Blood Transfusion

1.Definition

Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another.

Blood transfusions can be life-saving in some situations, such as massive blood loss due to trauma, or can be used to replace blood lost during surgery. Blood transfusions may also be used to treat a severe anaemia orthrombocytopenia caused by a blood disease. People suffering from hemophilia or sickle-cell disease may require frequent blood transfusions. Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood.

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2.Blood Group

Human blood is classified in to four main groups (A, B, AB and O) on the basic of polysaccharide antigen on the erythrocyte surface. These antigens type A and Type B, commonly cause antibody reaction and are called agglutinogens. In other words;

a) group A blood contain type A agglutinogen,

b)group B blood contain type B agglutinogen,

c) group AB contain both A & B agglutinogens,

d) group O blood containe neither agglutinogen.

In addition to agglutinogens on the erythrocytes agglutinin (antibody) are present in the blood plasma. No individual can have agglutinin and agglutinogen of the same type, that person's system would attack its own cells.

a) group A blood does not contain agglutinin A but does contain agglutinin B.

b) Group B blood does not contain agglutinin B but does contain agglutinin A.

c) Group AB blood contain neither agglutinin

d) group O contain both anti A and anti B agglutinin.

Blood transfusion must be match to the patient blood type in term of compatible agglutinogen mismatch blood will cause hemolytic reaction.

Rhesus (Rh) and other factors

Rh antigen also on the surface of erythrocytes are present in about 85% of the population are can be a mayor cause of hemolyt

ic reaction. Persons who possess the Rh factor are referred to as Rh positive those who do not are referred to as Rh negative. Unlike the A and B agglitinogen, the Rh factor cannot cause a hemolytic reaction on the first exposure to mismatched blood, because the Rh antibody is not normally present in the plasma of Rh negative person.

3. Types of blood transfusions

Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts. The type of blood transfusion you need depends on your situation. For example, if you have an illness that stops your body from properly making a part of your blood, you may need only that part to treat the illness.

Red blood cell transfusions

Red blood cells are the most commonly transfused part of the blood. These cells carry oxygen from the lungs to your body's organs and tissues. They also help your body get rid of carbon dioxide and other waste products. You may need a transfusion of red blood cells if you've lost blood due to an injury or surgery.
You also may need this type of transfusion if you have severe anemia due to disease or blood loss. Anemia is a condition in which your blood has a lower than normal number of red blood cells, or the red blood cells don't have enough hemoglobin. Hemoglobin – an iron-rich protein that gives blood its red color – carries oxygen from thelungs to the rest of the body.

Platelets and clotting factor transfusions

Platelets and clotting factors help stop bleeding, including internal bleeding that you can't see. Some illnesses may cause your body to not make enough platelets or other clotting factors. You may need regular transfusions of these parts of your blood to stay healthy. For example, if you have hemophilia A, you may need a special clotting factor to replace the clotting factor you're lacking. Hemophilia is a rare, inherited bleeding disorder in which your blood doesn't clot normally.
If you have hemophilia, you may bleed for a longer time than others after an injury or accident. You also may bleed internally, especially in the joints (knees, ankles, and elbows).

Plasma transfusions

Plasma is the liquid part of your blood. It's mainly water, but also contains proteins, clotting factors, hormones, vitamins, cholesterol, sugar, sodium, potassium, calcium, and more. If you have been badly burned or have liver failure or a severe infection, you may need a plasma transfusion.

Who needs a transfusion?

Some people need blood or parts of the blood because of illnesses. You may need a blood transfusion if you have:

• A severe infection or liver disease that stops your body from properly making blood or some parts of blood.


• An illness that causes anemia, such as kidney disease or cancer. Medicines or radiation used to treat a medical condition also can cause anemia. There are many different types of anemia, including aplastic,Fanconi, hemolytic, iron-deficiency, and sickle cell anemias and thalassemia.


• A bleeding disorder, such as hemophilia or thrombocytopenia.

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4.Transfusion reaction

Transfusion reaction can be categorized as hemolytic, febrile, circulatory over load and allergic. The nurse must asses a client closely for reactions. Sign of an acute reaction include;

a) sudden chills or fever,

b) low back pain,

c) drop in blood pressure,

d) nausea,

e) flushing agitation

f) respiratory disorders.

Sign of less severe allergic reaction include;

a) hives and itching but no fever.

Nursing management for transfusion reaction:

•Stop the transfusion. Maintain the intravenous line with normal saline solution
through new intravenous tubing, administered at a slow rate.

•Asses the patient carefully, compare the vital sign with those from the base line assessment.

•Notify the physician of the assessment findings and implement any order obtained.

•Notify the blood bank that a suspected transfusion reaction has occurred.

•Send the blood container and tubing to the blood bank for repeat typing and
culture, the identifying tag and number are verified.

Before commencing a blood transfusion determine:

1.Base line data regarding blood pressure, temperature, pulse and respiration.

2.Any previous reaction to a blood transfusion.

