1. BLOOD TRANSFUSION Mary Vanderhoef MSN, ARNP
Revised by Octavia Mercado, BSN, RN, CCRN
SEPT 2015

2. Blood Transfusion
Blood transfusion is the process of transferring blood or blood-based products from one person to another
Can be life saving as in massive blood loss due to trauma
Treatment for severe anemia
Thrombocytopenia

3. History
First fully documented human blood transfusion by Dr. Jean-Baptiste Denis, physician to King Louis XIV of France in 1667.
Transfusion of blood from a sheep into a 15 year old boy that survived

4. History
Dr. James Blundell, British Obstetrician, performed the first successful blood transfusion of human blood in 1818 for treatment of post partum hemorrhage.
Used the blood of the patient’s husband and directly infused into the patient.

5. History
In the 1910’s it was discovered that by adding anticoagualnt and refrigerating the blood, it was possible to store the blood for several days..
First non-direct transfusion was performed in 1914
Dr. Luis Agote (2nd from right) overseeing one of the first safe and effective blood transfusions in 1914

6. History
In the 1930’s and 1940’s Dr Charles Drew’s research led to discovery that blood could be separated into plasma and red blood cells.

7. Indications Indications for blood transfusion
ANEMIA: A decrease in red blood cells (rbc’s) secondary to blood loss or deficient production

8. Blood Transfusion Normal Hgb Levels
Males: g/dl
Females g /dl
Hematocrit is the proportion of rbc’s in total volume of blood
Males: 40-54%
Females 38-48%

9. Blood Transfusions are generally ordered when Hgb 8 g/dl or less OR
If patient is symptomatic

10. S&S Effects of Anemia and decreased O2 delivery:
Tachycardia, dyspnea, palpitations, fatigue, weakness, light headedness
If severe, anemia could lead to:
CVA, or MI secondary to decreased perfusion to heart and brain

11. Causes of Anemia Causes of Anemia Sudden blood loss Chronic bleeding
Phlebotomy in critically ill patients (increases with blood draws 3 x greater in ICU patients)

12. BLOOD PRODUCTS Whole Blood Packed Red Blood Cells (prbc’s) Platelets
Fresh Frozen Plasma (FFP)
Cryoprecipitate

13. Whole Blood Rarely used in the US
Restores fluid volume and circulation
Contains rbc’s, wbc’s plasma and platelets

14. Packed Red Blood Cells Most common transfusion
Restores blood’s ability to carry O2
Contains few platelets and wbc’s
Generally mls per unit
Transfuse over 2-4 hours: based on pts need to receive blood and pts other issues
Shorter transfusion time: symptomatic
Longer transfusion time: CHF, ESRD
Increases the Hgb 1 g/Hct 3-4 %
Shelf life 42 days

15. Platelets Platelets are thrombocytes Restores clotting ability
Usual dose is 5-10 units
OK for rapid transfusion (1 unit over 10 min)
Increases platelet count by 5000 per one unit
4-5 day shelf life

16. Fresh Frozen Plasma (FFP)
Unconcentrated source of all clotting factors and proteins from a single unit of blood (contains albumin, fibrinogen, and antibodies)
Treats bleeding caused by factor deficiencies and for Liver failure, DIC, and reversal of coumadin/warfarin therapy
Is frozen and can be stored for up to 1 year
Notify blood bank 30 minutes prior to when needed in order for them to thaw the FFP
After thawing by blood blank must infuse within 6 hours
Generally ml per unit ordered
OK for rapid transfusion (1 unit over 10 min)

17. CRYOPRECIPITATE
Concentrate of 4 clotting factors from FFP. Usually used for patients with specific bleeding disorders sucha as hemophilia, von Willibrands disease.
Storage and usage same as for FFP

18. BLOOD TYPES A+ B+
AB+ O+ A- B-
AB- 0-

19. Blood Types Universal Donor O- (only 6.6% of the population)
Universal Recipient AB+
Most prevalent blood type O+ (37% of the population)

20. Giving and Receiving

21. Rh Factor Rh typing Looks at 8 different genes Rh present (positive)
Rh absent (negative)
Typing is done to prevent complications from giving incompatible blood

22. Transfusion Reactions

23. What to do in Case of Reaction
If transfusion reaction suspected
STOP the transfusion
Notify Physician
Give supportive treatment (per orders/protocol):
Normal saline fluids
Antipyretics
antihistamines

24. Blood Screening
Viral is the most common transfusion-transmitted infection
Hepatitis B
Hepatitis C
HIV (most feared)
Long period for seroconversion (25-45 days)
CMV which belongs to the herpes group (transmitted by whole blood and rbc’s)
Can cause immunosuppression leading to risk of pneumonia, gastroenteritis, and hepatitis particularly in the critically ill

25. Bacterial Contamination
Stored units can become contaminated with bacteria and cause infection to recipient
Mortaility rate from bacteremia = 50%
Causes:
Inadequate skin prep at phlebotomy site, small leaks in blood containers, contaminated containers, asymptomatic bacteremia at time of donation

26. Shelf Life of Blood/Components
Whole Blood ~ 35 days
PRBC’s ~ 42 days (after this there is a decline in the quality with an increase in inflammatory mediator release)
Can be frozen up to 10 years
WBC’s ~ <42 days (after this wbc’s begin to die and release toxic cell enzymes)
Platelets 5 days

27. Blood Donation Types
Autologous
Allogenic/Homologous
Cell Saver

28. Autologous Safest Giving pt their own blood
Can donate 72 hours before the scheduled surgery
Limiting factors:
Hgb < 12.5 g/dl
Age < 17
Weight < 110 lbs (50kg)
No chronic health problems
Tatoos/body piercing < 1 year

29. Allogenic/Homologous
All other donated blood, other than the patients own blood.

30. Cell Saver
Collects, Washes and spins blood that has been suctioned from patient during surgery
Debris and hemolytic by products removed
Reinfused into patient

31. Contraindications to Autologous and Cell Saver Transfusions
Malignancy
Sepsis
Enteric contamination
Coagulopathy
Pulmonary infection
Impaired renal function
Excessive hemolysis

32. Incidence of Infection from Transfusions
HIV – 1: 2 million
Hepatitis B - 1: 200,000
Hepatitis C – 1: 1-2 million
Creuzfeldt-Jacob disease – very rare