BLOOD TRANSFUSION

BLOOD TRANSFUSION Infusion of blood products for the purpose of restoring circulating volume. Administration of blood and blood components requires knowledge of correct administration techniques and possible complications. A single unit of whole blood contains 450 mL of blood and 50 mL of an anticoagulant

BLOOD TRANSFUSION May be whole Blood or blood components ( Platelets, Plasma , PRBC, Albumin ) The procedure usually takes 1 to 4 hours, depending on how much blood is needed. A unit (bag) of red blood cells usually takes two to three hours to give. If needed, a unit can be given more rapidly – for example, to treat severe bleeding. A unit of platelets or plasma is given in 30 to 60 minutes.

Blood Components BLOOD DESCRIPTION INDICATION Leukocyte-free PRBC: Most WBCs removed to reduce risk of reaction Whole blood: Most common blood product given in the hospital shock, low blood volumes, low hematocrit and hemoglobin, hemorrhage Packed RBCs: Separated from plasma Used to treat anemia, and reduce risk of volume overload

Blood Components BLOOD DESCRIPTION INDICATION Fresh frozen plasma (FFP): separated from whole blood by a centrifuge process Used to restore plasma volume, treat some bleeding problems Cryoprecipitate thawing fresh frozen plasma and collecting the precipitate contains high concentrations of factor VIII and fibrinogen used in cases of hypofibrinogenemia, which most often occurs in the setting of massive hemorrhage or consumptive coagulopathy. Platelets Maintain normal coagulability of blood Used to treat some bleeding disorders, and to compensate when marrow can not produce enough

SOURCES OF BLOOD 1. Autologous transfusion - A patient’s own blood may be collected for future transfusion; elective surgeries where the potential need for transfusion is high (eg, orthopedic surgery). Preoperative donations are ideally collected 4 to 6 weeks before surgery. If the blood is not required, it can be frozen until the donor needs it in the future (for up to 10 years). The blood is never returned to the general donor supply of blood products to be used by someone else. Patients with cancer may donate for themselves.

Advantages of Autologous Transfusion : Prevention of viral infections from another person’s blood safe transfusion for patients with a history of transfusion reactions prevention of alloimmunization avoidance of complications in patients with alloantibodies.

Contraindications for Autologous Transfusion acute infection, severely debilitating chronic disease, hemoglobin level less than 11 g/dL, hematocrit less than 33%, unstable angina, Acute cardiovascular or cerebrovascular disease. A history of poorly controlled epilepsy may be considered a contraindication in some centers.

SOURCES OF BLOOD 2. allogenic or homologous transfusion. - using another's blood. Blood is most commonly donated as whole blood intravenously and collecting it with an anticoagulant. Donors should be in good health and without any of the following: history of urticaria, or allergy to medications, receiving a blood transfusion or an infusion of any blood derivative , viral hepatitis, Malaria, syphilis, drug abuse, skin infection, asthma, possible exposure to HIV, at any time in the past, or a history of close contact with a hepatitis or dialysis patient within 6 months, Pregnancy within 6 months, history of tooth extraction or oral surgery within 72 hours, A history of exposure to infectious disease within the past 3 weeks, Recent immunizations , recent tattoo, Cancer, history of whole blood donation within the past 56 days

Blood Donor’s Requirement Body weight: more than 50 kg (110 pounds) for a standard 450- mL donation. Donors weighing less than 50 kg donate proportionately less blood. 17 years old and above Oral temperature not more than 37.5°C (99.6°F). Pulse rate: regular and between 50 - 100 beats per minute. Systolic arterial pressure: 90 to 180 mm Hg, Diastolic pressure : 50 to 100 mm Hg. The hemoglobin level : at least 12.5 g/dL for women and 13.5 g/dL for men.

Blood Storage Life BLOOD Storage STORAGE LIFE PRBC 4°C With special preservatives, they can be stored safely for up to 42 days PLATELETS ROOM TEMPERATURE only 5 days ; platelets are gently agitated while stored PLASMA IMMEDIATELY FROZEN lasts for 1 year if it remains frozen; Plasma can be further pooled and processed into blood derivatives, such as albumin, immune globulin, factor VIII, and factor IX.

