BLOOD

TRANSFUSION
AND
BLOOD PRODUCTS
PREPARED BY:
AM VYELLICA MARICOR CO MAGUYON,
RN
BLOOD TRANSFUSION
• is the intravenous (IV) administration of whole blood, its components, or a plasma-
derived product for therapeutic purposes.
• it requires knowledge of correct administration techniques and possible complications.
• provides blood or blood components if you’ve lost blood due to an injury, during surgery
or have certain medical conditions such as anemia., certain cancers, hemophilia and
sickle cell disease.
TWO METHODS OF BLOOD TRANSFUSION:
1. ALLOGENEIC BLOOD - blood donated from someone else
2. AUTOLOGOUS TRANSFUSION OR AUTOTRANSFUSION - a patient’s own blood is
collected and reinfused for the purpose of intravascular volume replacement
BLOOD COMPONENTS:
BLOOD PRODUCT
FRESH WHOLE BLOOD
Packed RED BLOOD CELLS
FRESH FROZEN PLASMA
PLATELETS ( Multiple/ random
donor)
PLATELETS—Single donor
Colloid components— ALBUMIN 5%
pooled
Colloid components— ALBUMIN 25%
pooled
VOLUME and INFUSION TIME
300-350ml ; within 4 hours
250-350ml ; within 4 hours
200-250ml ; infuse 24 hrs of thawing
Within 4 hrs
40-70 mL/unit ; Within 6 hrs of pooling
200-500 mL ; within 4 hours
250-500 mL ; 1-10 mL/min
50-100 mL ; 0.2-0.4 mL/min
ACTION
replaces red cell mass and plasma
volume
replacing red blood cell mass;
Replaces plasma without RBCs or
platelets; contains most coagulation
factors, control of bleeding
Used in patients with
thrombocytopenia.
most useful in immunologically
refractory patients
used to treat hypoproteinemia in burns
and hypoalbuminemia in shock and
ARDs; used to support blood pressure in
dialysis and acute liver failure
Increases circulating blood volume
THREE BLOOD-TYPING SYSTEMS:
1. ABO SYSTEM
• uses the presence or absence of specific antigens on the surface of red blood cells to
identify blood groups.
2. RH (Rhesus) Factor
• It is the presence or absence of the D antigen that determines a person’s Rh type.
• 50 types of Rh antigen may be present on the surface of red blood cells.
• A person with the D antigen is Rh positive, and a person without the D antigen is Rh
negative
• A Rh-negative mother exposed to Rh antigen can transfer Rh antibodies across the
placenta to an Rh-positive fetus which can result to fetal hemolysis which is fatal in
infant. A Rh(D) immune globulin (RhoGam) is given by intramuscular injection to the
mother and suppress or destroy the fetal Rh-positive blood cells that have passed from the
fetal to the maternal circulation.

3. Human Leukocyte Antigen (HLA

• highly immunogenic antigens that can cause serious transfusion complications
BLOOD TYPING COMPATIBILITY
 TRANSFUSION REACTIONS:
REACTION SIGNS AND SYMPTOMS NURSING INTERVENTION
FEBRILE Fever and chills. Headache and muscle pain. Stop transfusion. Administer
antipyretics as ordered. Monitor
temperature every 4 hrs.

ACUTE HEMOLYTIC Pain in kidney area and chest. Increase heart Stop transfusion. Remove. Notify.
TRANSFUSION rate. Chest tightness and dyspnea. Hypotension. Monitor. Administer. Foley Catheter
REACTION insertion. I and O. watch out: SHOCK.
Blood and urine samples. Document.

DELAYED HEMOLYTIC Unexplained fever, unexplained decrease in Monitor laboratory values for
TRANSFUSION Hgb/Hct, increased bilirubin levels, jaundice anemia. Notify. Most delayed
REACTION hemolytic reactions require no
treatment

ALLERGIC REACTION Local erythema, hives, and urticaria, itching or Stop transfusion. Notify. Anti-
(MILD-TO-MODERATE) pruritus Histamines. Monitor v/s. If fever,
dyspnea and wheezing are not
present, transfusion may resume.
 REACTION SIGNS AND SYMPTOMS NURSING INTERVENTION
ALLERGIC REACTION Coughing, nausea, vomiting, respiratory Stop transfusion. IV access. Notify.
(SEVERE) distress, wheezing, hypotension, loss of Anti-histamines, corticosteroids,
consciousness, possible cardiac arrest epinephrine, anti-pyretics. Monitor
v/s. CPR!
GRAFT-VERSUSHOST Skin rash, fever, jaundice caused by liver methotrexate and corticosteroids
DISEASE dysfunction, bone marrow suppression

CIRCULATORY Dyspnea, cough, crackles at lung bases, Slow or stop transfusion. Elevate
OVERLOAD tachypnea, headache, hypertension, tachycardia, head. Notify. Diuretics.
increased central venous pressure, distended
neck veins
INFECTIOUS DISEASE Cardiac dysfunction, SOB, arrhythmias, heart Stop transfusion. IV access. Notify.
TRANSMISSION failure, increased serum transferrin, increased Monitor v/s. Blood culture and
liver enzymes, jaundice Gram stain. Anti-microbials,
vasopressors, steroids
IRON OVERLOAD Cardiac dysfunction, SOB, arrhythmias, heart Heart Failure. Cardiac Disorder.
failure, increased serum transferrin, increased Liver Disorder.
liver enzymes, jaundice
PATIENT - CENTERED CARE:

Consider the following:

• patient’s values and cultural beliefs.

