BLOOD TRANSFUSION Academics.

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Prepared By: Models excellence.
NR-NUR 122 Team 2019-2020
BLOOD AND BLOOD COMPONENTS
Blood is:
• a mixture of cells
• a complex transport mechanism that:
– transports hormones
– removes waste products
– regulates body temperature
– protects the body
– promotes hemostasis
– supplies oxygen
BLOOD AND BLOOD COMPONENTS
Composition of Blood:
Temperature: 38˚C (100.4˚F)
pH: 7.35-7.45
Specific Gravity: 1.048 – 1.066
Body weight: 8%
Volume: Male - 5-6 liters
Female - 4-5 liters

*** 5 times the viscosity of water

BLOOD AND BLOOD COMPONENTS

Body Weight /
Blood Volume Ratio
BLOOD AND BLOOD COMPONENTS
• Portions of the Blood Composed of:
• 55% plasma
• 45% cellular components
_____________________________________
• Plasma = fluid portion
• Coagulation factors
• Inorganic substances
• Antibodies
 BLOOD TRANSFUSION THERAPY
• Blood transfusion is the
transfer of blood or its
components from one
individual (donor) to
another (recipient).
• Done to:
– Increase oxygen transport
to tissues
– Prevent and stop bleeding
– Combat infection
WHO CAN AND CAN’T GIVE BLOOD?

Republic Act 7719

National Blood Services Act of 1994

AN ACT PROMOTING VOLUNTARY BLOOD

DONATION, PROVIDING FOR AN
ADEQUATE SUPPLY OF SAFE BLOOD
REGULATING BANKS, AND PROVIDING
PENALTIES FOR VIOLATION THEREOF.
 WHO CAN AND CAN’T GIVE BLOOD?
Eligible donors:
• Be at least age 17
• Weigh at least 110 lbs (50 kg)
• Be 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)
WHO CAN AND CAN’T GIVE BLOOD?
Ineligible donors:
• Have HIV/AIDS
• Have taken illegal IV drugs
• Have had sex with prostitutes in the past 12 months
• Have had sex with anyone in the abovementioned
categories
• Have had hepatitis
• With certain types of cancer
• With hemophilia
• Have received clotting factor concentrations
BLOOD TYPE COMPATIBILITY
 BLOOD TRANSFUSION
The Nurse’s Responsibility
• Nurses must be knowledgeable about blood
products
• Assure that informed consent has been
obtained before starting a transfusion
• Instruct patient to alert the nurse about any
unusual sensations he or she might
experience during or after the infusion
• Document all patient education regarding
transfusion therapy
 BLOOD TRANSFUSION
The Nurse’s Responsibility
• Obtain important medical hx information,
and review pertinent laboratory values
• Double check the physician’s order for BT
• Establish baseline VS and assessment
findings
• Always double check the blood received from
the blood bank with the accompanying
transfusion record
WHAT TO CHECK…

THE BAG
LABEL
 WHAT TO CHECK…

UNIT
INTEGRITY
WHAT TO CHECK…

APPEARANCE
 WHAT TO CHECK…
• RBCs should not be appreciably darker than the
bag segments and the remaining plasma should
not be murky, purple/blue, brown, or reddish.

• Platelets should be clear to yellow/straw to light

strawberry color, without obvious aggregates

• Thawed FFP should be clear with the color varying

from yellow straw to light green to orange.
Before Transfusion…
• Recheck the physician’s order
• Two qualified individuals should verify the
patient and unit identification
• Compare and verify patient name & hospital
ID/no. on the patient identification band and
transfusion report
• Compare and verify patient’s blood type and
the unit blood type in the transfusion report
Before Transfusion…
• The two people verifying the patient/unit identification
should sign the transfusion report.
• Document the date and time the transfusion started
• Keep the Unit Record attached to the unit until the
transfusion is complete
Before Transfusion…
• Assess the patency of the patient’s vascular access
• Spike and prime the transfusion
• Obtain baseline vital signs then recheck after 15 minutes of
transfusion and as ordered by the physician.
 During Transfusion…
• Administer the blood or component at the recommended
rate, based on the patient’s condition.

• If the patient experiences any symptoms of a reaction to the

transfusion, discontinue it immediately and call for
assistance.
 …After Transfusion
• Document the transfusion in the patient’s
chart. The “Chart Record” portion of the
Transfusion Report should be placed in the
patient’s chart as a permanent record.

