BLOOD TRANSFUSIONS

LEA S. LANDICHO, RN MAN

Blood Transfusions
Restoration of intravascular (blood) volume Restoration of bloods ability to transport

oxygen and carbon dioxide, to clot, to fight infection and to keep ECF within IVC.

Blood & blood products (culturally competent care)

JW do not receive blood or blood products.

Blood volume expanders are acceptable if they are not derivatives of blood.
Christian scientists do not ordinarily use blood

or blood products.

Blood groups
Main groups A, AB, B, O Antigens proteins that can be found in RBC

Agglutinogens clumping of blood cells

Blood groups with constituent agglutinogens and agglutinins

Blood types RBC antigens (agglutinogens) Plasma antibodies (agglutinins)

A B AB O

A B A&B -

B A A&B

Rhesus (RH) factor

Rh Rh +

Occurrence of antigen-antibody reaction and

hemolysis of RBCs

Blood typing & Crossmatching

Blood typing determine ABO blood group

and RH factor status

Crossmatching identify possible interactions

of minor antigens with their corresponding antibodies.

Selection of Blood donors

Contraindicated as blood donors

Hx of hepatitis
HIV infection (or risk factors) Heart disease

Most cancers
Severe asthma Bleeding disorders

Convulsions

Selection of Blood donors

Contraindicated as blood donors

People with malaria

Pregnant Surgery

Anemia
High/low BP Certain drugs

Blood & blood products

Products Whole Blood PRBCs Autologous RBC Platelets FFP Albumin, plasma protein fraction Clotting factors and cryo Use Extreme cases of acute hemorrhage; replaces BV and all blood products Increase O2-carrying capacity of blood in anemias, sx, d/o of slow bleeding; 1 u raises hct to 2-3% Blood replacement ff. planned elective sx; 4-5 weeks prior to sx Bleeding d/o or platelet disorders; increase average adult platelet ct. by about 5000 plt/ml Expand BV and provides clotting factors; no need to be typed and xmatched. Increase 2-3% clotting factor BV expander, provides plasma protein Clotting factors deficiencies; cryo contains fibrinogen.

Blood administration
Special precautions:

Obtain blood from blood bank

Do not store the blood in the refrigerator on

nursing unit. Use g. 18 or g. 20 IV needle or catheter Prepare a Y-type BT set with an in-line or add-on filter Follow policy of an agency on administering BT.

Purpose of BT
To restore blood volume after severe

hemorrhage
To restore O2-carrying capacity of the blood To provide plasma factors such as AHF or

factor VIII or platelet concentrates.

Assessment
Clinical signs of rxn: sudden chills, fever,

nausea, itching, rash, low back pain, dyspnea.

Manifestations of hypervolemia Status of infusion site

Any unusual symptoms

Planning
Verify doctors order

Verify pt. consent and baseline data prior to

BT Verify signed consent form was obtained Assess VS Determine any known allergies or previous adverse rxn to blood. Note specific signs related to pts pathology and reason for BT

Equipments
Blood product

BT set
NSS IV pole

Venipuncture site g.18/20

Chlorhexidine solution Alcohol swabs

Tape
Clean gloves

Intervention
Preparation:

Prepare the client

Introduce self and verify clients identity Explain procedure and its purpose

Check the clients IV line (needle &

solution) Check agencys policy on BT

Intervention
Performance:

Obtain correct blood component for patient.

Verify pts identity accdg to agency protocol Set up the infusion set

Prime the tubing

Start the saline solution Prepare the blood bag

Establish the blood transfusion

Observe the pt closely for 5-10 minutes

Intervention
Performance:

Document relevant data

Monitor the pt Terminate the transfusion

Follow agency protocol for disposition of

blood bag Document relevant data

Evaluation
Evaluate the following:

Changes in VS/health status

Presence of chills, nausea, vomiting or skin

rash

Nursing Diagnosis
Deficient Fluid Volume

Transfusion Reactions
Reaction: Causes Hemolytic rxn: incompatibility Clinical Signs Chills, fever, headache, backache, dyspnea, cyanosis, chest pain, tachycardia, hypotension Nursing Intervention DC the BT Maintain vascular access Notify MD Monitor VS Monitor fluid I & O Send BT set, blood, urine in laboratory DC BT Antipyretics Notify MD KVO c NSS

Febrile rxn: sensitivity to WBC or plasma proteins

Fever, chills, warm flushed skin, headache, anxiety, muscle pain

Transfusion Reactions
Reaction Allergic Rxn (mild): sensitivity to infused plasma proteins Allergic Rxn (severe): antibody-antigen rxn Clinical Signs Flushing, itching, urticaria, bronchial wheezing Dyspnea, chest pain, circ collapse, cardiac arrest Nursing Intervention Stop/slow BT Notify MD Antihistamines Stop BT KVO c NSS MD VS. CPR if needed Meds / O2 inhalation Upright position c feet dependent Stop/slow BT MD Diuretics & O2 as needed

Circulatory Overload : fast BT rate

Cough, dyspnea, crackles (rales), DNV, tachycardia, hypertension

Transfusion Reactions
Reaction Sepsis: contaminated blood Clinical Signs Hi-fever, chills, vomiting, diarrhea, hypotension Nursing Intervention Stop BT KVO c NSS MD IVF & antibiotics BCS Blood and BT sets to lab

Thank You!
Any Questions?