Simon John L. Crisostomo, RN

Packed RBCReplaces erythrocyte and resolution of anemia,

usually a unit of packed RBC’s are supplied in 250 ml unit bag

Each unit increases the hemoglobin by 1 g/dl and hct by 2-3% which will change in 4-6 hours after completion of blood transfusion

Whole BloodRarely used, used to resolve Hypovolemic shock

from HemorrhageEach unit normally contain 500ml

Platelets Used to treat Thrombocytopenia and Platelet

dysfunction Cross-matching is not required but may done, bags

contains 50-70 ml per unit to 200-400 ml per unit Administered immediately on receipt from blood

bank and may be given rapidly over 15 to 30 minutes

Fresh Frozen Plasma Provides Clotting factors or Volume expansion; NO

PLATELETS Infused within 6 hours, Rh and ABO compatibility

test required About 200-250 ml per unit PT and PTT is a done post transfusion for resolution

of Coagulation defects or Hypovolemia

Albumin Prepared in plasma and can stored for 5 year Treat Hypovolemic shock or Hypoalbunemia

Cryoprecipitate Are prepared from Fresh Frozen Plasma and can be

stored for 1 year Used to replace clotting factors, especially Factor

VIII and Fibrinogen

Introduction of whole blood plasma, serum erythrocyte or platelets into the venous circulation.

1. To increase the circulating blood volume as in shock due to hemorrhage.

2. To increase red cell volume of hemoglobin content of the blood as in anemia.

3. To increase WBC content of the blood as in agranulocytosis and leukopenia.

4. To increase the quantity of protein malnutrition, excessive loss of protein from burns or vesicular skin diseases.

1. IV tray 2. Compatible BT test 3. IV catheter/needle g 18/19 4. Plaster 5. Tourniquet 6. Blood product 7. Plain NSS 8. IV stand 9. Gloves

1. Verify doctor’s order -To avoid mistakes.and make a treatmentcard.2. Explain procedure to - Encourage client’s coo-client. peration and decrease

anxiety.3. Request blood/blood component from hospi-tal blood bank to includeblood typing and cross matching.

4. Warm blood at - To prevent unto-room temperature ward blood reac-by wrapping the tion. blood bag with atowel. Blood shouldbe transfused notmore than 20 mins.from the time it arrives from the bloodbank.

5. Have the doctor and To prevent any problem in relationa nurse countercheck to transfusion.the compatible blood to be transfused.a) name and identifica-tion numberb) client’s blood groupand Rh typec) donor’s blood groupand Rh typed) crossmatch compati-bilitye) blood unit and serialcomponentf) expiration date of bloodproduct

6. Get the base- - To compare anyline vital signs be- change in vitalfore transfusion. signs before and

during BT.7. Give pre-med - To prevent minor 30 mins.before allergic reactions.transfusion.

8. Wash hands and - To preventcontami-don gloves. nation of microor-

ganisms. 9. Prepare equipments - To facilitate inter-needed. vention.

Clients blood sample are drawn and labelled at the bedside when drawn, the client is asked to state his or her name, which compared with the name of the client’s identification band or bracelet.

The recipient’s ABO and Rh type are identified

An Antibody screen is done to determine the presence of antibodies other than anti-A and Anti-B

Cross-matching is done in which donor RBC are combined with recipient’s serum and Coomb’s serum; Crossmatching is compatible if NO RBC Coagulation occurs

The Universal RBC donor is O negative, The Universal recipient is AB positive

Infusion controllers and Pumps Used to administer blood products if they are

designed to function with opaque soln’ Special manual Pressure Cuff

May be used to increase the flow rate but should not exceed 300 mmHg

To prevent HYPOTHERMIA and adverse reactions when several units of blood being administered

Do not warm blood products in the microwave or in hot water

Avoid large vol. of refrigerated blood infused rapidly which can cause cardiac dysrhythmias

No other soln’ other than NSS should be added to blood components

Medications are NEVER added to blood components or piggy backed into a blood transfusion

Infusions (1 Unit) shout NOT exceed 4 hours to avoid Septicemia

Blood administration set should be changed every 4-6 hours

Always check the blood bag for the expiration date

Inspect the blood bag for leaks, abnormal color clots and bubbles

Blood must be administered as soon as possible (within 20-30 mins.) from receiving from the blood bank

Never refrigerate blood, if blood is administered within 20-30 mins. Return it to the blood bank

Blood is infused as quickly as the clients condition allows

Components containing few RBC and Platelets may be infused rapidly but caution must be taken to avoid circulatory overload

The nurse should measure the vital signs and assess the lung sounds before the transfusion and again after the 1st 15 mins and every hour until 1 hour after the transfusion is completed

Blood will be released from the Blood Bank only by recognized personnel

The Name and the identification number of the intended recipient must be provided to the blood bank and a documented permanent record of this information must be maintained

Blood should be transported from the blood bank to only one client at a time to prevent blood delivery to the wrong patient

The most critical phase of the transfusion is Confirming product compatibility and verifying clients identity

Two registered nurses are needed to check the physician’s order, the clients identity, and the client’s identification band or bracelet and number, verifying that the name and number are identical to those on the blood component bag

At the bedside, the nurse ask the client to state his or her name, the nurse compares he name with the name on the identification band or bracelet

