BLOOD TRANSFUSION

Presented by:
Ms. B.Priyadharshini,
First year M. Sc [Nursing],
Dept of MEDICAL SURGICAL NURSING,
KGNC
DEFINITION:
• Blood transfusion is the intravenous administration of the
whole blood or a component such as plasma packed red
blood cells or platelets to patients
PURPOSES:
• To increase circulation / circulating blood volume
• To increase the number of red blood cells and to maintained the HB
level
• To provide plasma clothing factors to help in controlling bleeding
• To combat infection due to decreased or defective white cells or
antibodies
• To correct deficiencies such as anaemia and bleeding disorders.
INDICATION:
• Before and After surgery
• Severe blood loss -Trauma, Surgery, Haemorrhage
• Severe anaemia
• Blood disorders such as Thalassemia and Agranulocytosis
Haemophilia
BLOOD COMPONENTS:
STORAGE:
BLOOD GROUPING:
• Human blood is classified in to four main groups (A, B, AB and O)
on the basic of polysaccharide antigen on the erythrocyte surface.
These antigens type A and Type B, commonly cause antibody
reaction and are called agglutinogens. In other words group A blood
contain type A agglutinogen, group B blood contain type B
agglutinogen, group AB contain both A & B agglutinogens, and
group O blood containe neither agglutinogen.
BLOOD GROUPING:
Rh GROUP:
• Rh antigen also on the surface of erythrocytes are present in about
85% of the population are can be a mayor cause of hemolytic
reaction. Persons who possess the Rh factor are referred to as Rh
positive those who do not are referred to as Rh negative.
PRE TRANSFUSION TESTING:
• Identification of recipient’s blood sample. Check name, age, sex,
Hospital No. and H/o Previous transfusion.
• ABO and Rh (D) grouping of the recipient.
• Select ABO and Rh compatible screened donor blood.
• Compatibility testing (Cross matching) of the recipients serum
against donor’s cell.
• Proper labeling of cross matched blood.
PRE TRANSFUSION TESTS:
• Viral Bacterial Parasitic
• Hepatitis B virus Malaria Syphilis
• (HBV)
• Hepatitis C virus
• (HCV)
• HIV
•  
PRE PREPARATION:
Obtain consent from the patient or relative.
• Verify the physician’s prescription
• Check the patient’s blood record and the blood bag labelling.
• Complete documentation as required by the blood bank.
• Ensure transfusion starts within 30 min of blood being taken out of storage.
• Patient’s name and identification number.
• Blood component blood type and Rh factor.
• Expiration date of blood.
• Obtain vital signs of the patient before the transfusion begins
• Put on gloves and provide for privacy
 NURSES RESPONSIBILITY:
• Ensure that correct preparation of the patient and the care procedure is
done.Double-check the order for transfusion and correlate this with the
clinical diagnosis and care plan of the patient.
• Verify the blood type of the patient on the chart. If needed, obtain a request for
blood typing.
• Once blood to be transfused or a donor is available, request for crossmatching
to be done. A sample will be obtained from the patient and from the
donor/blood pack and tested.
• After crossmatching is done, a request for the number of units to be transfused
should be made.
• NOTE: Universal donor is blood type O-, while type AB+ is the universal
recipient.
• Obtain consent. The consent must be obtained prior to starting any invasive
procedure or therapy. NOTE: The physician is the one explaining the procedure
and asks the patient to sign the form. The role of the nurse is to witness the
signing.Assess for any allergies the client may have.
• Ask the client for any previous blood transfusion and their reaction to it.
• If the patient has had a BT before, the physician may need to prescribe
premedication to prevent a febrile non-hemolytic reaction, common with
patients who have had several blood transfusions done.
• Usual premedication given is Benadryl (diphenhydramine) and
acetaminophen, 30 minutes to 1 hour before transfusion.
• Verify the BT order. Check the patient record and the order of the
physician. The following are verified:
• Patient identification and the information about the patient
from the blood bank;
• Results of typing and crossmatching;
• Expiration date of the blood product to be administered.
• Warm the blood products.
• Determine the correct gauges of IV needle. Usual IV needles
from a blood transfusion are gauge 18 0r 16. Larger bore needles
are needed for BT because it allows the passage of RBCs.
• Ensure proper IV tubing and access site. Y-tubing with an in-line filter
is typically used for BT. If the patient needs any other IV fluids, this is
administered on another line.
• Prime the line. The BT line is primed prior to the administration of BT.
0.9% NaCl is used to prime the line and is the only compatible IV fluid
with blood transfusions. NOTE: Once the line is primed, the BT can be
started.
• Obtain vital signs. These vital signs are taken prior to the start of the
BT and several times during the BT. Blood pressure, temperature and
pulse rate can be used as indicators of potential adverse reactions to
transfusion.
• Start the transfusion. Ensure that the patient is positioned comfortably
since the BT may last for anytime between 30 minutes to 4 hours.
• Monitor patient response to the therapy. Apart from vital signs,
the patient may be assessed for the following:Rashes. This is an
indication of an allergic reaction either to the blood type or the
additives in the blood products.
• Chills. A sign of pyrogenic reaction, especially when this is seen in
the patient with an increase in temperature.
• Shortness of breath. This is a sign of hemolytic reaction and
necessitates the stopping of the transfusion.
• Headache, back pain, nausea and vomiting.
• NOTE: If using an infusion pump, set the pump at 2mL/min for the
first 15 to 30 minutes of transfusion and monitor the patient’s
response. Vital signs must be monitored as per the following
schedule:
• At the first 5 minutes after starting the transfusion;
• 15 minutes after transfusion started
• On the 30th minute;
• Every hour until the transfusion is done;
• 1 hour after the transfusion is over.

• Once transfusion is done, the line should be flushed with normal

saline solution. If there are no more succeeding transfusions, the
line is discontinued, and the BT set is disposed of properly.
TRANSFUSION REACTION NURSES RESPONSIBILITY:
• Stop the flow of the transfusion and flush the line with 0.9% normal
saline solution.
• If needed, the line must be disconnected from the set-up, and a new
tubing must be used to ensure that the line is kept patent and no
new insertions of access site are to be made.
• Take the patient’s vital signs, document together with all the
reactions seen and complained by the patient.
• Notify the physician immediately of the event.
• Inform the blood bank of the event.
• Be prepared to administer medications to the patient to combat
any reaction that must be addressed:
• Antihistamines
• Corticosteroids
• Vasopressors
• Epinephrine
• Diuretics

• Coordinate with the laboratory the need for tests and studies to
rule out other complications.
• Save the blood bag and other related equipment for inspection and
assessment if needed. Make sure that these are correctly labeled.
COMPLICATION:
• Anxiety
• Allergic reaction
• Circulatory over lode
• Chest or back pain
• Trouble breathing
• Fever, chills, flushing, and sticky/sweaty skin
• A quick pulse or low blood pressure