assessing your patient before a
transfusion:
– Obtain important medical history information
– Review pertinent laboratory values
• Review the doctor’s order, including any special
processing requested
– Perform physical assessment
• When you received the delivery from the blood bank,
you should receive both the product and the
transfusion record that corresponds to it.

• Inspect for the following:

– Labels

– Integrity of Unit

– Appearance
• Perform the verification process to ensure the correct blood
is being given to the correct patient.
• Two qualified individuals should verify the patient and unit
identification.
• Assess the patency of the patient’s vascular access.

• Check and recheck vital signs 15 minutes after starting the

transfusion.
DURING TRANSFUSION
• Administer the blood or component at the
recommended rate.

• Stay with the patient for the first few

minutes of the transfusion

• Review signs and symptoms of what the

patient should report to you.
• Discontinue transfusion immediately
once the patient manifest symptoms of
transfusion reaction, assess the patient
and notify the doctor.

• Finally, document the transfusion in the

patient’s chart.
AFTER TRANSFUSION
• Continue to monitor patient for any signs and
symptoms of reaction for at least one hour
after the transfusion.

• Obtain any ordered post-transfusion

laboratory studies.
 Blood Indications Nursing Considerations
Products

Whole •To restore blood •Don’t infuse over more than 4

Blood volume in hours.
hemorrhaging, •Warm blood if giving a large
trauma, or burn quantity.
patients •Avoid giving when the patient
can’t tolerate the circulating
volume.
PRBC •To restore or •Don’t infuse over more than 4
maintain oxygen – hours.
carrying capacity •RBCs have the same oxygen –
•To correct anemia carrying capacity as whole blood,
and surgical blood minimizing the hazard of volume
loss overload.
 Blood Indications Nursing Considerations
Products

Platelets •To treat •ABO compatibility isn’t necessary but is

thrombocytopenia preferable with repeated platelet
•To treat acute leukemia transfusions; Rh type match is preferred.
and marrow aplasia •Infuse 100 ml over 15 minutes.
•Administer at 150 to 200 ml / hour, or
as rapidly as the patient can tolerate;
don’t exceed 4 hours.
•Avoid administering platelets when the
patient has a fever.
FFP •To expand plasma •Cross – matching: ABO compatibility
volume isn’t necessary but is preferable with
•To treat postsurgical repeated plasma transfusions; Rh type
hemorrhage or shock match is preferred.
•To correct an •Large – volume transfusions of FFP
undetermined may require correction for hypocalcemia.
coagulation factor Citric acid in FFP binds calcium.
deficiency
 SAFETY PRECAUTIONS
• Make sure that YOU are protected too by:

– Wear proper Personal Protective Equipment (PPE)

– Always perform disinfection technique.
– If possible, use a needleless system.
– If using sharps, do not recap the needle.
– Always observe proper waste disposal according to your
institution’s policy.
– If there are spills, never touch the blood with bare hands.
– Make sure that blood bag is secured.
– Always double or triple check.
– Always perform HAND HYGIENE
• Acute Transfusion Reactions usually appear
within the first 5-15 minutes after the
transfusion is started.

• Types of Acute Transfusion Reactions:

– Acute hemolytic Transfusion Reaction
– Febrile nonhemolytic Transfusion Reaction
– Mild allergic (Urticarial)
– Anapylactic
– Transfusion Associated Circulatory Overload
– Transfusion – Related Acute Lung Injury
– Septic Transfusion Reaction
• Symptoms you might see during an acute transfusion
reaction include:

– Temperature increase of more than 1°C or 2°F

– Bloody urine
– Chills
– Hypotension
– Severe low back, flank, or chest pain
– Low or absent urine output
– Nausea and vomiting
– Dyspnea, wheezing
– Anxiety, "sense of impending doom"
– Diaphoresis
– Generalized bleeding, especially from punctures and surgical
wounds.
WHAT TO DO IF TRANSFUSION REACTION
OCCURS…

• When they do occur, it is usually because

of ABO incompatibility between patient
and donor during transfusion of red cells.

• Ensure that the intended recipient is

getting the intended unit at the time of
transfusion.
• Should any of these symptoms occur, discontinue the unit immediately,
hang normal saline (on a new tubing) to maintain vascular access, and call
for assistance.

• Closely monitor the patient’s vital signs and symptoms.

• Notify the physician and obtain further orders to address the patient’s
symptoms.

• Recheck the patient’s identifying information against the transfusion

record and blood bag.

• All bags, tubings, filters, and paperwork should be retained and forwarded
per hospital policy.
DOCUMENTING BLOOD TRANSFUSIONS
• Date and time the transfusion was started
and completed
• Name of the health care professional who
verified the information of the patient and
the blood
• Catheter type and gauge
• Total amount of the transfusion
• Patient’s vital signs before and after the
transfusion
• Infusion device used
• Flow rate and if blood warming was used
• Vital signs obtain prior to, during, and after the
transfusion
• Name of the component, unit number
• Evidence of possible transfusion reaction.
– Document interventions done and to whom you notified.
• Patient’s outcome.