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Catanduanes State Colleges College of Health Sciences NURSING DEPARTMENT Virac,Catanduanes



Submitted to: Ms. MARIA ALMA V. TABIRARA, RN., MAN Clinical Instructor

and freeze-drying large volumes of plasma. Granulocytes ( basophils. 2. 11. Single donor plasma. 3. Increases availability of needed blood products to larger population. indicated to increase the oxygen-carrying capacity of blood with minimal expansion of blood. 2. Fresh frozen plasma. infection. Packed RBCs (100% of erythrocyte. and freeze-drying large volumes of plasma. autoimmune destruction. and hypertension. a concentrated form of factor IX prepared by pooling. either HLA (human leukocyte antigen) matched or unmatched. Whole blood stored for more than 6 hours does not provide therapeutic platelet transfusion. Leukocyte-poor packed RBCs. nor does it contain therapeutic amounts of labile coagulation factors (factors V and VIII). factor XIII. the preferred product for reversal of Coumadin-induced anticoagulation. a plasma derivative rich in factor VIII. it may be necessary for the blood bank to divide a unit into smaller volumes. poor incremental increases occur with alloimmunization from previous transfusions. Cryoprecipitate. and 20% of plasma originally present in one unit of whole blood). 10. Provides optimal therapeutic benefit while reducing risk of volume overload. bleeding. indicated for patients who have experience previous febrile no hemolytic reactions. Prothrombin complex. fractionating. Avoids the risk of sensitizing the patients to other blood components. Whole blood transfusion o 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. if patient cannot tolerate volume over a maximum of 4 hours. 3. providing proper refrigeration of remaining blood until needed. fractionating.000/mm3: however. Platelets o Administer as rapidly as tolerated (usually 4 units every 30 to 60 minutes). Platelets. Factor VIII concentrate. and some factor XI.BLOOD TRANSFUSION THERAPY involves transfusing whole blood or blood components (specific portion or fraction of blood lacking in patient). containing all coagulation factors. Albumin. One unit of whole blood consists of 450 mL of blood collected into 60 to 70 mL of preservative or anticoagulant. containing all stable coagulation factors but reduced levels of factors V and VIII. 8. Principles of blood transfusion therapy 1. . Packed RBCs o Should be transfused over 2 to 3 hours. and fibronectin. 100% of leukocytes. 2. IX. 3. ADVANTAGES of blood component therapy 1. X. hemactocrit 3%. One unit of packed red cells should raise hemoglobin approximately 1%. including factors V and VIII (the labile factors). 6. eosinophils. Each unit of platelets should raise the recipient¶s platelet count by 6000 to 10. fibrinogen. containing prothrombin and factors VII. 7. 9. Factor IX concentrate. 4. a plasma protein. BLOOD COMPONENTS include: 1. and neutrophils ) 5. fever. a concentrated form of factor IX prepared by pooling.

