BLOOD TRANSFUSION

Definition:Blood transfusion is the transfer of blood from the vein of one

person (donor) to the vein of another (recipient).
Therapeutic uses or Indications:1) When blood is reduced as in acute haemorrhage, eg. Haemoptysis,
Haematemesis

postpartum

haemorrhage,

operations

etc.

(Haemoptysis means caughing up and spitting of blood from the

lungs. Haematenesis means vomiting of blood from the stomach)
2) When quality of blood is impaired eg:a) Red cell volume or haemoglobin content of the blood is reduced as
in anaemias
b) Leucocyte count of the blood is reduced as in granulocytosis, and
neutropenia
c) Deficiency in platelets ai in thrombocytopenic purpura.
(Haemorrhagic spots under the skin, bleeding from mouth etc.
3) The quantity of the protein is reduced as in malnutrition, excessive
loss of protein as burns or vesicular skin diseases.
4) Immunotransfusions-when there is an infection

with

lowered

immunity that might be raised by giving the ill persons, some blood
or plasma from the person who have just recovered from the same
disease.
5) Haemorrhagic diseases as in heamophilia and erythro blastosis
foetalis.
Donor:- The one who gives the blood.
6) Recipient:- The one who receives the blood.
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Points to be Remembered Before Blood Transfusion

Selection of donor and grouping of blood:a) Donor must have a normal temperature and blood pressure. He
should be free from syphilis, malaria and upper respiratory
diseases and give no history of viral hepatitis, skin diseases or
other allergic diseases.
b) In case of women, they must not have been pregnant within last 6
months and their haemoglobin must not fall below 12.5 gm
perl00cc of blood.
c) The blood should contain at least 80 percent haemoglobin and the
person should have normal weight
d) The donor should be healthy. Before the blood is collected from the
donor, a sample is taken and sent for serological test syphilis and
the blood is grouped also.

Blood grouping:
The blood of all human beings may be classified into one of four
groups '0' 'A' 'B' 'AB' based on the phenomina of agglutination. If the R B
C of one group clump together when mixed with the serum of blood of a
different group agglutination has occured. Agglutinin is sensitising
antibody which causes agglutination of R B C in a suspension.

Group AB or I

Universal

recipient-can

blood from any person but

2

receive
can

only give to group AB.

can receive blood from groups 'A' and '0'

Group 'A' or 'II'

and give to "AB" and 'A'

can receive from groups 'B' and '0' and

:
Group 'B' 'III'

give to AB or B
Group 'O' or 'IV

Blood group
AB.
A
B
0

universal donor-can give blood to all groups,

can only receive from group '0'

May give blood to

AB
AB&A
AB or B
A,AB, O&B

May receive blood from

A,AB, B &0
A&O
B&O
0

Rhesus Factor (R. H. Factor)

Human beings are divided in to R H positive and RH negative. R. H.
positive:- Person whose erythrocytes or R B C are agglutinated by the
antiserum are termed R. H. Positive:
R. H, negative:- Those whose cells are not agglutinated termed R. H.
negative. R. H. negative should never be given to any persons whose
blood is R. H. positive.
R. H. negative mother carrying a foetus who has inherited R. H.
positive blood cells, may develop antibodies against the R. H. positive
cells of the foetus and those antibodies in the mother's blood cause
erythroblastosis foetalis. The first bone child may be alright. In
subsequent pregnancies there may be reactions and the child may form
deformities and may cause haemolytic diseases of the new born, like

jaundice, haemorrhage, anaemia at birth or later on may develop

anaemia and baby may be born macerated.
Immediate Signs of R. H. Incompatibility while blood transfusion
Cyanosis, costricting pain in the chest and loins are felt by the
patients, rigors and shivering and even collapse may occur.
Contra Indications of blood transfusion:- Hypertension, severe
toxaemia.
Technique of taking blood from the donor:There are two methods:1 Direct method.
2. Indirect method.
Direct Method:The donor and the recipient are placed side by side and blood
taken from one person is given directly to the other so that theoretically
the blood has no time to clot.