• SAFETY!

Preparation, Administration and Monitoring

Patient’s identification and blood unit labels
Policy and procedures
Verification
ASSESSMENT:
STEPS RATIONALE
1. Verify doctor’s order. To ensure appropriate blood component, time and
date of transfusion and pre and post medications to
be given.
2. Obtain patient’s transfusion history and any known To anticipate similar reaction and be prepared to
allergies. rapidly intervene.
3. Verify that IV cannula is patent and without any Patent IV ensures that transfusion will be infused
infiltration and phlebitis. within established time guidelines
• Adult: 14- to 24-gauge short peripheral catheter. Large-gauge cannulas promote rapid flow of blood
components.
• Pediatric: 22- to 24-gauge requires blood bank to divide the unit so each half can
be infused within allotted time

4. Assess laboratory values such as hematocrit, Provides baseline for later evaluation of patient
coagulation values, platelet count response to transfusion
5. Secure consent for blood transfusion before Need consent before receiving blood component
retrieving the blood. therapy due to inherent risks.
 STEPS
6. Know indications or reasons for transfusion
7. Obtain and record pretransfusion baseline vital
signs
8. Assess patient’s need for IV fluids or medications
while transfusion is infusing
9. Assess patient’s understanding of procedure and
rationale.
RATIONALE
Allows you to anticipate patient’s response to therapy
Alerts nurse to potential transfusion reaction or
adverse effect of therapy
If IV medications need to be administered during
transfusion, second IV site is necessary. No other
infusions are to be administered through same IV site
as blood transfusion. Administer blood or blood
components only with 0.9% normal saline solution
Alleviates patient’s anxiety.
NURSING DIAGNOSES: PLANNING:
1. Expected outcomes after the
• Activity intolerance completion of the procedure.
• Decreased cardiac output • Verbalizes understanding the rationale
• Deficient fluid volume for therapy.
• Deficient knowledge regarding • Improves activity tolerance
transfusion • Mucous membranes are pink and
• Excess fluid volume patient has brisk capillary refill.
• Ineffective peripheral tissue perfusion • Cardiac output
• Systolic blood pressure improves and
urine output
• Laboratory values improve in targeted
areas

2. Explain procedure to patient

IMPLEMENTATION
1. Preadministration
a. Blood transfusion must be initiated within 30 minutes after release from laboratory
b. Check blood bag for any signs of contamination
c. Verbally compare and correctly verify patient, blood product, and type with another person before initiating
transfusion
• Identify patient using two identifiers
• Transfusion record number and patient’s identification number match
• Patient’s name is correct on all documents
• Check unit number on blood bag with blood bank form
• Blood type matches on transfusion record and blood bag.
• Check that patient’s blood type and Rh type are compatible with donor blood type and Rh type
• Check expiration date and time on unit of blood.
• check patient identification information with blood unit label information. Do not administer blood to
patient without an identification bracelet.
• Both individuals verify patient and unit identification record process
d. Review purpose of transfusion and ask patient to report any changes that he or she may feel during the
transfusion
e. Empty urine drainage collection container or have patient void.
BLOOD UNIT WITH LABEL TWO NURSES VERIFYING
IDENTIFICATION OF PATIENT
AND BLOOD PRODUCT.
TWO NURSES VERIFYING DOCTOR’S ORDER
2. Administration:
a. Hand hygiene. Use clean gloves.
b. Open Y-tubing blood administration set for single unit. Use multiset if multiple units are to be
transfused
c. “off” all clamps.
d. Hooked 0.9% normal saline IV bag with one of Y-tubing spikes. Prime IV tubing. Squeeze drip
chamber until fluid covers filter and one third to one half of drip chamber
e. Clamp “off” the blood product side of Y-tubing. Open common tubing clamp to finish priming
tubing to distal end of tubing connector. Close tubing clamp when tubing is filled with saline. All
three tubing clamps should be closed. Maintain protective sterile cap on tubing connector.
f. Gently agitate blood unit bag, turning back and forth, upside down. Remove protective cover.
Spike blood component unit with other Y connection. Close normal saline. open clamp above
filter to blood unit, and prime tubing with blood. Tap filter chamber to ensure that residual air is
removed.
g. Maintaining asepsis, attach primed tubing. Open common tubing clamp and regulate blood
infusion to allow only 2 mL/min to infuse in initial 15 minutes
SET PRIME WITH NORMAL SALINE UNIT OF BLOOD CONNECTED TO Y-TUBING
h. Remain with patient during first 15 minutes of transfusion
i. Monitor patient’s vital signs at 5 minutes, 15 minutes, and every 30 minutes until 1
hr after transfusion.
j. If there is no transfusion reaction, regulate rate of transfusion, check drop factor for
blood tubing.
k. After blood has infused, clear IV line with 0.9% normal saline and discard blood
bag. When consecutive units are ordered, maintain IV patency with 0.9% normal saline
at keep vein open (KVO) rate
l. Appropriately dispose of all supplies. Remove gloves and perform hand hygiene.
EVALUATION
1. Observe IV site and status of infusion each time vital signs are taken.
2. Observe for any changes in vital signs and any signs of transfusion reactions such as chills, flushing,
itching, dyspnea, or rash.
3. Observe patient and assess laboratory values to determine response to administration of blood component