Type and Crossmatch Blood undergoes “type and crossmatch”: Typing to determine ABO and Rh factor Crossmatching to determine compatibility between donor and recipient blood Blood Types: A, B, AB, O The Rh factor is made up of numerous complex antigens When it is present, the person is Rh positive (Rh+); if not present, the person is Rh negative (Rh–)

Blood Typing An Rh positive person may receive either – or + blood An Rh negative person must receive only Rh– blood If an Rh– person receives Rh+ blood, antibodies will form If another transfusion of Rh+ blood is given, the antibodies will agglutinate with the Rh antigens of the blood being transfused

Blood compatibilities

Blood typing for transfusion Universal donor= O- Does not contain A, B, or Rh antigens Universal recipients= AB+ Blood contains A, B, and RH antigens Usually blood banks exactly match the pt blood

Blood Screening Prior to be being released for patient use testing for: Hepatitis C Human immunodeficiency virus (HIV)

Y-type blood tubing

INDICATIONS OF BLOOD TRANSFUSION Severe blood loss during major surgery, childbirth or a severe accident anemia that has failed to respond to other treatments inherited blood disorders, such as thalassaemia or sickle cell anaemia An illness that causes bleeding, such as a bleeding ulcer. An illness that destroys blood cells, such as hemolytic anemia or thrombocytopenia

Infusion Therapy Risks Risk factors: Disease transmission Hepatitis B, Hepatitis C, Hepatitis A, HIV , Syphillis) Bacterial contamination Acute or delayed transfusion reactions Allergic reactions Mismatched ABO Incompatible Death Circulatory overload

Infusion Therapy Hazards Some risks specific to massive transfusion (replacement of > one blood volume in 24 hours): Hypothermia Hemodilution Platelet dysfunction Electrolyte problems

ADMINISTRATION PROCESS PRE TRANSFUSION PHYSICAL ASSESSMENT Systematic physical assessment and measurement of baseline vital signs Respiratory system: auscultation of the lungs, use of accessory muscles. Cardiac system: edema, other signs of cardiac failure (eg, jugular venous distention). Skin: Rashes, petechiae, and ecchymoses. EENT: sclera should be examined for icterus. ASSESS Transfusion history Previous transfusions, allergies and reactions Type of transfusion reaction, manifestations, and treatment

Interventions Once the blood has been taken from the blood bank, it must be administered within 30 minutes Use 18 or 20 gauge IV cannula Check vital signs prior to administration Use BT Set for administration

Interventions The nurse must ensure: Positive patient identification Appropriateness of blood component Verification of donor – recipient compatibility Blood product inspection (checked by 2 licensed nurses. ) Verify product expiration date , name, medical record number, type of blood, blood band id, pt age

administration of blood Monitor for blood reactions, vital signs continuously during administration For first 15 minutes, run the transfusion slowly—no faster than 5 mL/min. If no adverse effects occur during the first 15 min, increase the flow rate unless the patient is at high risk for circulatory overload. Signs of adverse reaction: restlessness, hives, nausea, vomiting, torso or back pain, shortness of breath, flushing, hematuria, fever, or chills.

Administration of blood Administration time does not exceed 4 hr because of the increased risk for bacterial proliferation. Be alert for signs of adverse reactions (Post Transfusion) circulatory overload, sepsis, febrile reaction, allergic reaction, and acute hemolytic reaction. Change blood tubing after every 2 units transfused, to decrease chance of bacterial contamination. A platelet count may be ordered 1 hr after platelet transfusion to facilitate this evaluation.

NURSING MANAGEMENT FOR TRANSFUSION REACTIONS If a transfusion reaction is suspected, Stop the transfusion. Maintain the intravenous line with normal saline solution through new intravenous tubing, administered at a slow rate. Assess the patient carefully. Compare the vital signs with those from the baseline assessment. Assess the patient’s respiratory status carefully. Note the presence of adventitious breath sounds, use of accessory muscles, extent of dyspnea (if any), and changes in mental status, including anxiety and confusion.

NURSING MANAGEMENT FOR TRANSFUSION REACTIONS Note any chills, diaphoresis, complaints of back pain, urticaria, and jugular vein distention. Notify the physician of the assessment findings, and implement any orders obtained. Continue to monitor the patient’s vital signs and respiratory, cardiovascular, and renal status. 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 tags and numbers are verified.

Transfusion Complications Noninfectious Complications (up to 1,000 times more likely than an infectious complication) Acute complications - occur within minutes to 24 hours of the transfusion, (Acute hemolytic reaction, Allergic reaction, Anaphylactic reaction, TRANSFUSION-ASSOCIATED CIRCULATORY OVERLOAD Delayed complications - may develop days, months, or even years later. (Delayed hemolytic reaction , Iron overload, Overtransfusion or undertransfusion Infectious Complications (Hepatitis B, C virus)