BLOOD TRANSFUSION

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Nursing Procedures- are the usual routine in a hospital setting. These include: blood transfusion, NGT, etc.


BLOOD TRANSFUSION
- The introduction of whole blood or components of the blood , plasma , serum, erythrocytes, or platelets into the venous circulation.

Why are blood transfusion performed?
- for anticipated loss of blood during the surgery
- a low blood count before, during or after the surgery
- severe heart failure (COPD , Anemic, CHF, MI)
- Bone marrow failure
- moderate to severe anemia

What is blood made of ?
- Human blood is made of a fluid called plasma that carries red and white blood cells and platelets.

What are red blood cells?
- It carry oxygen from the lungs to to her body organs and carbon dioxide back to the lungs.

What are white blood cells ?
- It fight infections by destroying bacteria, viruses and germs.

What are platelets?
- It helps control bleeding by making clots in the blood vessels opened by surgery or injury.

What is plasma?
- It carries the blood cells throughout the body and contains proteins and minerals. some proteins help the blood to clot.

Is blood tansfusion safe?
- Blood used at most hospitals are from volunteer donors.
- Each blood donor must answer medical history questions and be given a limited physical examination before accepted as donor.
- Donated blood is carefully tested for hepatitis viruses B and C, HIV, human T- lymphotrophic viruses I and II, and syphilis


Transfusion products:

Packed Red Blood Cells
- most commonly transfused blood component
- restores blood oxygen during capacity
- can be refrigerated for up to 42 days
- take oxygen through the bloodstream to every part of the body and bring carbon dioxide back to the lungs
- normally made in the bone marrow, the soft inner part of the bone
- usually given into a vein over 2-4 hours

Whole Blood
- contains red blood cells and plasma
- often used for open heart surgery, for exchange transfusion in newborn babies with hemolytic disease and for massive blood loss

Fresh Frozen Plasma
- plasma which was frozen and stored shortly after it was obtained from the blood donor
- defined as the fluid portion of one unit of human blood that has been centrifuged, separated and frozen solid at 18 degrees Celsius within 6 hours of collection.
- thawed plasma may be transfused up to 5 days after thawing
- one unit is approximately 250ml and must be ABO compatible

Cryoprecipitate
- a frozen blood product prepared from plasma
- indicated for hemophilia A , hypofibrinogenaemia , bleeding from excessive anticoagulation, massive hemorrhage, and disseminated intravascular coagulation.
- compatibility testing is not indicated but it is given as ABO compatible
- AB type is the universal plasma donor; O type is the universal plasma recipient

Platelets
- cell fragments which prevent or stop bleeding or bruising by physically plugging the hole in the blood vessels.
- usually given into a vein over a few minutes to an hour
- indicated for thrombocytopenia, acute leukemia, to restore platelet count preoperatively
- if a patient's bone marrow is not producing platelet, then platelet transfusion is needed once or twice a week

Granulocytes
- type of white blood cells that help the body fight infection
- also called neutrophils
- for severe gram negative infection or severe neutropenia unresponsive to routine forms of therapy in immunosuppressive patients
- usually infused into a vein over 1-2 hours
- given daily for 5 days or until the patient's granulocyte count returns to normal level

BLOOD TYPE IDENTIFICATION
Patient/ (Compatible Transfusion) Plasma/ RBC
Type A / Type A or AB/ Type A or O
Type B/ Type B or AB / Type B or O
Type AB / Type AB / Type A, B, AB or O
Type O / Type A, B, AB or O/ Type O
Rh(-)/ Must receive RH (-) blood
Rh (+)/ Can receive Rh (-) or (+)
O(-)/-/ Universal donor for RBC
AB (+)/ Universal donor for plasma

Purposes
- to increase the circulating blood volume as in shock due to hemorrhage
- to increase red cell volume of hemoglobin content of the blood as in anemia
- to increase WBC content of the blood as in agranulocytosis and leukopenia
- to increase the quantity of protein (malnutrition), excessive loss of protein from burns or vesicular skin diseases

MATERIALS NEEDED
- Intravascular tray
- Plain NSS
- Compatible blood transfusion set
- Tourniquet
- Intravenous catheter/ needle/ gauge 18/19
- Blood product
- Gloves (sterile)
- Micropore
- IV stand / pole
- Cotton balls with alcohol

PROCEDURE
1. Verify doctor's order and make a treatment card.> To avoid mistakes
2. Explain procedure to the patient.> Encourage patient's cooperation and decrease anxiety
3. Check the availability of blood components, blood typing and amount of blood. > To prevent blood transfusion reaction and lethal effect of transfusion
4. Warm the blood at room temperature (30 C) by wrapping the blood bag with towel. Blood should be transfused not more than 20 minutes from the time it arrives from the blood bank. > To prevent untoward blood reaction
5. Have a doctor or a nurse to countercheck the compatible blood to be transfused:
> Name and identification number
> Patient's blood group and Rh type
> Donor's blood group and Rh type
> X-match compatibility
> Blood unit and serial component
> Expiration date of blood product (FWB, PRBC, FFP, Cryoprecipitate)
> To prevent any problem in relation to transfusion
6. Get the baseline vital signs before transfusion. (PR/CR, RR, BP, Temperature). > To compare any change in vital signs before and during BT
7. Get premedication 30 minutes before transfusion (anti-histamine, benadryl, antamin, paracetamol). > To prevent minor allergic reaction
8. Wash hands and don gloves. > To prevent contamination of microorganisms
9. Initiate an intravenous line with appropriate cannula with plain NSS, anchor catheter properly and regulate rate. > To flush out tubing and keep IV open
10. Open compatible blood aseptically and spike blood bag carefully; prime tubing and remove bubbles. > To prevent air embolism
11. Disinfect the Y injection port of IV tubing and insert the needle from the BT administration set and secure with adhesive tapes.
12. Close IV fluid of plain NSS or regulate to KVO while transfusion is going on.
13. Transfuse the blood for 4-6 hours via injection port at 10-15 gtts/min then regulate at ordered time.
14. Observe for any untoward signs and symptoms such as chills, elevated temperature, itchiness, urticaria, flushed skin and dyspnea. > Transfusion reaction occurs during the first 10-15 minutes of transfusion. If any occurs, stop the transfusion and report to the physician.
15. Swirl the bag (FWB) once in a while.> To mix the solid and liquid elements of the blood.
RBC tends to settle at the bottom of the solution while the plasma rises to the top as the blood bag hangs
16. If blood is consumed, close roller clamp of blood transfusion set then disconnect from the intravenous line and regulate the intravenous fluid as ordered.
17. Carry out post BT order such as repeat hgb and hct, bleeding time, serial platelet count , etc.
18. document observations done.
>Time started
>Time ended
>Blood transfusion reactions, if any

ADVERSE REACTIONS:
- Circulatory overload
- Sepsis
- Febrile reaction
- Allergic reaction
- Acute hemolytic reaction