Sunday, August 10, 2008

Blood Transfusion Handout

What is blood transfusion?
infusion of the whole blood or a blood component into a patient’s venous circulation (Evans-Smith, pp. 656)
A life-saving medical procedure ordered by the doctor
What are the risks of blood transfusions?
• Hepatitis B
• Hepatitis C
Prior to Blood Transfusions
• Proper cross-matching of the donor’s blood and the blood of the recipient (to assure compatibility)

Equipments needed
• Blood product
 Fresh whole blood
 Packed RBC
 Platelet concentrates
 Fresh frozen plasma
 Cryoprecipitate
 Granulocyte concentrates
 Human Albumin
Fresh Whole Blood
Platelet Concentrate
Fresh Frozen Plasma
Equipments needed
• Blood administration set (with an in-line filter)
• IVF= 0.9 NaCl (Plain NSS)
• IV pole
• IV catheter (gauge 19 or larger)
• Disposable gloves
• Tape
• Obtain baseline vital signs, lung sounds, and urinary output
• Review recent laboratory values
• Ask about previous transfusion reactions
• Inspect IV insertion site and check the type of solution
Doing Blood Transfusion
• Determine whether patient knows reason for transfusion
• Explain to patient what will happen. Check for signed consent. Advise patient to report any chills, itching, rash, or unusual symptoms.
• Give premedications, if ordered by the physician.
Doing Blood Transfusion
• Hang container of 0.9% normal saline with blood administration set. Initiate infusion
• Start IV with gauge 18 or 19. Run normal saline at KVO
• Obtain the blood product
Doing Blood Transfusion
• Complete identification and checks (serial number, blood group and type, expiration date, patient’s name, inspect blood for clots)
• Take baseline Vital Signs
• Start infusion of blood (thaw 1st)

Checking the blood product
Identifying the blood product
Doing Blood Transfusion
 Prime in-line filter with blood
 Start administration slowly (25-50 ml for the first 15 minutes)
 Stay with the patient for the first 5-15 minutes of transfusion
 Check vital signs (every 15 minutes for 1 hour)
Doing Blood Transfusion
• Observe patient for flushing, dyspnea, itching, hives, rash
• Consume blood within 4 hours
• Assess frequently for transfusion reactions.

• Definition: Reaction of the body to a transfusion of blood that is not compatible with its own blood
• Signs and Symptoms include:
– Anxiety
– Flushing
– Tachycardia
– Hypotension
– Chest pain
– Back pain
– Dyspnea
– Fever
– Chills
– Jaundice
Types of transfusion reactions
• Febrile non-hemolytic transfusion reaction – most common
– Fever and dyspnea 1-6 hours post transfusion
• Viral Infection
• Bacterial Infection
Types of transfusion reactions
• Acute Hemolytic Transfusion – medical emergency
– Common cause: clerical error
– Fever, chills, back pain, hemoglobinuria

Treatment of transfusion reactions
• stop the transfusion immediately (saving the remaining blood and IV tubing for testing) and to provide supportive care to the patient.

Doing Blood Transfusion
• If a Transfusion Reaction is suspected, stop blood transfusion, and run 0.9% Normal Saline. Notify the doctor and the Blood Bank
• When transfusion is complete, clamp off blood and infuse 0.9% Normal Saline
Doing Blood Transfusion
• Record administration of blood and patient’s reaction.
Positive Outcome
Exhibit signs and symptoms of
 Fluid Balance
 Improved Cardiac Output
 Enhanced Peripheral Tissue Perfusion
Evans-Smith, Pamela., Taylor’s Clinical
Nursing Skills: A Nursing Process
Approach, Lippincott Williams and
Wilkins, 2005, pp. 656-658

Blood transfusion
-is the process of transferring blood or 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 or thrombocytopenia caused by a blood disease

Great care is taken in cross-matching to ensure that the recipient's immune system will not attack the donor blood.

In addition to the familiar human blood types (A, B, AB and O) and Rh factor (positive or negative) classifications, other minor red cell antigens are known to play a role in compatibility. These other types can become increasingly important in people who receive many blood transfusions, as their bodies develop increasing resistance to blood from other people via a process of alloimmunization.

Transfusion reaction

In medicine, a transfusion reaction is any adverse event which occurs because of a blood transfusion.

These events can take the form of an allergic reaction, a transfusion-related infection, hemolysis related to an incompatible blood type, or an alteration of the immune system related to the transfusion.

The risk of a transfusion reaction must always be balanced against the anticipated benefit of a blood transfusion.

Types of transfusion reactions

• Febrile non-hemolytic transfusion reaction.

