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Blood Transfusion Therapy

What is Blood Transfusion?
 Blood transfusion therapy involves transfusing whole blood or blood
components (specific portion or fraction of blood lacking in patient)
...
Whole blood stored for more than 6 hours
does not provide therapeutic platelet transfusion, nor does it contain
therapeutic amounts of labile coagulation factors (factors V and VIII)
...
Packed RBCs (100% of erythrocyte, 100% of leukocytes, and 20% of plasma
originally present in one unit of whole blood), indicated to increase the
oxygen-carrying capacity of blood with minimal expansion of blood
...
Leukocyte-poor packed RBCs, indicated for patients who have experience
previous febrile no hemolytic reactions
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Platelets, either HLA (human leukocyte antigen) matched or unmatched
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Granulocytes (basophils, eosinophils, and neutrophils)
5
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7
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8
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11
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Advantages of blood component therapy
1
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2
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3
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Principles of blood transfusion therapy
1
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2
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One unit of packed red cells should raise
hemoglobin approximately 1%, hematocrit 3%
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Platelets


Administer as rapidly as tolerated (usually 4 units every 30 to
60 minutes)
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4
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5
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g
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g
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Fresh frozen plasma should be

administered as rapidly as tolerated because coagulation
factors become unstable after thawing
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Albumin


Indicated to expand to blood volume of patients in
hypovolemic shock and to elevate level of circulating albumin in
patients with hypoalbuminemia
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7
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8
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Objectives
 To increase circulating blood volume after surgery, trauma, or

hemorrhage
 To increase the number of RBCs and to maintain hemoglobin levels in

clients with severe anemia

 To provide selected cellular components as replacements therapy

(e
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clotting factors, platelets, albumin)

Nursing Interventions
1
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Inform the client and explain the purpose of

the procedure
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Check for cross matching and typing
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Obtain and record baseline vital signs
4
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At least 2 licensed nurse check the label of the blood transfusion
 Check the following:
 Serial number

 Blood component
 Blood type
 Rh factor
 Expiration date
 Screening test (VDRL, HBsAg, malarial smear) – *this is

to ensure that the blood is free from blood-carried
diseases and therefore, safe from transfusion
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Warm blood at room temperature before transfusion to prevent chills
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Identify client properly
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8
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This allows easy flow of blood
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Use BT set with special micron mesh filter
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10
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Remain at bedside for 15 to 30
minutes
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11
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Altered vital signs indicate adverse reaction
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Do not mix medications with blood transfusion
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13
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9% NaCl before; during or after BT
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Dextrose causes hemolysis
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Administer BT for 4 hours (whole blood, packed RBC)
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Notify physician
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Allergic Reaction – it is caused by sensitivity to plasma protein of

donor antibody, which reacts with recipient antigen
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Febrile, Non-Hemolytic – it is caused by hypersensitivity to donor white
cells, platelets or plasma proteins
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Septic Reaction – it is caused by the transfusion of blood or components
contaminated with bacteria
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Circulatory Overload – it is caused by administration of blood volume at
a rate greater than the circulatory system can accommodate
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Hemolytic reaction
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

Assessment:
Low back pain (first sign)
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 Chills
 Feeling of fullness


Tachycardia
 Flushing
 Tachypnea


Hypotension
 Bleeding
 Vascular collapse


 Acute renal failure

Assessment findings
1
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2
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Clinical signs and laboratory findings in delayed hemolytic reaction
include:
 fever
 mild jaundice
 gradual fall of hemoglobin
 positive Coombs' test

4
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Signs and symptoms of septic reaction include;
 Rapid onset of high fever and chills
 vomiting
 diarrhea
 marked hypotension

6
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Signs and symptoms of circulatory overload include:
 Dyspnea
 cough
 rales
 jugular vein distention

8
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9
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g
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Reactions associated with massive transfusion produce varying
manifestations

Possible Nursing Diagnosis
1
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Decreased Cardiac Output
3
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Fluid Volume Excess
5
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Hyperthermia
7
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High Risk for Infection
9
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Pain
11
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Altered Tissue Perfusion

Planning and Implementation
1
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 Inspecting the blood product for any gas bubbles, clothing, or
abnormal color before administration
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 Transfusing blood within 4 hours, and changing blood tubing every 4
hours to minimize the risk of bacterial growth at warm room
temperatures
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Nursing Interventions when complications occurs in Blood
transfusion
1
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STOP THE TRANSFUSION
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Start IV line (0
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Place the client in fowler’s position if with SOB and administer O2

therapy
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The nurse remains with the client, observing signs and symptoms
and monitoring vital signs as often as every 5 minutes
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Notify the physician immediately
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The nurse prepares to administer emergency drugs such as
antihistamines, vasopressor, fluids, and steroids as per physician’s
order or protocol
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Obtain a urine specimen and send to the laboratory to determine
presence of hemoglobin as a result of RBC hemolysis
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Blood container, tubing, attached label, and transfusion record are
saved and returned to the laboratory for analysis
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 The patient demonstrates adequate cardiac output
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 The patient maintains good fluid balance
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 The patient remains free of infection
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 The patient maintains or returns to normal electrolyte and blood

chemistry values

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