Blood tranfusions

Dr.Boyke Marthin Simbolon,MKed(An),SpAn

 What is a blood transfusion?
Purpose
Indications
Overview Blood products
Nursing implications
Administering a blood
transfusion (skill)
 Administration of blood or one of its
components through an intravenous line
What is a (IV)
Blood
Transfusion? Reaches patient’s blood vessels and
enters the circulatory system
 Restore blood volume
Replace clotting factors
Purpose of a Blood Improve oxygen carrying capacity
Transfusion
Restore blood elements that are depleted
Prevent complications
 What would indicate the need for a blood
transfusion?

Question
 Lab Test Normal Results Why is this ordered?
Type and crossmatch Based on ABO system To determine the primary blood
Positive = incompatibility group, screen for antibodies and
Negative = probable determine donor-recipient
compatibility compatibility.

Hbg (hemoglobin) Male 140-175 g/L Hbg carries oxygen in the blood. It
Female 123-153 g/L can decrease due to blood loss.
Critical Value:

Lab Tests Male <130 g/L

Female <110 g/L
Hct Male 41.5%-50.4% Hct measures the proportion of blood
(hematocrit) Female 25.9%-44.6% volume occupied by RBCs. It
Critical Value: decreases with blood loss and
<18% or >54% anemia.

Platelet count 150,000-400000 cells/uL Platelets initiate the coagulation

Critical Value: process. A decreased amount
<50,000 cells/uL increases the risk for hemorrhage.
  Composition:
- Red Blood Cells
- White Blood Cells
- Plasma
- Platelets
- Hematocrit
Whole Blood - Clotting Factors

 Purpose:
- Volume replacement
- Increase oxygen-carrying capacity

 Indications:
- Significant blood loss (>25% blood lost, i.e. hemorrhage)
- Newborn babies with hemolytic disease
  Composition:
- RBCs with little plasma (hematocrit about 75%)
- Some platelets and WBCs remain

 Purpose:
- Increase RBC mass and oxygen-carrying capacity

Packed Red - Assists the body to rid carbon dioxide and other waste products

Blood Cells  Indications:

(RBCs) - Symptomatic and chronic anemia

- Blood loss due to injury or surgery
  Composition:
- Platelets
- Plasma
- RBCs
- WBCs
Platelets
 Purpose:
- Helps to stop bleeding (restore clotting ability)
- Essential for coagulation of blood

 Indications:
- Decreased platelet count
- Hemophilia
- Thrombocytopenia
- Platelet dysfunction (End stage renal disease, DIC)
  Composition:
- WBCs or leukocytes suspended in 20% of the plasma

 Purpose:
- Increase number of WBC’s
- Replaces WBC’s that are functioning abnormally

White
 Indications:
Blood Cells - Sepsis (not responsive to antibiotics)

(WBCs) - Persistent fever

- Granulocytopenia
  Composition:
- Plasma
- All coagulation factors

 Purpose:
- Increase blood plasma
- Replenish clotting factors
Fresh
Frozen  Indications:
- Bleeding in patients with coagulation factor
deficiencies; plasmapheresis
Plasma - Burn
- Liver Failure
- Severe Infection
  Composition:
- Albumin

 Purpose:
- Volume expansion leading to increased blood volume

 Indications:
- Hypoproteinemia
- Burns
Albumin - Shock
- Trauma
- Surgery
- Infections
  Verification procedure

 Type of blood

Documentation  Amount administered

 Vital signs

 Patient’s response to therapy

 Acute haemolytic reaction
Mechanism Onset Signs and Symptoms

Increased temperature, increased heart

rate, heat and pain surrounding vein,
5-15 minutes
chills, headache, nausea, chest or back
following
ABO, Rh pain, chest tightness, dyspnea,
initiation of
incompatibility bronchospasm, hypotension, anxiety,
blood
vascular collapse, hemoglobinemia,
transfusion
hemoglobinuria, disseminated
intravascular coagulation
 Delayed haemolytic reaction

Mechanism Onset Signs and Symptoms

Immune
response
Fever, decrease in Hgb/Hct, increased
against non- 2-14 days
bilirubin levels, jaundice
ABO donor
antigens
 Febrile, nonhaemolytic reaction

Mechanism Onset Signs and Symptoms

30 minutes
Sensitivity to after initiation
leukocytes or to 6 hours Fever, flushing, chills, headache,
platelets in after muscle pain
donor’s blood completion of
transfusion
 Allergic reaction

Mechanism Onset Signs and Symptoms

5-15 minutes
Allergy to a Local erythema, gives, urticaria,
following
plasma pruritus, coughing, nausea, vomiting,
initiation of
protein or respiratory distress, wheezing,
blood
antigen in hypotension, loss of consciousness,
transfusion, up
donor’s blood cardiac arrest
to 1 hour after
 Graft-versus-host disease

Mechanism Onset Signs and Symptoms

Attack of
transfused Skin rash, fever, jaundice, liver
lymphocytes Days to weeks dysfunction, bone marrow
on host suppression
lymphocytes
 Circulatory overload