This is the most common adverse reaction to a blood transfusion. Symptoms include fever and dyspnea 1 to 6 hours after receiving the transfusion. Such reactions are clinically benign, causing no lasting side effects or problems, but are unpleasant for the patient. Furthermore, they must be carefully differentiated from hemolytic transfusion reactions or infection (see below).

• Viral infection.

The risk of viral infection is a common concern when receiving a blood transfusion. In fact, the blood supply in developed countries is carefully screened for a number of infectious agents, in addition to careful screening of donors themselves. Nonetheless, viral transmission has been documented, albeit extremely rarely. The risk for acquiring hepatitis B via transfusion in the United States is about 1 in 250,000 units transfused, and the risk of acquiring HIV or hepatitis C via a blood transfusion is estimated, as of 2006, at 1 per 2 million units transfused. Bacterial infection is a much more common problem (see below).

• Bacterial infection.

Blood products can provide an excellent medium for bacterial growth, and can become contaminated after collection while they are being stored. The risk is highest with platelet transfusion, since platelets must be stored near room temperature and cannot be refrigerated. The risk of severe bacterial infection and sepsis is estimated (as of 2001) at about 1 in 50,000 platelet transfusions, and 1 in 500,000 red blood cell transfusions.

• Acute hemolytic reaction.

This is a medical emergency resulting from rapid destruction (hemolysis) of the donor red blood cells by host antibodies. The most common cause is clerical error (i.e. the wrong unit of blood being given to the wrong patient). The symptoms are fever and chills, sometimes with back pain and pink or red urine (hemoglobinuria). The major complication is that hemoglobin released by the destruction of red blood cells can cause acute renal failure.

• Anaphylactic reaction.

An anaphylactic (or severe allergic) reaction can occur at a rate of 1 per 30,000-50,000 transfusions. These reactions are most common in people with selective IgA deficiency (although IgA deficiency is often asymptomatic, and people may not know they have it until an anaphylactic reaction occurs). An anaphylactic reaction is a medical emergency, requiring prompt treatment, and may be life-threatening.

• Transfusion-associated acute lung injury (TRALI).

TRALI is a syndrome of acute respiratory distress, often associated with fever, non-cardiogenic pulmonary edema, and hypotension. It may occur as often as 1 in every 2000 transfusions.Symptoms can range from mild to life-threatening, but most patients recover fully within 96 hours, and the mortality rate from this condition is less than 10%.

• Volume overload.

Patients with impaired cardiac function (eg congestive heart failure) can become volume-overloaded as a result of blood transfusion, leading to edema, dyspnea (shortness of breath), and orthopnea (shortness of breath while lying flat).

• Iron overload.

Each transfused unit of red blood cells contains approximately 250 mg of elemental iron. Since elimination pathways for iron are limited, a person receiving numerous red blood cell transfusions can develop iron overload, which can in turn damage the liver, heart, kidneys, and pancreas. The threshold at which iron overload becomes significant is somewhat unclear, but is likely around 12-20 units of red blood cells transfused.

• Transfusion-associated graft-vs-host disease (GVHD).

GVHD refers to an immune attack by transfused cells against the recipient. This is a common complication of stem cell transplantation, but an exceedingly rare complication of blood transfusion. It occurs only in severely immunosuppressed patients, primarily those with congenital immune deficiencies or hematologic malignancies who are receiving intensive chemotherapy. When GVHD occurs in association with blood transfusion, it is almost uniformly fatal. Transfusion-associated GVHD can be prevented by irradiating the blood products prior to transfusion.

Treatment of transfusion reactions

The most important step in treating a presumed transfusion reaction is to stop the transfusion immediately (saving the remaining blood and IV tubing for testing) and to provide supportive care to the patient. More specific treatments depend on the nature and presumed cause of the transfusion reaction. Most hospitals and medical centers have transfusion reaction protocols, which specify testing of the blood product and patient for hemolysis, bacterial contamination, etc.
• Whole Blood
– Exchange transfusion
– Exsanguinations
– Lifespan – 30 days
– Blood more than 2 days old has no effective Plt
• Packed red cells (>70%)
– Correction of anemia
– Bleeding
– Give 40 mg furosemide orally with alternate units if old or prone to heart failure
• Platelets
• Fresh Frozen Plasma (FFP)
– To correct clotting abnormalities. Ex. DIC, warfarin
• Human Albumin Solution – 4.5 or 20%
– Hypoalbuminemia
– Hypoproteinnemic who is fluid overloaded, without giving an excess salt load.
• Cryoprecipitate
– To correct Hypofibrinogenemia. Ex. DIC

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