• Continue to monitor your patient for any

signs and symptoms of reaction for at least
one hour after the transfusion. Obtain any
ordered post-transfusion laboratory studies.
COMPARING CELLULAR PRODUCTS

Whole Blood
Packed RBCs
WBCs
Platelets
FFP
 Whole Blood
• Complete (Pure) blood
• Volume: 500 mL
• Ideal infusion time:
4 hours
Indications:
• Restore blood volume in
hemorrhaging, trauma,
or burn patients
 Whole Blood
Nursing Considerations:
• Cross-matching must be ABO identical
• Use a straight-line or Y-type IV set
• Whole blood is used frequently in emergency
treatment
• Reduce the risk of transfusion reaction by
adding a microfilter
• Warm blood if giving a large quantity
• Avoid giving whole blood when the patient
can’t tolerate the circulating volume.
 Packed Red Blood Cells
• Same RBC mass as whole blood with
80% of the plasma removed
• Volume: 250 mL
• Ideal infusion time: 4 hours
 
Indications:
• To restore or maintain oxygen-
carrying capacity
• To correct anemia and surgical blood
loss
• To increase RBC mass
 Packed Red Blood Cells
Nursing Considerations:
• Follow blood compatibility table for recipients
• Use a straight-line or Y-type IV set
• RBCs have the same oxygen-carrying capacity as
whole blood, minimizing the hazard of volume
overload.
• Using packed RBC avoids the potassium and
ammonia buildup that sometimes occurs in the
plasma of stored blood.
 White Blood Cells
• Whole blood with all the red blood cells and
80% of the plasma removed
• Volume: usually 150 mL
• Ideal infusion time: slowly over 2-4 hours

Indications:
• To treat a patient with life-threatening
granulocytopenia who isn’t responding to
antibiotics
 White Blood Cells
Nursing Considerations:
• Cross-matching follows that for PRBC
• WBCs are preferably human leukocyte antigen
(HLA)-compatible
• Use a straight-line IV set with a standard in-line
blood filter.
• Dosage is 1 unit daily for 5 days or until the
infection clears.
• Because reactions are common, administer
slowly over 2 to 4 hours.
 White Blood Cells
• Check the patient’s vital signs and assess him every 15
minutes throughout the transfusion
• Give the transfusion in conjunction with antibiotics to treat
infection
• Agitate the container to prevent WBCs from settling, thus
preventing delivery of a bolus dose of WBCs.
• Don’t use a microaggregate filter
 Platelets
• Platelet sediment from red
blood cells or plasma
• Volume: 35-50 mL/U; 1 unit
of platelets = 7x107 platelets
• Ideal infusion time:
– Infuse 100 mL over 15 minutes
– Administer at 150-200 mL/hr,
or as rapidly as the patient can
tolerate; don’t exceed 4 hours
 Platelets
Indications:
• To treat thrombocytopenia caused by
decreased platelet production, increase
platelet destruction, or massive transfusion
of stored blood
• To treat acute leukemia and marrow aplasia
• To restore platelet count in a preoperative
patient with a count of 100,000/mL or less
 Platelets
• Cross-matching: ABO compatibility isn’t
necessary but is preferable with repeated
platelet transfusions; Rh type match is
preferred.
• Use a blood component drip administration
set
• Don’t use a microaggregate filter
• Platelet transfusions aren’t usually indicated
for conditions of accelerated platelet
destruction
 Platelets
• Patients with a history of platelet reaction
require premedication with antipyretics and
antihistamines
• Avoid administering platelets when the
patient has a fever
• A blood platelet count may be ordered 1
hour after platelet transfusion to determine
platelet transfusion increments.
 Fresh Frozen Plasma
• Uncoagulated plasma
separated from RBCs,
rich in coagulation
factors V, VIII, IX
• Volume: 200-250 mL
• Ideal infusion time: As
rapidly as the patient
can tolerate
 Fresh Frozen Plasma
Indications:
• To expand plasma volume
• To treat postsurgical hemorrhage or shock
• To correct an undetermined coagulation
factor deficiency
• To replace a specific factor when that factor
alone isn’t available
• To correct factor deficiencies resulting from
hepatic disease
 Fresh Frozen Plasma
Nursing Considerations:
• Cross-matching: same as with Platelets
• Use a straight-line IV set
• Large-volume transfusions of FFP may require correction for
hypocalcemia. Citric acid in FFP binds calcium
S afety

