Boold transfusion presentation

1. Prepared By ,
Deepu Raj D
Staff Nurse
Cathlab

2. BLOOD
Blood is a constantly
circulating fluid
providing the body
with nutrition,
oxygen, and waste
removal. Blood is
mostly liquid, with
numerous cells and
proteins suspended
in it, making blood
"thicker" than pure
water. The average
person has about 5
liters (more than a
gallon) of blood.

3.  A liquid called plasma makes up about half of the content
of blood. Plasma contains proteins that help blood to clot,
transport substances through the blood, and perform other
functions. Blood plasma also contains glucose and other
dissolved nutrients.
 About half of blood volume is composed of blood cells:
• Red blood cells, which carry oxygen to the tissues
• White blood cells, which fight infections
• Platelets, smaller cells that help blood to clot
 Blood is conducted through blood vessels (arteries and
veins). Blood is prevented from clotting in the blood
vessels by their smoothness, and the finely tuned balance
of clotting factors.

4.  Red blood cell count
 Hemoglobin
 Hematocrit
 White blood cell count
 Platelet count
 Male: 4.35-5.65 trillion cells/L*
(4.35-5.65 million cells/mcL**)
 Female: 3.92-5.13 trillion cells/L
(3.92-5.13 million cells/mcL)
 Male: 13.2-16.6 grams/dL***
(132-166 grams/L)
 Female: 11.6-15 grams/dL
(116-150 grams/L)
 Male: 38.3-48.6 percent
 Female: 35.5-44.9 percenT
 3.4-9.6 billion cells/L
(3,400 to 9,600 cells/mcL)
 Male: 135-317 billion/L
(135,000 to 317,000/mcL)
 Female: 157-371 billion/L
(157,000 to 371,000/mcL)

5.  Red blood cell transfusions are used to treat hemorrhage and to
improve oxygen delivery to tissues. Transfusion of red blood cells
should be based on the patient's clinical condition. Indications
for transfusion include symptomatic anemia (causing shortness
of breath, dizziness, congestive heart failure, and decreased
exercise tolerance), acute sickle cell crisis, and acute blood loss
of more than 30 percent of blood volume.
 Fresh frozen plasma infusion can be used for reversal of
anticoagulant effects.
 Platelet transfusion is indicated to prevent hemorrhage in
patients with thrombocytopenia or platelet function defects.
 Cryoprecipitate is used in cases of hypofibrinogenemia, which
most often occurs in the setting of massive hemorrhage or
consumptive coagulopathy.

6.  Acute complications occur within minutes to 24 hours of the transfusion, whereas
delayed complications may develop days, months, or even years later.
ALLERGIC REACTIONS
 Some people have allergic reactions to blood received during a transfusion, even when
given the right blood type. In these cases symptoms include hives and itching. Like most
allergic reactions, this can be treated with antihistamines. However, a doctor should be
consulted if the reaction becomes serious.
FEVER
 Developing a fever after a transfusion is not serious. A fever is your body’s response to the
white blood cells in the transfused blood. However, it can be a sign of a serious reaction if
the patient is also experiencing nausea or chest pain. Patients should consult their
doctors if other symptoms or side effects are present.
ACUTE IMMUNE HEMOLYTIC REACTION
 An acute immune hemolytic reaction is a very serious, but rare, reaction caused by a
patient’s body attacking the transfused red blood cells. The attack triggers a release of a
substance that damages the kidneys. This is often the case when the donor blood is not a
proper match with the patient’s blood type. Symptoms include nausea, fever, chills, chest
and lower back pain, and dark urine.

7. BLOOD-BORNE INFECTIONS
 All donated blood is screened and tested for potential
viruses, bacteria, and parasites. However, occasionally
these agents can still infect a patient after a transfusion.
 The risk of catching a virus or any other blood-borne
infection from a blood transfusion is very low.
 HIV. All donated blood is thoroughly tested for HIV. There
is a 1 in 2 million chance that donated blood will not only
carry HIV but also infect a transfusion recipient.
 Hepatitis B and C. The odds of catching hepatitis B from
donated blood is about 1 in 300,000. The risk with hepatitis
C is 1 in 1.5 million.
 West Nile Virus. The risk of catching West Nile Virus from
a blood transfusion is approximately 1 in 350,000.

8. INFORMED CONSENT
 All Patients must sign an informed consent before
transfusion of blood components or blood products
 Patients should be provided with adequate
information that includes a description of blood
products, associated risks and benefits.
 The informed consent for blood transfusion is valid for
the duration of that admission, A new consent should
be obtained for each admission.