Indirect Method:This method is commonly used. Blood is taken from the donor
and given to the recipient days or weeks later. Clotting is prevented by
the addition of ananti-coagulent solution and the blood is preserved by
refrigeration (at a temperature of 4 degrees to 6 degrees C)
Standard of Reservation:1) Citrated whole blood must not be used after 3 weeks.
2) The anti-coagulant must be sterilized in such a way that the
dextrose is not damaged.
Solutions Used:- 2 percent sodium citrate 1 oz (30 ml) for 10 oz(300ml)
of blood.
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Equipment Needed for Taking Blood:1. Bottle containing anti-coagulant.

2. Blood Donor set containing Two lengths of rubber tubing, one has
a needle at one end is plugged with cotton wool at the other end.
This needle is pushed through the one perforation of the rubber
diaphragm of the bottle to act as the air way.
3. Second longer piece of the tubing has a needle at each end, one is
pushed through the second perforation of the bottle and the other
is for insertion in the vein of the donor.

A Sterile Tray Containing:1) Cotton swabs, (gauze)

2) Sterile towel.
3) Artery clamp.
An unsterile tray containing: 1) Mackintosh and towel
2) Arm board.
3) Kidney tray.
4) Bowl of cold water or cold sodium citrate solution to keep the tube

5)
6)
7)
8)
9)

and needle after use.

Bottle of spirit.
Tr. Benzoine.
Adhesive plaster and scissors.
Tourniquet.
Warm drink for the donor.
(All equipment that comes in contact with the blood should be

absolutely-sterile).
Preparation of Donor:-

Mental preparation-Win the confidence and co-operation and allay

fear and anxiety, by proper explanation of the procedure. Reassure him.
The individual should have thorough understanding of that is to be done
and keep the person engaged in conversation which helps to prevent
fainting. Blood should not be taken in empty stomach or soon after a
meal. It is advisable to take blood 2 hours after the meal.
Position:-Place the donor comfortable in dorsal position.
Procedure:

Assemble the equipment to the bedside.

Privacy should be maintained.
Place the mackintosh and towel under the arm.
Extend the donor's arm on the arm board.
Apply cuff of the sphygmomanometer upside down high up in the

arm.
Clean the area with a swab moistened with methylated spirit.

Assist the doctor to drape the area.

Pump up the cuff to pressure of 80 mm to get the vein distended.
Give the donor a roller bandage to hold.
Assist the doctor to insert the needle into the vein.

When the needle has entered in the vein, blood will flow into the
bottle through the rubber tube. Then rotate bottle gently in order to mix
the blood with sodium citrate solution in the bottle. When the blood flow
is established the cotton plugged in the air way is removed.

The donor may be asked to clasp his hand over the bandage to
increase the flow of blood from the vein.
When the required quantity of blood has been withdrawn (Usually
10 ounce to 1 pint) the cuff is removed, the needle withdrawn and firm
pressure made over the puncture and apply sterile dressing or flex the
elbow.
At the end of the procedure a few ml of blood from the tubing is
run to test tube to be used for testing and checking the blood group, if it
has not been checked already. Label and send it for refrigeration. In case
of preserving the blood for special individual, write the ward number, bed
number, name, age and date to be used and the group of blood in the
bottle.

Put the rubber tubing and needle into the bowl containing cold
water.
Give the donor a palatable drink. (Sweetened tea, coffee, orange or
egg flip)
Provide at least half an hour rest for donor before he leaves the
hospital.
All throughout the procedure the donor should be watched for
shock restlessness and fainting.
Tidy up the unit.
Clean and replace the articles
Enter his name age, address amount of blood taken and date in
doner's register.

Special points to be stressed:1) All equipments and supplies used should be sterile and the
procedure should be performed with strict aseptic technique.
2) Watch the donor for shock, restlessness and fainting.
3) Always label the bottle, specifying the group before sending it for
refrigeration.
4) Blood should always be kept at a temperature of 4 to 6 degree
centigrade or 39.2 degree Fahrenheit.
The donor should be given nourishing drinks and instruct him to
remain in bed for at least half an hour. Before the donor is allowed to
leave, his pulse rate is checked, his colour should be natural and he
should be questioned as to feeling of giddiness or a feeling of illness. Any
indication that his not completely recovered from the weakening effect of
loss of blood he should be kept under close observation.
5) A second withdrawal should not be made until the blood volume
and its constituents have returned to normal (usually after 3
months)
Administration of Blood: Procedure:- Same as for I V. infusion.
Check and recheck the blood to be given to ascertain the group.
The rate at which the blood is given should be carefully regulated. Give
the blood slowly and watch the patient for any adverse reaction like
restlessness, dyspnoea, pain in the chest, cyanosis, cough and chill. In