P recautions
What to do if you suspect
a transfusion reaction…
ACUTE TRANSFUSION REACTIONS
Types of Acute Transfusion Reactions:
• Acute Hemolytic Transfusion Reaction
• Febrile Non-Hemolytic Transfusion Reaction
• Mild Allergy (Urticarial)
• Anaphylactic
• Transfusion Associated Circulatory Overload
• Transfusion – Related Acute Lung Injury
• Septic Transfusion Reaction
 ACUTE TRANSFUSION REACTIONS
Symptoms you might see
during an AHTR include:
• Temperature increase of
more than 1˚C
• Bloody urine
• Chills
• Hypotension
ACUTE TRANSFUSION REACTIONS
• 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 WHEN TRANSFUSION REACTION OCCURS

• 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
WHAT TO DO WHEN TRANSFUSION REACTION OCCURS

• 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
• Infusion device used
DOCUMENTING BLOOD TRANSFUSIONS
• Flow rate and if blood warming was used
• Vital signs obtained 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
B
lood

T
ransfusion
…The Procedure
PREPARATION FOR
TRANSFUSION
Patient
Materials
Suitable Vein
Handling of Blood
MATERIALS NEEDED
 ACTUAL TRANSFUSION PROCESS

1. Follow hospital policy in checking

identification information on the
blood pack against the recipient

2. Check information with the doctor

or another nurse and both should
sign to ensure proper recipient.
 PROCEDURE
1. Verify doctor’s written prescription and
make a treatment card according to
hospital policy.
 PROCEDURE
2. Observe ten (10) R’s when preparing and
administering any blood or blood
components.
3. Explain the procedure/rationale for giving
blood transfusion
4. Explain the importance of the benefits on
Voluntary Blood Donation (RA 7719-
National Blood Services Act of 1994)
PROCEDURE
5. Request prescribed blood
or blood components from
the blood bank to include
the typing and cross-
matching & blood result of
transmissible disease.

6. Using a clean lined tray,

get compatible blood from
hospital blood bank.
 PROCEDURE
7. Wrap a blood bag with clean
towel and keep it at room
temperature

8. Have a doctor and a nurse

assess patient’s condition
 PROCEDURE
9. Get the baseline vital signs
10. Give pre-meds 30 minutes before the
transfusion as prescribed
 PROCEDURE

11. Do hand hygiene before and after the

procedure
 PROCEDURE
12.Prepare the necessary
equipment needed for
BT:
• IV injection tray,
• IV catheter/needle
– G18/19 (adult)
– G23 (pedia)
• Plaster
• Tourniquet
• Gloves
 PROCEDURE

Blood component
to be transfused
• Compatible BT set
• G 18 needle (only if needed)
 PROCEDURE
• Plain NSS, IV set

Sterile 2x2 gauze

or Transparent dressing
 PROCEDURE

13. Initiate an appropriate IV line

PROCEDURE
14.Open compatible blood set
aseptically
15.Disinfect the Y-injection port of IV
tubing (PNSS) and insert the
needle from BT administration set
and secure with adhesive tape.
16.Close the roller clamp of the PNSS
and then regulate at KVO while
transfusion is ongoing.
17.Transfuse the blood via the
injection port and regulate at 10-
15 gtts. initially for 15 minutes and
then the prescribed rate.
 PROCEDURE
18. Observe patient for 10 -
15 minutes for any
immediate reaction.
19. Observe patient on an
ongoing basis for any
untowards signs and
symptoms
 PROCEDURE
20.Swirl the bag hourly
21.When blood is consumed, close the roller clamp of BT
22.Continue to observe and monitor patient

23. Re-check Hgb and Hct, bleeding

time, serial platelet count

24. Discard blood bag and BT set

and sharps according to Health
Care Waste Management
(DOH/DENR)
PROCEDURE
25. Document the procedure,
pertinent observations and
nursing interventions then
endorse accordingly.
 POST TRANSFUSION CARE
1. Record all pertinent data
2. Carry out post-transfusion
orders: lab exams, etc.
The
E nd