The nurse checks the blood bag tag, label, blood requisition form to ensure that ABO and Rh type are compatible

If the nurse notes any unconsistencies when verifying client identity and compatibility, the nurse notifies the blood bank immediately

Assess for any cultural or religious beliefs regarding blood transfusion (Jehovah’s witness)

Ensure that an Informed consent is signed Determine any previous reaction to blood

transfusion

Check the clients VS, assess renal, circulatory and respiratory status and the client’s ability to tolerate intravenously administered fluids

If the client’s temperature is elevated, notify the physician before beginning the transfusion, a fever may be a cause for delaying the transfusion in addition to masking a possible symptoms of an acute transfusion reaction

Maintain standard, transmission based, and other precautions as necessary

Insert an IV line and infused normal saline; maintain the infusion at KVO

An 18 or 19 gauge IV needle will be needed to achieved maximum flow rate of blood products and prevent damage to RBC; if a smaller gauge needle must be used, RBC must be diluted with normal saline

Always check the bag for the volume of the blood component

Blood products should be infused through administration set designed specifically for blood; use a Y tubing or straight tubing blood administration set that contains a filte designed to trap fibrin clots and other debris that accumulate during blood storage

Premedicate the client with Acetaminophen or Diphenylhydramine as prescribed if the client has a history of adverse reactions 30 minutes before the transfusion is started if orallly or immediately before transfusion if IV administered

Instruct the client to report anything unusual immediately

Determine the rate of infusion by physician order

Begin the transfusion slowly under close supervision; if NO reaction is noted within the 1st 15 mins. The flow can be increased to the prescribed rate

During the transfusion, monitor the client for signs and symptoms of transfusion reaction, the 1st 15 mins of the transfusion are the most critical, and the nurse must stay with the client

If a major compatibility exist or a severe allergic reaction occurs, the reaction is usually evident within the 1st 50 ml of the transfusion

Document the clients tolerance to the administration of the blood products

Monitor appropriate laboratory values and document the effectiveness of treatment related to the specific type of blood products

If a transfusion reaction occurs, stop the transfusion, the change in IV tubing down to the IV site, keep the IV line open with normal saline, notify the physician and blood bank and return blood bag and tubing in the blood bank

Do not leave the client alone and monitor the client for nay life life threatening symptoms

Obtain appropriate: laboratory samples, such as blood and urine samples (free hemoglobin indicates the RBC cell are hemolyzed)

Signs: chills and diaphoresis, muscle aches, back pain, or chest pain, rashes, hives, itching swelling, rapid thready pulse, dyspnea, cough, wheezing or rales, pallor, cyanosis, apprehension, tingling and numbness, headache, nauses, vomiting, abdominal cramping and diarrhea

Unsconscious client: weak pulse, fever, tachycardia or bradycardia, hypotension, visible hemoglobinuria, oliguria or anuria

Delayed Transfusion reaction: occurring days to years after a transfusion

Nursing Interventions:Stop the transfusionKeep the intravenous line open with 0.9% normal

salineNotify the physician and the blood bankRemain with the client, observing signs and

symptoms and monitoring vital signs as often as every 5 minutes

Prepare to administer Emergency medications such as antihistamines, vasopressors, fluids, corticosteroids as prescribed

Obtain urine specimen for laboratory studiesReturn blood bag, tubing attached labels,

transfusion record to the blood bank

Signs: Cough, dyspnea, chest pain, and rales, headache, hypertension and tachycardia and a bounding pulse, distended neck veins

Nursing Interventions:Slow the rate of InfusionPlace the client in an Upright position, with the

feet in a dependent positionNotify the physicianAdminister O2 diuretics, morphine, SO4 as

prescribedMonitor for dysrythmiasPhlebotomy also may be a method of prescribed

treatment in a severe case

Signs: Rapid onset of chills and a high fever Nursing Interventions:

Notify the physician Obtain blood cultures and cultures in the blood

bag Administer O2, IV fluids, antibiotics, vasopressors

and corticosteroids as ordered

Signs: Vomiting, diarrhea, hypotension, altered hematological values

Nursing Interventions: Deferoxamine (Desferal) administered IV or SubQ,

removes accumulated iron via the kidneys Urine turns red as iron is excreted aa administration

of deferoxamine; treatment is discontinued when serum iron level return to normal

Signs: A disease commonly transmitted is Hepatitis C which is manifested by anorexia, nausea, vomiting, dark urine, and jaundice; the symptoms usually occur within 4-6 weeks after the transfusion

Other infectious agents transmitted include Hepatitis B virus, HIV, HHV6, Epstein-Barr Virus, Human T-cell Leukemia, Cytomegalovirus and Malaria

Nursing Intervention:Donor screeningAntibody testing of donors for HIV

Description: Citrate is transfused, blood binds with Calcium and is exercised

Nursing Intervention Assess serum Calcium before and after the

transfusion Monitor for signs of Hypocalcemia Slow the transfusion Notify physician if signs og Hypocalcemia occurs

Description: Stored blood liberates K+ through Hemodialysis

Nursing Intervention: The older blood the greater risk of hyperkalemia;

therefore patient at risk such as those with renal insufficiency or renal failure, should receive fresh blood

Assess the date on the blood and the serum potassium level before and after the transfusion and notify the physicians if signs of Hyperkalemia occur