RECORD and REPORT the following:

• pretransfusion medications, vital signs, location and condition of IV site, and
patient education
• type and volume of blood component, blood unit/ donor/recipient
identification, compatibility, and expiration date
• volume of normal saline and blood component infused.
• signs and symptoms of a transfusion reaction immediately
• amount of blood received by autotransfusion and patient’s response
• any intratransfusion/ posttransfusion deterioration in cardiac, pulmonary,
and/or renal status.
• vital signs before, during, and after transfusion
CLINICAL DECISION POINT!
• If you notice a discrepancy during verification procedure, do not administer the product
• Initiate the blood transfusion within 30 minutes from time of release from blood bank. If this cannot be
completed because of factors such as an elevated temperature, immediately return the blood to the blood
bank and retrieve it when you can administer it.
• Normal saline is compatible with blood products, unlike solutions that contain dextrose, which cause
coagulation of blood. Only use 0.9% normal saline solution to administer blood. No other solutions are to
be administered with blood
• If signs of a transfusion reaction occur, stop the transfusion, start normal saline with a new primed
tubing directly, the NOTIFY. Do not infuse saline through existing tubing because it will cause blood in
tubing to enter patient
• Do not let a unit of blood hang for more than 4 hours because of danger of bacterial growth.
Administration sets should be changed at the completion of each unit or every 4 hours to reduce bacterial
contamination
• NEVER inject medication into the same IV line with a blood component because of the risk for
contaminating the blood product with pathogens and the possibility of incompatibility. Maintain a
separate IV access if patient requires IV solutions or medications
MONITORING FOR ADVERSE TRANSFUSION REACTIONS
ASSESSMENT:
• Observe and monitor patient for the following:
o fever with or without chills.
o drop in blood pressure
o hives or skin rash, including assessment of trunk and back.
o Flushing
o gastrointestinal symptoms
o wheezing, chest pain, and possible cardiac arrest
o headache or muscle pain in presence of fever
o disseminated intravascular coagulation (DIC), renal failure, anemia, and
hemoglobinemia/ hemoglobinuria through complete blood count with hemoglobin
and hematocrit.
o monitor central venous pressure through lung auscultation
o jaundice and increased liver enzyme levels (liver damage), decreased RBC, WBC and
platelets (bone marrow suppression
o observe for mild hypothermia, cardiac dysrhythmias, hypotension, hypocalcemia,
and hemochromatosis (iron overload) in massive blood transfusions
NURSING DIAGNOSES:
• Acute pain
• Anxiety
• Decreased cardiac output
• Excess fluid volume
• Hyperthermia
• Hypothermia
• Impaired gas exchange
• Risk for infection
PLANNING:
1. Expected outcomes following completion of
the procedure:
• cardiac parameters (heart rate, blood
pressure, CVP) return to baseline
• maintains core body temperature of
36° to 37.2°C (97° to 99° F)
• urine output of 0.5 to 1 mL/kg/hr
• oxygen saturation of greater than
95%
• comfortable and calm
2. Explain treatment of reaction.
IMPLEMENTATION:
1. If transfusion occurs:
• Immediately STOP the transfusion
• Remove blood component and tubing. Hooked new of 0.9% normal saline and tubing.
• If mild allergic reaction occurs, administer anti-histamine, stop and restart transfusion
depending on doctor’s order.
• Maintain patent IV line using 0.9% normal saline
• Obtain vital signs. Do not leave patient alone.
• NOTIFY the attending physician and blood bank
• Obtain blood samples(as ordered) from extremity opposite extremity receiving transfusion
• Return remainder of blood component and attached blood tubing to blood bank
• Monitor patient’s vital signs every 15 minutes or more
• Administer prescribed medications: epinephrine, antihistamine, antibiotic,
antipyretics/analgesics, diuretics/morphine, corticosteroids, IV fluids
• In the event of cardiac arrest, initiate CPR.
• Insert a foley catheter to obtain first voided urine and send to laboratory as urine sample.
EVALUATION:
• Continue monitoring patient for signs and symptoms of transfusion reactions

RECORD and REPORT the following:

• Document the exact time transfusion reaction vital signs and
other physiologic assessments, treatments and patient response.
• Immediately report presence of transfusion reaction and
patient’s physical assessment findings
REFERENCE:

• CLINICAL NURSING SKILLS AND TECHNIQUES 8th Edition

Perry A.G, Potter P.A Ostendorf
• WIKIPEDIA
• AMERICAN SOCIETY OF HEMATOLOGY
• Video clip: https://www.youtube.com/watch?v=SX_bbPvbKMM
THANK YOU!