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- 1. BLOOD TRANSFUSION C.MULENGA (MSN) 7September 2021
- 2. Presentation Outline Definition Purpose of blood transfusion Blood groups Selection of blood donors Routine tests before transfusion Blood components/ products Nursing considerations during blood transfusion Transfusion reactions
- 3. Introduction Intravenous fluidscan replace fluid volume, but they do not restore oxygen-carrying capacity or replace clotting factors When red or white blood cells, platelets, or blood proteins are lost because of haemorrhage or disease, it may be necessary to replace these components to restore the blood’s ability to transport oxygen and carbon dioxide, clot, fight infection, and keep extracellular fluid within the intravascular compartment
- 4. Blood Transfusion Defined A blood transfusion is the introduction of whole blood or blood components into venous circulation.
- 5. Purpose of bloodtransfusion To restore blood volume or blood components lost through trauma, surgery, or a disease process To increase the number of Red Blood Cells (RBCs) and maintain haemoglobin levels in patients with severe anaemia To provide selected cellular components as replacement therapy (e.g., clotting factors, platelets, albumin).
- 6. Blood groups Humanblood is classified into four main groups (A, B, AB, and O) based on the presence or absence of certain antigens and antibodies. The antigens are found in RBCs membranes while the plasma contains antibodies against specific RBC antigens. Blood group A, has A antigens on the surface of the red blood cells (RBCs), and B antibodies in the plasma . Blood group B has B antigens on the surface of the RBCs, and A antibodies in the plasma Blood group AB has A and B antigens on the surface of the RBCs and no antibodies at all in the plasma. Blood group O has neither A nor B antigens on the surface of the red blood cells but has both A and B antibodies in the blood plasma
- 7. Blood groups (cont’d) The antibodies are responsible for the rapid and severe reaction that occurs when ABO-incompatible blood is administered Anti-A antibodies destroy A antigens, and Anti-B antibodies destroy B antigens. People with blood group O negative blood are often referred to as universal donors because the O blood type has neither A nor B antigens. Likewise patients with AB positive blood are often referred to as universal recipients because they lack antibodies
- 8. Blood groups (cont’d) An additional antigen, known as Rhesus (Rh) factor, is also important with blood typing. If the antigen is present, the blood group is referred to as Rh positive (Rh+). If it is absent, the blood group is Rh negative (Rh–). Thus, one can belong to one of the following eight blood groups: A Rh+ B Rh+ AB Rh+ O Rh+ A Rh– B Rh– AB Rh– O Rh–
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- 10. Selection of BloodDonors 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. Potential donors are eliminated by a history of hepatitis, HIV infection (or risk factors for HIV infection e.g. people who engage in anal sex, people with multiple sexual partners, IV/injection drug users, sexual partners of people at risk for HIV, and people with haemophilia), heart disease, most cancers, severe asthma, bleeding disorders, or seizures. Donation may be deferred for people who have malaria, have been exposed to malaria or hepatitis, are anaemic, have received blood in past 12 months, whole blood donation within the past 56 days, have high or low BP, have low body weight; <50kgs, young or very old (donors to be between 17-65 years), or who are pregnant, have had recent surgery, or take certain medications
- 11. Selection of BloodDonors All donors are expected to meet the following minimal requirements: Body weight should exceed 50 kg for a standard 450-mL donation. More than 17 years of age. The oral temperature should not exceed 37.5 degrees Celsius The pulse rate should be regular and between 60 and 100 bpm. The systolic arterial blood pressure should be 90 to 180 mm Hg, and the diastolic pressure should be 50 to 100 mm Hg. The haemoglobin level should be at least 12.5 g/dL for women and 13.5 g/dL for men.
- 12. Types of Donations a)Directed Donation This is where friends and family of a patient donate blood for that person b) Standard Donation Done by usual blood donors
- 13. Types of Donations c)Autologous Donation This is where a patient’s own blood may be collected for future transfusion. This method is useful for many elective surgeries where the potential need for transfusion is high (e.g., orthopaedic surgery). Preoperative donations are ideally collected 4 to 6 weeks before surgery
- 14. Types of Donations d)Intraoperative Blood Salvage This transfusion method provides replacement for patients who cannot donate blood before surgery and for those undergoing vascular, orthopaedic, or thoracic surgery. During a surgical procedure, blood lost into a sterile cavity (e.g., hip joint) is suctioned into a cell-saver machine. The whole blood or PRBCs are washed, often with saline solution; filtered; and then returned to the patient as an IV infusion.
- 15. Types of Donations e)Hemodilution This transfusion method may be initiated before or after induction of anaesthesia. About 1 to 2 units of blood are removed from the patient through a venous or arterial line and simultaneously replaced with a colloid or crystalloid solution. The blood obtained is then reinfused after surgery.