Fresh frozen plasma should be administered as rapidly as tolerated because coagulation factors become unstable after thawing. carries a high risk of hepatitis because it requires pooling from many donors. But if you have Rh-negative blood. it's either A positive or A negative. Cryoprecipitate o Indicated for treatment of hemophilia A. or natural disasters²need blood transfusions to replace blood lost during the injury. About 40 percent of the population has type O blood. The blood used in a transfusion must work with your blood type. BLOOD TYPES Every person has one of the following blood types: A. Type O blood is safe for almost everyone. . Some people need blood or parts of blood because of illnesses. Some people who have serious injuries²such as from car crashes. you should only get Rh-negative blood. almost 5 million Americans need blood transfusions. For example. heat-treated product decreases the risk of hepatitis and HIV transmission. Rh-negative blood is used for emergencies when there's no time to test a person's Rh type. 10. if you have type A blood.4. Factor VIII concentrate o Indicated for treatment of hemophilia A. Plasma o Because plasma carries a risk of hepatitis equal to that of whole blood. about one-third of all heart surgery patients have a transfusion. 9. Granulocytes o May be beneficial in selected population of infected. antibodies (proteins) in your blood attack the new blood and make you sick. If it doesn't.g. Also. WHO NEEDS A BLOOD TRANSFUSION? Blood transfusions are very common. and uremic bleeding. every person's blood is either Rh-positive or Rh-negative. People who have type AB blood are called universal recipients. Von Willebrand¶s disease. you can get Rh-positive or Rh-negative blood. This means they can get any type of blood. 8. Albumin o Indicated to expand to blood volume of patients in hypovolemic shock and to elevate level of circulating albumin in patients with hypoalbuminemia. This procedure is used for people of all ages. 6. 7. If you have Rh-positive blood. severely granulocytopenic patients (less than 500/mm3) not responding to antibiotic therapy and who are expected to experienced prolonged suppressed granulocyte production. Factor IX concentrate o Indicated for treatment of hemophilia B. if only volume expansion is required. 5. Type O blood is used for emergencies when there's no time to test a person's blood type. or O. disseminated intravascular coagulation (DIC). albumin) or electrolyte solutions (e. Each year. Many people who have surgery need blood transfusions because they lose blood during their operations. AB.. other colloids (e. Prothrombin complex-Indicated in congenital or acquired deficiencies of these factors. People who have this blood type are called universal donors. war.g. Ringer¶s lactate) are preferred. So. B.. The large protein molecule is a major contributor to plasma oncotic pressure. You may need a blood transfusion if you have: y A severe infection or liver disease that stops your body from properly making blood or some parts of blood.

Lung Injury Although it's unlikely. Over-the-counter fever medicine usually will treat the fever. However. and other parts of your body. These people usually were very ill before the transfusion. Iron overload can damage your liver. If you have iron overload. such as HIV. such as hemophilia or thrombocytopenia (THROM-bo-si-to-PE-ne-ah). The health care team determines how mild or severe the reaction is. such as kidney disease or cancer. This is usually your body's normal response to white blood cells in the donated blood. hemolytic.y An illness that causes anemia. Most patients recover. which requires multiple transfusions. Doctors aren't completely sure why blood transfusions damage the lungs. and clammy skin A quick pulse or low blood pressure Nausea (feeling sick to the stomach) y y y y y y A nurse or doctor will stop the transfusion at the first signs of an allergic reaction. iron-deficiency. This usually occurs within about 6 hours of the procedure. chills. WHAT ARE THE RISKS OF A BLOOD TRANSFUSION? Most blood transfusions go very smoothly. This makes it less likely that you will have a reaction after the transfusion. Fanconi. serious problems can occur. Fever You may get a sudden fever during or within a day of your blood transfusion. what treatments are needed. very rarely. The risk of catching a virus from a blood transfusion is very low. Allergic Reactions Some people have allergic reactions to the blood given during transfusions. However. To keep blood safe. Iron Overload Getting many blood transfusions can cause too much iron to build up in your blood (iron overload). This can happen even when the blood given is the right blood type. Medicines or radiation used to treat a medical condition also can cause anemia. you may need iron chelation (ke-LAY-shun) therapy. There are many types of anemia. 5 to 25 percent of patients who develop lung injuries die from the injuries. Viruses and Infectious Diseases Some infectious agents. and whether the transfusion can safely be restarted. For this therapy. mild problems and. flushing. heart. Symptoms can include: Anxiety Chest and/or back pain Trouble breathing Fever. blood banks carefully screen donated blood. People who have a blood disorder like thalassemia. Some blood banks remove white blood cells from whole blood or different parts of the blood. are at risk for iron overload. and sickle cell anemias and thalassemia (thala-SE-me-a). making it hard to breathe. medicine is given through an injection or as a pill to remove the extra iron from your body. Antibodies (proteins) that are more likely to be found in the plasma of women who have been pregnant may . can survive in blood and infect the person receiving the blood transfusion. including aplastic. blood transfusions can damage your lungs. y A bleeding disorder. Allergic reactions can be mild or severe.

