Blood Transfusions

Blood Transfusions

A blood transfusion is the introduction of whole blood or blood components into venous circulation.

Selection of Blood Donors:

Screening of blood donors is rigorous. Criteria have been established to protect the donor from possible ill effects of donation and to protect the recipient from exposure to diseases transmitted through the blood.
1.Blood donors are unpaid volunteers. Potential donors are eliminated by a history of hepatitis, HIV infection (or risk factors for HIV infection),
2.Heart disease,
3.Most cancers,
4.Severe asthma,
5.Bleeding disorders, or
6.Seizures.
7. Donation may be deferred for people who have malaria, have been exposed to malaria or hepatitis, are anemic,
8.have high or low BP, have low body weight, or who are pregnant, have had recent surgery, or take certain medications
PURPOSES
• To restore blood volume after severe hemorrhage
• To restore the oxygen-carrying capacity of the blood
• To provide plasma factors, such as antihemophilic factor (AHF) or factor VIII, or platelet concentrates, which prevent or treat bleeding
.
The hospital must have a protocol relating to transfusion reactions. Common measures include:
1.Notify the blood bank.
2.Examine the label on the blood container to check for errors in identifying the client, blood, or blood component.
3.Obtain laboratory specimens (e.g., blood work, urine sample).
4.Send blood container (whether or not it contains any blood), attached
infusion set, and IV solution to the blood bank
Equipment
1. Unit of whole blood, packed RBCs, or other component
2. Blood administration set
3. IV pump, if needed
4. 250 mL normal saline for infusion
5. IV pole
6. Venipuncture set containing a #14- to #22-gauge catheter (if one is not already in place)
7. Alcohol swabs
8. Tape
9. Clean gloves


Blood Products for Transfusion
Uses
Product
Not commonly used except for extreme cases of acute hemorrhage. Replaces blood volume and all blood products: RBCs, plasma, plasma proteins, fresh platelets, and other clotting factors.
Whole blood
Used to increase the oxygen-carrying capacity of blood in anemias, surgery, and disorders with slow bleeding. One unit of PRBCs has the same amount of oxygen-carrying RBCs as a unit of whole blood. One unit raises hematocrit by approximately 2% to 3%.
Packed red blood cells (PRBCs
Used for blood replacement following planned elective surgery. Client donates blood for autologous transfusion 4–5 weeks prior to surgery
Autologous RBCs
Replaces platelets in clients with bleeding disorders or platelet deficiency. Fresh platelets are
most effective. Each unit should increase the average adult client’s platelet count by about
5,000 platelets/microliter.
Platelets
Provides clotting factors. Does not need to be typed and crossmatched (contains no RBCs).
Fresh frozen plasma
Blood volume expander; provides plasma proteins
Albumin and plasma protein fraction
Used for clients with clotting factor deficiencies. Each provides different factors involved in the clotting pathway; cryoprecipitate also contains fibrinogen.
Clotting factors and cryoprecipitate

Transfusion Reactions

Nursing Intervention
Clinical Signs
Causes
Reaction
No
1. Discontinue the transfusion immediately.
Note: When the transfusion is discontinued, the blood tubing must be Removed as well. Use new tubing for the normal saline infusion.
2. Maintain vascular access with normal saline, or according to agency protocol.
3. Notify the primary care provider immediately.
4. Monitor vital signs.
5. Monitor fluid intake and output.
6. Send the remaining blood, bag, filter, tubing, a sample of the client’s blood, and a urine sample to the laboratory.
Fever or chills, flank pain,
and reddish or brown urine,
tachycardia, hypotension
incompatibility between
client’s blood and donor’s
blood
Hemolytic reaction
1
1. Discontinue the transfusion immediately.
2. Keep the vein open with a normal saline infusion.
3. Notify the primary care provider.
4. Give antipyretics as ordered
Fever; chills; warm, flushed
skin; headache; anxiety;
nausea
Sensitivity of the client’s blood to
white blood cells, platelets, or plasma proteins; does not cause hemolysis
Febrile reaction
2
1. Stop the transfusion immediately. Keep vein open with normal saline.
2. Notify the primary care provider.
3. Administer medication (antihistamines, steroids) as ordered.


Flushing, urticaria, with or
without itching
sensitivity to infused
plasma proteins
Allergic reaction (mild):

3
1. Stop the transfusion immediately.
2. Keep the vein open with a normal saline solution.
3. Notify the primary care provider immediately.
4. Monitor vital signs. Administer cardiopulmonary resuscitation if needed.
5. Administer medications and/or oxygen as ordered.
Dyspnea, stridor,
decreased oxygen
saturation, chest pain,
flushing
antibody–antigen reaction
Allergic reaction (severe):
4
1. Stop the transfusion immediately.
2. Place the client upright.
3. Notify the primary care provider.
4. Administer diuretics and oxygen as ordered
Dyspnea, hypotension,
orthopnea, crackles (rales),
distended neck veins,
tachycardia, hypertension


Circulatory overload:
blood administered faster
than the circulation can
accommodate
Circulatory overload:

5
1. Stop the transfusion.
2. Keep the vein open with a normal saline infusion.
3. Notify the primary care provider.
4. Administer IV fluids, antibiotics.
5. Obtain a blood specimen from the client for culture.
6. Send the remaining blood and tubing to the laboratory
High fever, chills,
vomiting, diarrhea,
hypotension, oliguria
contaminated
blood administered

Sepsis:

6