- 16. Routine tests Onceblood is donated, several tests are performed on the sample: ABO group (blood type) and Rh type Screening tests : hepatitis B and C, HIV 1 and 2, human T-lymphotropic viruses, and syphilis. If all disease screens are negative, the blood is acceptable for transfusion and is placed in the pool of available products
- 17. Routine tests Blood Typingand Cross matching To avoid transfusing incompatible red blood cells, both blood donor and recipient are typed and their blood crossmatched. Blood typing is done to determine the ABO blood group and Rh factor status. Cross matching is done to identify possible interactions of minor antigens with their corresponding antibodies. RBCs from the donor blood are mixed with serum from the recipient; a reagent is added, and the mixture is examined for visible agglutination. If agglutination does not occur, the risk of a transfusion reaction is small
- 18. Blood Products Whole blood It contains all blood components Mostly indicated for patients who need both RBCs and volume replacement to reverse the effects of hypothermia, acidosis and coagulopathy or after significant blood loss Red blood cells They are prepared from whole blood by removing the plasma. Indicated where there is need to raise the client’s haematocrit and haemoglobin while preventing fluid overload RBCs are available for transfusion as packed RBCs (PRBCs).
- 19. Blood Products Platelets Consistsof platelet concentrates and platelet rich plasma. The major function is to help in blood clotting and haemostasis Platelets are used to treat clients who have a shortage of platelets or have abnormal platelet function White blood cells (WBCs) Administered to patients with a low or abnormal WBC count It may be indicated for infections that are unresponsive to antibiotic therapy Also given to patients with cancer who have low white cell counts due to chemotherapy or the effects of cancer
- 20. Blood Products Fresh frozenplasma (FFP) It is a plasma protein rich in fibrinogen and blood clotting factor VIII FFP is administered to provide clotting factors to patients with coagulation deficiencies who are bleeding or about to undergo an invasive procedure Albumin It is a plasma protein contained within plasma It is used to restore intravascular volume and maintain cardiac output in patients with hypoproteinemia
- 21. Nursing considerations duringblood transfusion Special precautions are necessary when administering blood: Blood to be collected in plastic bags (cooler) from the blood bank just before starting the transfusion. Do not store the blood in the refrigerator on the nursing unit; lack of temperature control may damage the blood. Once blood or a blood product is removed from the blood bank refrigerator, it must be administered within a limited amount of time (e.g., packed RBCs should not hang for more than 4 hours after being removed from the blood bank refrigerator).
- 22. Nursing considerations duringblood transfusion With the exception of 0.9% sodium chloride, no drug or medication should be added to blood or blood components If an additional unit needs to be transfused, a new blood administration set is to be used Transfusion of blood or blood components is a nursing procedure but usually requires an order from a doctor/ clinician. Patient safety is a nursing priority and patient assessment, verification of health care provider’s order, and verification of correct blood products for the correct patient are imperative
- 23. Nursing considerations duringblood transfusion Perform a thorough patient assessment before initiating a transfusion and monitor carefully during and after the transfusion. Pre-transfusion assessment includes establishing the following: whether the patient knows the reason for the blood transfusion History of previous transfusion History of transfusion reaction Baseline vital signs 5-15 minutes before initiating the infusion Intravenous site is patency
- 24. Nursing considerations duringblood transfusion Before beginning a transfusion, explain the procedure and instruct the patient to report any side effects (e.g., chills, dizziness, or fever) once the transfusion begins Ensure that he or she has signed an informed consent Check the blood for any abnormalities e.g. clots For patient safety always verify three things: that blood components delivered are the ones that were ordered; that blood delivered to the patient is compatible with the blood type listed in the medical record; that the right patient receives the blood
- 25. Nursing considerations duringblood transfusion At least two nurses (check agency policy and procedures) must verify the details of the blood against patients’. If even a minor discrepancy exists, do not give the blood; notify the blood bank immediately When administering a transfusion use a bigger intravenous catheter and blood administration tubing that has a special in- line filter Prime the tubing with 0.9% sodium chloride (normal saline) to prevent haemolysis or breakdown of RBCs. Initiate a transfusion slowly to allow for the early detection of a transfusion reaction.
- 26. Nursing considerations duringblood transfusion Maintain the ordered infusion rate, monitor for side effects assess vital signs, and promptly record all findings Stay with the patient during the first 15 minutes, the time when a reaction is most likely to occur. After the initial time period, continue to monitor the patient and obtain vital signs at least every 30 minutes through out the transfusion. If a transfusion reaction is anticipated or suspected, obtain vital signs more frequently A unit of RBCs is usually administered over 2-4 hours Document observations in the medical record
- 27. Transfusion Reactions Atransfusion reaction is an immune system reaction to the transfusion that ranges from a mild response to severe anaphylactic shock or acute intravascular haemolysis, both of which are life threatening. There are different types of transfusion reactions : a) Haemolytic reaction b) Febrile reaction c) Allergic reaction d) Circulatory overload e) Septic reaction f) Transfusion-related acute lung injury (TRALI)
- 28. Transfusion Reactions Haemolytic reaction Can occur due to incompatibility between client’s blood and donor’s blood. It is the most serious of the acute complication, and it’s life threatening The haemolysis results in agglutination of RBCs, which then obstructs the capillaries, disrupting the flow of blood and oxygen to vital organs. Clinical Signs Facial flushing, fever, chills, headache, low back pain, tachycardia, dyspnoea, hypotension and blood in urine
- 29. Transfusion Reactions Haemolytic reaction(cont’d) Nursing Intervention Discontinue the transfusion immediately, discard the blood tubing, and use new tubing for the normal saline infusion. Maintain vascular access with normal saline, or according to agency protocol. Notify the primary care provider immediately. Monitor patient closely: vital signs, fluid intake and output. Treat shock Send the remaining blood, bag, filter, tubing, a sample of the client’s blood, and a urine sample to the laboratory.