Because of this risk. Help prevent transfusion reaction by: o Meticulously verifying patient identification beginning with type and cross match sample collection and labeling to double check blood product and patient identification prior to transfusion. hospitals are starting to use men's and women's plasma differently.e. Both acute and delayed hemolytic reactions are most common in patients who have had a previous transfusion.. Your body destroys red blood cells so slowly that the problem can go unnoticed until your red blood cell level is very low. People who have weakened immune systems are the most likely to get GVHD. o Preventing infectious disease transmission through careful donor screening or performing pretest available to identify selected infectious agents. fever.disrupt the normal way that lung cells work. Acute Immune Hemolytic Reaction Acute immune hemolytic reaction is very serious. On detecting any signs or symptoms of reaction: o Stop the transfusion immediately. 2. The symptoms include chills. Symptoms start within a month of the blood transfusion. o Inspecting the blood product for any gas bubbles. particularly during the first 15 minutes (severe reactions usually manifest within 15 minutes after the start of transfusion). clothing. but also very rare. Your body attacks the new red blood cells. o Preventing GVH disease by ensuring irradiation of blood products containing viable WBC¶s (i. o Transfusing blood within 4 hours. It occurs if the blood type you get during a transfusion doesn't match or work with your blood type. platelets. nausea. Delayed Hemolytic Reaction This is a much slower version of acute immune hemolytic reaction. Graft-Versus-Host Disease Graft-versus-host disease (GVHD) is a condition in which white blood cells in the new blood attack your tissues. and dark urine. and observing the patient closely. and notify the physician. o Beginning transfusion slowly ( 1 to 2 mL/min) or 20 drops/min. GVHD usually is fatal. and diarrhea. o Preventing hypothermia by warming blood unit to 37 C before transfusion. This is done to ensure the patient's safety and health. or abnormal color before administration. the doctor will order a blood specimen to confirm the patient's blood type and compatibility with the blood being donated. The doctor will stop the transfusion at the first sign of this reaction. which then produce substances that harm your kidneys. PLANNING AND IMPLEMENTATION 1. and changing blood tubing every 4 hours to minimize the risk of bacterial growth at warm room temperatures. To protect against GVHD. pain in the chest or back. people who have weakened immune systems should receive blood that has been treated so the white blood cells can't cause GVHD PREPARATION FOR BLOOD TRANSFUSION Before a blood transfusion is performed. whole blood. irradiation alters ability of donor lymphocytes to engraft and divide. They include fever. This test is done even when the patient is donating his own blood. . rash. packed RBC¶s and granulocytes) before transfusion. o Removing leukocytes and platelets aggregates from donor blood by installing a microaggregate filter (20-40-um size) in the blood line to remove these aggregates during transfusion.