the first 30 mi nuts the rate of flow should be5 to10 drops per minute
and the subsequent flow rate depends upon the condition of the patient.
If any untoward symptoms are noted, stop the flow and report
immediately.
Before and during the transfusion the bottle will need gentle
shaking as the ted cells will have a tendency to from a sediment. Any
vigorous shaking should be avoided. Watch the needle whether it is in
position or any leakage, bulging rate of flow, any haematoma, pain or
swelling in the limb. Blood should not be heated before being used for
transfusion. If it has been kept in the refrigerator it should be allowed to
stand at the room temperature for at least an hour or more before it is
administered to the patient.
Once the blood is exposed to atmosphere it should be discarded.
Record the treatment, time and manner in which blood is given, by
whom, amount and the patient's reaction to the treatment.
Reaction and Complications:1) Pyrogenic Reaction: Characterized by fever and chills may occur
during or immediately after the transfusion.
2) Haemolytic Reactions:- Caused by incompatibility between the
red cells of the donor and serum of the recipient or by the red cells
of the recipient being haemolysed by the serum of the donor.
3) Proteolytic Reaction:- It is allergic in nature and usually
characterised by urticaria.
4) Circulatory Overloading:- Caused by excessive increased blood

volume. It may result from giving too fast or giving too much blood.
5) Air Embolism:- Can be prevented by elimination of all air from the
tubing before the flow of blood is started. Corks and connections
should be air tight. Care should be

taken to avoid the entry of air

when the needle is removed.

6) Transmission of Diseases:- Smphilis, malaria, jaundice and
allergic diseases may be caused by giving of contaminated blood.
Careful checking of blood supply and refrigeration of blood
eliminate the possible complication of administering contaminated
blood.
Venesection or Venisection:Means surgical opening of a vein.
It is usually done in cases where it is difficult to get the vein with a
needle eg. In case of dehydration the veins become collapsed. In case of
obesity where the vein is not visible.
Requirements:A sterile tray containing:- 2 cc syringe and needle for local anaesthesia.
1) Scalpel or B. P. handle and blade
2) Fine toothed dissecting forceps.
3) Pointed scissors
4) Mosquito forceps - 2
5) Aneurism needle 1
6) Skin needle and needle holder
7) Small hooks
8) Curved needles
9) Polythene canula or intravenous canula.
10) Cotton thread size 60 or caught size '0' for tying the canula.
11) Gauze piece, cotton swabs, sterile towels 2 and towel clips, I V set
and solution.(Unsterile things same as for blood transfusion).The nurse may
prepare these things, IV solution and Set. The physician will do the procedure.
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BIBLIOGRAPHY
1) Theresamma. CP., 2006 Fundamentals of Nursing Procedure
manual for General nursing & Midwifery Course. 1 st Edition,
Jaypee Brothers, Medical Publishers (p) Ltd., New Delhi.p:182-187.
2) Nancy Sr., 2002, Principles & Practice of Nursing & Nursing arts
procedures, 5th edition published & Printed by N.R. Publishers,
House, Indore.p:340-347.
3) LC Gupta US, Sahu, Priya Gupta, 2007 Practical Nursing
Procedure. 3rd Edition, Printed at Para Offset Pvt. Ltd. New Delhi;
p: 300-308.
4) Sagunthala Sharma Birpuri 1997 Principles and Practice of
Nursing 1st edition Printed at Lordson Publishers (P) ltd., New
Delhi. p. 250-252.
5) Brunner & Siddarths, 2001, Text book of Medical- surgical
Nursing- 12th edition, volume2, published by Wolters Kluwer
(India) pvt. Ltd New Delhi, Page No: 941-945
6) Lewis, collier, Heitkemper, 1996 Medicalsurgical Nursing, 4 th
Edition, Mosby year book- Inc USA, Page no: 881-889

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