3.The request for blood transfusion form has been completed and send specimen for typing and cross matching

4.Purpose
1.Restore blood volume after hemorrhage

2.Maintain hemoglobin levels in severe anemia

3.Replace specific blood component.

5. Assessment focus

Clinical signs of reaction (e.g. sudden chills, nausea, itching rash, dyspnea) status of infusion, site, any unusual symptoms.

Equipment

1.Unit of whole blood

2.Blood administration set either a straight line or a Y set ( Y set is preferred)

3.Normal saline solution

4.IV dressing (tegaderm)

5.Vena puncture set containing a 18 needle or catheter, or if blood is to be
administered quickly no 16 needle or a larger.

6.Alcohol swab

7.Tape

8.Disposable gloves (non Sterile)

6.Initiating, Maintaining and Terminating a Blood Transfusion

***Nursing Intervention

a.Pre Procedure

1.Obtain patient’s base line data before the transfusion.
•Asses base line data: Temp, Pulse, Respiration and Blood Pressure.
•Determine any known allergies or previous adverse reaction to blood.
Note specific signs related to the client's pathology and reason for transfusion
(e.g. an anemic client, note the hemoglobin level less than 10g/L).

2.Obtain the correct blood component for the patient.
•Check the physician's order with the requisition. See that doctor check and write
to start.
•Check the requisition form and the blood bag label with a specially check the
patient name, identification number, blood type and Rh group the blood donor
number, and the expiration date of blood.
•Ensure that doctor’s counter check and sign
•With another nurse (RN) compare the laboratory blood type round with :
•The client's name and identification number. Ask the patient to state the full name as a double check.
•The number on the blood bag label
•The patient’s blood group and label, amount of blood, calculate and adjust.
•Check blood for any abnormalities, gas bubles dark color or cloudiness, clots and excess air
•Make sure that the blood is left at room temperature for no more than 30 minutes before starting the transfusion. RBCs deteriorate and lose their effectiveness after 2 hours at room temperature. Agencies may designate different times at which the blood must be returned to the blood bank if it has not been started. As blood component warm, the risk of bacterial growth also increases.

Rational :

If the patient’s Clinical status permits, delay transfusion if baseline temperature is greater than 38.50 C

b.Procedure

1.Wash and dry hands

2.If any pre medication order, give before transfusion

3.Prepare the patient
•Identify the patient and explain the procedure and its purpose to the patient such as blood product to be transfused, approximate length of time, and desired outcome of transfusion.

4.Assemble the equipment and bring to the patient

5.Wear gloves.

6.Positioning the patient comfortably

7.Prime the tubing with saline solution.( 50cc)
Establish the saline infusion See that the set used in appropriate, as sometimes
attached filter is not suitable for some product

8.If the patient has an intravenous solution infusing check whether the needle and solution are appropriate to administer blood. The needle should be no. 18 gauge or larger and the solution must be saline. If solution is not compatible remove it and dispose of it according to hospital policy. Dextrose which causes lysis of RBCs, Ringer's Solution, medication and other additives and hyper alimentation solution are incompatible.

9.If patient does not have an intravenous solution infusing, in the case you will
need to perform veni puncture on a suitable vein. Select a large vein that allows
patient some degree of mobility and place bed protector under the site. Start the
prescribed intravenous infusion

10.Establish the blood transfusion. Invert the blood bag gently several times to mix the cell within the plasma

11.Start infusion slowly at 2 ml/mnt. Remain at bed side for 5-30 minutes. If there are not sign of circulatory overloading, the infusion rate may be increased

12.Observe the patient closely for chilling, nausea, vomiting, skin rashes
tachycardia as they early sign and symptom reaction

13. check vital sign
a) 1st hour - every 15 minutes

b) 2nd hours- every 30 minutes

c) 3rd hours - every 60 munites

14) Report sign and symptoms of reaction immediately to physician to minimize consequences. Acute reaction may occur at anytime during the transfusion.

**If any reaction:

1) close clamp & run normal saline,

2) report to doctor,

3) Send urine FEME, FBC to lab.

4) complete blood form and send to blood bank together with unfinish blood bag.

5) continue observation.

Rational :

The majority of acute fatal transfusion reaction are caused by clerical errors. Patient and product verification is the single most important fucntion of the nurse. It is strongly recommended that two qualified individuals perform this task. Do not proceed with the transfusion if there is any discrepancy. Contact the blood bank immediately

c. Post procedure

1) Give IV Lasix 20mg according doctor's order before complete transfusion.

2) Obtain vital sign and compare with base line assessment.

3) Document procedure in patient's medical record including:
•Product , blood type Rh, volume transfused, rate, site infused.
•Product identification number
•Name of individual verifying, patient ID, name of person starting and ending
transfusion.
•Patient assessment findings and tolerance to procedure.
•Monitor patient for response to and effectiveness of the procedure.

4) Flush with Normal saline about 50cc after finish transfusion

5) Terminate the transfusion
Discard administration set according to policy procedure.
(i.e. If any reaction, save the set for further investigations)

Rational :

Rationale it must be possible to trace each transfusion product to the original

blood donor

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