12. 13. blood component to be transfused. DIC. get compatible blood from hospital blood bank. and retyping. IV set . If main IVF is with dextrose 5% initiate an IV line with appropriate IV catheter with Plain NSS on another site. immediate treatment includes positioning the patient upright with feet dependent. Intervene as appropriate to address symptoms of the specific reaction: o Treatment for hemolytic reaction is directed at correcting hypotension. Close roller clamp of IV fluid of Plain NSS and regulate to KVO while transfusion is going on. 8. Send the blood bag and tubing to the blood bank for repeat typing and culture. o Febrile. (If hives are the only manifestation. Open compatible blood set aseptically and close roller clamp. and renal failure associated with RBC hemolysis and hemoglobinuria. Using a clean lined tray. Request prescribed blood/blood components from blood bank to include blood typing and X-matching and blood result of transmissible disease. Do hand hygiene before and after the procedure. diuretics. 3. Give pre-med 30 minutes before transfusion as prescribed. o Intervene for allergic reaction by administering antihistamines. and expiry date with the blood bag label and other laboratory blood exam as required before transfusion (Hgb and Hct). 2. 16. 6. . such as antihistamines and acetaminophen. culture. treat septicemia with antibiotics. Prepare equipment needed for BT. The nurse performing the transfusion will then insert an intravenous line into the patient's arm. 15. Explain the procedure/rationale for giving blood transfusion to reassure patient and significant others and secure consent. Before the transfusion begins. the gauge of needle is disregarded). Disinfect the Y-injection port of IV tubing (Plain NSS) and insert the needle from BT administration set and secure with adhesive tape. 9. IV catheter/needle G 18/19. Get patient¶s history regarding previous transfusion 4. RR. 7. serial no. fill the drip chamber at least half full. Wrap blood bag with clean towel and keep it at room temperature. 1. gloves. o In septic reaction. of each blood unit. increased hydration. Explain the importance of the benefits on Voluntary Blood Donation (RA 7719 ± National Blood Service Act of 1994). nonhemolytic transfusion reactions are treated symptomatically with antipyretics. temperature before transfusion. IV injection tray. 11. Have a doctor and a nurse assess patient¶s condition. 3. before the transfusion. 14. tourniquet. Draw another blood sample for plasma hemoglobin.) o For circulatory overload. prime tubing and remove air bubbles (if any). leukocyte-poor blood products may be recommended for subsequent transfusions. 10. TRANSFUSION PROCEDURE Before the transfusion begins.9% saline to provide access for possible IV drug infusion. Verify doctor¶s written prescription and make a treatment card according to hospital policy. sterile 2x2 gauze or transparent dressing. Refer to MD accordingly. the patient must sign a consent form. plaster. Spike blood bag carefully. Get the baseline vital signs ± BP. oxygen and aminophylline may be prescribed. transfusion can sometimes continue but at a slower rate. Use needle G 18 or 19 for side drip (for adults) or of 22 for pedia (if blood is given through the Y-injection port. steroids and epinephrine as indicated by the severity of the reaction. Observe ten (10) Rs when preparing and administering any blood or blood components. Plain NSS 500 cc. 5.o o o o o Disconnect the transfusion set-but keep the IV line open with 0. steroids and vasopressors as prescribed. Countercheck the compatible blood to be transfused against the X-matching sheet noting ABO grouping and Rh. The doctor will then order the patient to take medications. Collect a urine sample as soon as possible for hemoglobin determination. anchor catheter properly and regulate IV drops. two nurses will check the patient's identity.

lower back pain.  After starting the transfusion. The vital signs are checked this often to monitor for a reaction to the blood. or swelling at the site where the IV is inserted. then 30 minutes from then. 23. pertinent observations and nursing intervention and endorse accordingly.  Before administering the unit. the nurse has to get consent forms signed by the patient or a qualified representative of the patient. 18. 21. then at one hour.  While reactions are rare. serial platelet count within specified hours as prescribed &/or per institution¶s policy. Transfuse the blood via the injection port and regulate at 10-15 gtts initially for 15 minutes and then at the prescribed rate (usually based on the patient¶s condition). Swirl the bag hourly to mix the solid with the plasma. 26. All patients have the right to refuse transfusions. Remind the doctor about the administration of Ca gluconate if patient had several units of blood transfusion (3-6 or more units of blood) NURSE'S RESPONSIBILITY BEFORE and DURING PROCEDURE The nurse handling the transfusion has a number of responsibilities to ensure that the procedure is performed correctly and to ensure the patient's safety and health. 