Mechanism Onset Signs and Symptoms

Any time
Dyspnea, cough, crackles, tachypnea,
Transfused at during or
headache, hypertension, tachycardia,
an excessive within 1-2
increased central venous pressure,
volume or rate hours after
distended neck veins
transfusion
 Sepsis

Mechanism Onset Signs and Symptoms

During
Bacterial transfusion to Fever, chills, abdominal cramping,
contamination 2 hours after vomiting, diarrhea, hypotension
transfusion
 Lab Test Normal Results Why is this ordered?
Antiglobulin (DAT) Negative Direct use is for post transfusion work-up to detect RBC
incompatibility. Positive result = hemolytic transfusion
reaction.
Bilirubin Indirect: 0.1-1.0 mg/dL An elevated indirect value may indicate ABO
incompatibility.
Urinary Hemosiderin Negative Used to measure hemoglobin in urine resulting from
intravascular hemolysis. Positive reaction = blood
transfusion reaction.
CBC (Complete Blood Count) WBC 4.8-10.8 x10 9/L To assess cellular characteristics of blood cells in response
RBC 4.2-5.4x10 12/L to transfusion i.e. ABO compatibility through  WBC.
HGB 120-160G/L

Lab Tests HCT 0.370-0.470

MCV 78-98 FL
MCH 25-24 PG
MCHC 320-360 G/L
RDW 0.110-0.150
Platelets 130-400 x10
MPV 7.0-11.0 FL
Lymphocyte 0.15-0.41 x10
Neutrophil 0.6-0.7 x10
Monocyte 0.06-0.41 x10
Esoinophil 0-0.04 x10
Basophil 0-0.2 x10
Luc 0-0.4 x10 9/L
  Stop transfusion
 Remove tubing that contains blood product

Nursing  Infuse with 0.9% normal saline

 Monitor vital signs
Implications  Notify physician
in a  Notify blood bank and return blood component
 Administer medication depending on type of reaction
Reaction  Epinephrine, antihistamines, antibiotics, antipyretics, analgesics,
diuretics, corticosteroids
Questions?
 Bare, B., Smeltzer, S. C., Williams, B., Paul, P., & Day, R. A. (2004). Medical-surgical nursing (10th Ed.).
Philadelphia, PA: Lippincott Williams & Wilkins.
Be Transfusion Smart. (2010). Screening and diagnosis. Retrieved from
http://www.betransfusionsmart.com/patient/screening_diagnosis.jsp?site=PU019478&source=01030&irmasrc
=EXJWB0221&usertrack.filter_applied=true&NovaId=4029461999768351678
Blood Book. (2005). Common blood products. Retrieved from
http://www.bloodbook.com/products.html#Whole%20Blood
Brundage, S., Curet, M., Dicker, R., Greco, R., Gregg, D., Morton, J., Nguyen, T., Norton, J., Shelton, A., Spain, D.,
Tavana, L., & Welton, M. (2004). Blood transfusion protocol at Stanford surgery ICU. Retrieved from
www.scalpel.stanford.edu/ICU/.../Transfusion%20Medicine%20TICU.ppt
Cincinnati Children’s Association. d(2010). Hematology and blood tests and procedures. Retrieved from
http://www.cincinnatichildrens.org/health/info/blood/procedure/components.htm
References Day, R. A., Paul, P., Williams, B., Smeltzer, S. C., & Bare, B. (2007). Brunner and Suddarth’s textbook of
medical-surgical nursing (1st Canadian Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Malarkey, L., & McMorrow, M. (2005). Nursing guide to laboratory and diagnostic tests. St. Louis, MI: Elsevier
Saunders.
National Heart Lung and Blood Institute. (n.d). Types of blood transfusions. Retrieved from
http://www.nhlbi.nih.gov/health/dci/Diseases/bt/bt_types.html
North Bay General Hospital. (2006). Nursing practice manual: Transfusion, blood and blood products (Policy No. NP
1-90).
Perry, A.G., & Potter, P. A. (2006). Clinical nursing skills & techniques (6th Ed.). St. Louis, MI: Mosby, Inc.
Watson, D., & Hearnshaw, K. (2010). Understanding blood groups and transfusion in nursing practice. Nursing
Standard, 24 (30), 41-48.
 LANGKAH/TUGAS PENGAMATAN
0 1 2 3
Transfuse darah
1. Cocokan identitas, lisan atau tertulis, dilakukan di sisi pasien
2. Identitas dan jumlah darah kemasan cocokkan formulir
permintaan darah
3. Mencuci tangan
4. Memberi salam pada pasien dan menjelaskan tindakan yang
akan dilakukan dan menanyakan kesiapan pasien
5. Periksa suhu, frekuensi denyut jantung dan tekanan darah
sebelum transfusi
6. Kemudian cairan NaCl 0,9% diganti dengan kantong darah yang
sudah disediakan
7.Menghitung jumlah tetesan sesuai dengan yang sudah
Diprogramkan dan mencatat waktu transfuse dimulai
8. Observasi ketat vital sign tiap 15 menit
9. Setelah darah habis kemb ali dipasangkan cairan NaCl 0,9 %
10.Kemudian semua infuse dibuka dan pasien dirapikan kembali dari
semua alat alat
11. Mencuci tangtan kembali catat waktu selesai transfuse dan reaksi
yang timbul selam proses transfusi