9.  Physician is the person authorized to order blood
products
 Physician order accurately identifies the patient name,
MRN, Blood component, rate of infusion, date, time
and special instructions.

10.  Unequivocal identification of the recipient and blood
component throughout the transfusion chain is
mandatory. Verifying patient identification is
essential at all times, time of sample collection from
the patient, time of issuing of blood components from
BTS and delivery to clinical areas and time of blood
administration to patient.
 At the time of sample collection and blood
transfusion, the patient full name and MRN must be
verified by asking the patient and checking the wrist
band.

11.  Blood components should be transfused using sterile, pyrogen free sets containing a
filter(170 to 260 microns)
 Blood administration sets should be connected directly to the IV access site.
 Blood component administration should begin within 30 minutes from the time the
component is released from temperature controlled storage.
 Blood should be returned to BTS immediately if the decision is made not to transfuse
(maximum 30 minutes from time of issue) .
 Blood administration sets should be changed at-least every 4 hours.
 Administration sets shall be changed between the administration of different blood
components.
 Medications shall not be added directly to a blood component nor to the administration
set.
 Priming of IV tubing before transfusion of blood must be with
 0.9 % sodium chloride solution.
 Blood components and blood products should be visibly inspected for clots, clumps or
discoloration immediately before issue. Expiry should be checked.
 Pushing blood components in syringes for fast administration is not acceptable and
increases the risk for hemolysis and hyperkalemia.

12.  Pre transfusion vital signs shall be monitored and
documented prior to transfusion of all blood components.
This include body temperature, pulse , Sp02 and blood
pressure.
 Adults: For the first 15 minutes transfuse at the rate of 2
ml per minute. If there is no sign of reaction at 15 minutes ,
record vital signs and increase the rate of infusion.
 Pediatrics: For the first 15 minutes transfuse at the rate of
1-2 ml/kg/hr. If there is no sign of reaction at 15 minutes ,
record vital signs and increase the rate of infusion

13. Component
 Red Blood Cells
 Platelets
 Plasma
 Cryoprecipitate
 2-4 ml per minute(120 to
240 ml per hour) A unit of
RBC should not be given
less than 2 hours and not
to exceed 4 hours.
 5 ml per minute (300 ml
per hour)
 10 – 20 ml per kg perhour
 10 – 20 ml per kg perhour
After 15 minutes

14. Component
 Red Blood Cells
 Platelets
 Plasma
 Cryoprecipitate
 1-5 ml per kg per hour.
And not to exceed 4
hours.
 10 – 20 ml per kg per
hour
 10 – 20 ml per kg per
hour
 10 – 20 ml per kg per
hour
After 15 minutes

15.  Before the transfusion begins
 Within the first 15 minutes of starting the transfusion
 At the end of transfusion

16.  The transfusion must be stopped immediately buy
clamping the tubing as close to the iv site as possible.
Lines should be kept open with 0.9% sodium chloride
using a new set.
 Check vitals and oxygen saturation
 The name of patient and identification number on the
patient identification band shall be confirmed against
the cross match bag and document.
 The treating physician should be notified.
 Assessment of volume status and chest x ray for
patients with respiratory symptoms.

17.  Ordering blood tests: grouping and antibody
screening, CBC, LDH, LFT,DCT and urine analysis.
 All observed signs and symptoms must be
documented on the patients medical record, the cross
match tag and adverse transfusion reaction form
which is printed from HIS.
 All Blood component containers with attached
administration set and iv solutions, whether empty or
not, appropriate blood and urine samples and the
transfusion reaction forms shall be returned to BTS as
soon as possible for follow up investigation.

18.  IV line flush
 Documentation of administration information on HIS
 Disposal of Blood Container
 Recording information for each blood component or
product issued at BTS

19.  If the patient condition permits , start the transfusion
slowly at 1 ml per minute for the first 15 minutes.
 The patient must be placed under closed supervision,
with the transfusionist for the first 15minutes ,
monitoring for any signs/ symptoms of a transfusion
reaction.
 If no Symptoms of transfusion reaction are noted after
15 minutes, the patient needs to be monitored
according to routine practice in addition to every hour
during the transfusion.

21.  KAUH Policy APP–BTS-002
 Human Anatomy By Matthew Hoffman, MD
 https://www.redcrossblood.org/