- 30. Transfusion Reactions Febrile reaction: Can occur if the recipient is hypersensitive to antigens on cell components, particularly the leukocytes Clinical Signs Fever and chills; and also; headache; malaise, anxiety; nausea, warm, flushed skin Nursing Intervention 1. Discontinue the transfusion immediately. 2. Keep the vein open with a normal saline infusion. 3. Notify the primary care provider and the blood bank 4. Monitor vital signs 5. Give antipyretics as ordered.
- 31. Transfusion Reactions Allergic reaction(mild) May occur due to recipients’ sensitivity to infused plasma proteins Clinical Signs Flushing, urticarial (hives), with or without itching, wheezing Nursing Intervention 1. Stop the transfusion immediately. Keep vein open with normal saline. 2. Notify the primary care provider. 3. Administer medication (antihistamines, steroids) as ordered
- 32. Transfusion Reactions Allergic reaction(severe): May occur due to antibody–antigen reaction Clinical Signs Dyspnea, stridor, decreased oxygen saturation, chest pain, Flushing Nursing Intervention 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.
- 33. Transfusion Reactions Circulatory overload May occur if blood is administered faster than the circulation can accommodate Clinical Signs Dyspnoea, coughing, orthopnoea, crackles (rales), distended neck veins, tachycardia Nursing Intervention 1. Stop the transfusion immediately. 2. Place the client upright with feet dependent 3. Notify the primary care provider. 4. Administer diuretics and oxygen as ordered
- 34. Transfusion Reactions Septic reactions Can occur if bacteria have contaminated the blood components being administered Common in patients receiving platelets, because they are stored at room T (20-24 degrees Celsius) for as long as 5 days Clinical Signs High fever, chills, vomiting, diarrhoea, hypotension, oliguria Nursing Intervention 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.
- 35. Transfusion Reactions Transfusion-related acutelung injury (TRALI) Thought to occur when the donor plasma contains an antibody against the patients leukocyte-specific antigen Occurs more frequently following transfusion with plasma, particularly FFP Clinical signs It is suspected when symptoms of dyspnoea, hypotension and fever develops within 30 minutes to 6 hours following a blood transfusion, and a chest radiograph shows diffuse infiltrates Also patient has new-onset symptoms of noncardiac pulmonary oedema, tachycardia, and severe hypoxia Management Ventilatory support Oxygen therapy Fluid resuscitation
- 36. Transfusion Reactions: GeneralManagement Guidelines If there are signs or symptoms of transfusion reaction, stop the transfusion immediately. Do not flush the tubing. Disconnect the administration set from the intravenous catheter. Call for help and prepare for emergency care. Obtain vital signs, and auscultate heart and breath sounds. Maintain patency of the intravenous catheter by hanging a new infusion of normal saline solution, using new tubing. Notify the primary care provider.
- 37. Transfusion Reactions: GeneralManagement Guidelines Remain with the patient, observing signs and symptoms and monitoring vital signs as often as every 5 minutes. Prepare to administer emergency drugs such as antihistamines, vasopressors, fluids, and corticosteroids per health care provider order or protocol. Prepare to perform cardiopulmonary resuscitation.
- 38. Transfusion Reactions: GeneralManagement Guidelines Place the administration set and blood product container, with the blood bank form attached, inside a biohazard bag and send the bag to the blood bank immediately. Obtain blood (in the extremity opposite the transfusion site) and urine specimens according to institution’s policy.
- 39. Prevention of bloodtransfusion reactions Administering the transfusion at a sufficiently slow rate Transfusing packed red blood cells rather than whole blood for patients at risk of circulatory overload Administering diuretics such as furosemide before commencement of transfusion for patients at risk of circulatory overload Paying meticulous attention to detail in labeling blood samples and blood components Ensuring that the right patients receive the right blood Maintaining aseptic technique during the transfusion process Close monitoring of patients on blood transfusion for early detection and prompt management Administering the blood within a 4 hour period because warm temperature promotes bacterial growth
- 40. References Craven, RF.& Hirnle, C.J. & Henshaw C.M. (2017). Fundamentals of nursing: Human health and function. (8th Ed). Philadelphia: JB Lippincott Company Kozier & Erb’s et al; (2016). Fundamentals of nursing: concepts, process and practice (10th Ed). Harlow, Essex Pearson Education Limited Smeltzer et al., (2010). Brunner and Suddarth’s textbook of Medical-Surgical Nursing (12th Ed) Wolters Klover/ Lippincot Williams & Wilkins.