20. they are monitored. bleeding time. Re-check Hgb and Hct. Symptoms for adverse reactions include breathing problems.17. the vital signs must be checked after 15 minutes. but not over 4 hours from the time of the start of the transfusion. open the roller clamp of the IV line with Plain NSS. 24. close the roller clamp of BT.  The nurse is responsible for insuring that the right unit of blood is to be administered to the right patient after typing and cross matching by the lab. 19. during and after the transfusion. a unit of whole blood (packed red blood cells) must be infused over 3. itching/hives. apprehensive feelings. Then the unit of blood has to be checked off with another nurse before administration. and disconnect from IV lines then regulate the IVF of plain NSS as prescribed 22.B. When blood is consumed. If any of these symptoms occurs stop the transfusion. This is done by checking the lot. N. 25. . itchiness. Discard blood bag and BT set and sharps according to Health Care Waste Management(DOH/DENR). serial numbers. blood type. If a reaction occurs. and will check for any signs of adverse reactions to the transfusion. and report to doctor immediately. Some hospitals may give premedications before transfusion to reduce the chance of a reaction. Blood can only be transfused with normal saline.  Before. nausea. Observe patient for 10-15 minutes for any immediate reaction. Patients are urged to keep the nurse abreast of any symptoms they experience. urticaria and dyspnea. rash. Continue to observe and monitor patient post transfusion for delayed reaction could still occur. Then vital signs must be checked every hour. tingling or numbness. the nurse will check the patient's temperature. Observe patient on an on. Document the procedure.  After consents are signed and the blood is checked by appropriate personnel. the nurse has to take a complete set of vital signs for a baseline. chills. pain. one BT set should be used for 1-2 units of blood. heat. fever. chills.5-4 hours. then the transfusion must be stopped immediately and normal saline infused. elevated temperature. pulse and blood pressure.going basis for any untoward signs and symptoms such as flushed skin. Only registered nurses are allowed by law to administer blood products. except in the cases of trauma or life saving situations if the patient is unable to make that decision. according to hospital protocol. and expiration date with another nurse or qualified lab personnel.

anxiety. 3. 5. itching. Notify the physician. chills. Flushing. muscle pain 3) Allergic reaction (mid): sensitivity to infused plasma proteins. flushed skin. Keep the vein open with a normal saline infusion. 4. vomiting.REACTION: CAUSE CLINICAL SIGNS NURSING INTERVENTION* 1. Monitor vital signs. 1. NOTE: When the transfusion is discontinued. chest pain. circulatory collapse. warm. Notify the physician immediately. Monitor fluid intake and output. the blood tubing must be removed as well. Notify the physician. hypotension Fever. bronchial wheezing 4) Allergic reaction (severe): antibody-antigen reaction Dyspnea. 2. Send the remaining blood. Send the remaining blood to laboratory 3. Notify the physician. Stop the transfusion. Stop or slow the transfusion 1. 5. diarrhea. Use new tubing for the normal saline infusion. 6. 3. or plasma proteins. dyspnea. cardiac arrest 5) Circulatory overload: blood administered faster than the circulation can accommodate Cough. cyanosis. Administer medications and/or oxygen as ordered. 1) Hemolytic reaction: incompatibility between client¶s blood and donor¶s blood 2) Febrile reaction: sensitivity of the client¶s blood to white blood cells. Keep the vein open with normal saline. Administer cardiopulmonary resuscitation if needed. 5. 1. 3. with feet dependent 2. chest pain. 1. Discontinue the transfusion immediately. 6. Discontinue the transfusion immediately. distended neck veins. Notify the physician. Keep the vein open with a normal saline infusion. and a urine sample to the laboratory. 2. Notify the physician immediately. Monitor vital signs. 4. Administer medication (antihistamines) as ordered. chills. a sample of the client¶s blood. tachycardia. Give antipyretics as ordered. crackles (rales). depending on agency protocol. Chills. Obtain a blood specimen from the client for culture. 3. 4. urticaria. hypotension . headache. Stop or slow the transfusion. or according to agency protocol. Place the client upright. Administer IV fluids. Stop the transfusion 2. Keep the vein open with normal saline. 4. backache. 2. 4. hypertension 6) Sepsis: contaminated blood administered High fever. 1. headache. dyspnea. platelets. antibiotics. fever. Administer diuretics and oxygen as ordered. 2. tachycardia. 3.