Define blood transfusion Enlist the purpose of blood transfusion Brief the history of blood transfusion Describe various component of blood Understand types of blood transfusion Perform the steps of the procedure Recognize the adverse reaction of blood transfusion

2. KRISHNA V GANDHI
BLOOD TRANSFUSION

3. OBJECTIVES
At the end of the procedure student will be
able to :
 Define blood transfusion
 Enlist the purpose of blood transfusion
 Brief the history of blood transfusion
 Describe various component of blood
 Understand types of blood transfusion
 Perform the steps of the procedure
 Recognize the adverse reaction of blood
transfusion

4. Blood transfusion is the transfusion
of the whole blood or its component
such as blood cells or plasma from
one person to another person.
Blood transfusion involves two
procedure that is
Collection of blood from donor
Administration of blood to the
recipient.
DEFINITION

5. PURPOSE
To restore the blood volume when there is
sudden loss of blood due to hemorrhage.
To raise the Hb level in cases of severe anemia
To treat deficiencies of plasma protein, clotting
factors or hemophilic globulin etc.
To provide antibodies to those persons who are
sick and having lowered immunity.
 To replace the blood with hemolytic agents with
fresh blood
To improve the leukocyte count in blood as in
agranulocytosis.
 To combat infection in leucopenia

6. 1665 – First recorded blood transfusion
in England , R Lower revived a dog by
transfusing blood from another dog via a
tied artery
1818 James Blundell performs the first
successful blood transfusion of human
blood to treat postpartum hemorrhage
1907 Blood typing and cross matching
between donors and patients is attempted
to improve the safety of transfusions. The
universality of the O blood group is
identified..
HISTORY

7. 1961 Platelet concentrates are recognized
to reduce mortality from hemorrhaging in
cancer patients.
1972 The process of apheresis is
discovered, allowing the extraction of
one component of blood, returning the
rest to the donor.
1985 The first HIV blood-screening test
is licensed and implemented by blood
banks.

8. Components
of blood
Whole blood
 Packed cell volume
 Fresh frozen plasma
Platelets
Cryoprecipitate

9. WHOLE BLOOD
 Whole blood is unseparated blood
containing an anticoagulant – preservative
solution.
Stored between +2 and +6 degrees
centigrade in a blood bank refrigerator.
 Transfusion should be started within 30
minutes of removal from the refrigerator
and completed within 4 hours of
commencement because changes in the
composition may occur due to red cell
metabolism.

10. PACKED RED CELLS
Packed red cells are cells that are
spun down and concentrated.
 One unit of packed red cells is
approx. 330 ml and has a haematocrit
of 50-70%.
 They are stored in a SAG-M
(saline-adenine- glucose-mannitol)
solution to increase their shelf life to
5weeks at 2-6degrees centigrade.

11. FRESH FROZEN PLASMA
 Fresh frozen plasma is rich in
coagulation factors.
 It is separated from whole blood
and stored at-40 to -50 degrees
centigrade with a 2year shelf-life.
 It is the first line therapy in the
treatment of coagulopathic
haemorrhage

12. CRYOPRECIPITATE
Cryoprecipitate is a supernatant precipitate of
fresh frozen plasma and is rich in factor VIII and
fibrinogen.
 It is stored at -30 degrees centigrade with a 2
years shelf life.
 Indicated in low fibrinogen states (<1g/l) or in
cases of factor VIII deficiency (hemophilia-a), von
will brand's disease and as a source of fibrinogen in
disseminated intravascular coagulation.
 Pooled units containing 3-6 gms fibrinogen in
200-500 ml raises the fibrinogen level by approx.
1g/L.
 Must be infused within 6 hours.

13. TYPES OF TRANSFUSION
Allogenic blood transfusion
(someone else blood)
Autogenic blood
transfusion (own blood)
Exchange blood
transfusion
TYPES OF
TRANSFUSION

14. PRE TRANSFUSION
REQUISITS

15. BLOOD GROUPING AND CROSS MATCHING

16. SELECTION OF BLOOD DONORS
•Screening of blood donors is rigorous.
•To protect the donor from possible ill effects of
donation
•To protect the recipient from exposure to diseases
transmitted through the blood.
•Donors are eliminated by a history of hepatitis,
HIV infection (or risk factors for HIV infection),
heart disease, most cancers, severe asthma,
bleeding disorders, or seizures.
• Donation may be deferred for people who have
malaria, have been exposed to malaria or hepatitis,
are anemic, have high or low BP, have low body
weight, or who are pregnant, have had recent
surgery, or take certain medications.

17. ASSESSMENT
Asses
s
• Vital signs
sess
• Physical examination including fluid balance and
heart and lung sounds as manifestations of hypo-
or hypervolemia
sess
• Status of infusion site
sess
• Blood test results such as hemoglobin value or
platelet count
Sess
• Any unusual symptoms

18. PLANNING
1. Review the client record regarding previous transfusions. Note
any complications and how they were managed (e.g., allergies or
previous adverse reactions to blood).
2.Confirm the primary care provider’s order for the number
and type of units and the desired speed of infusion.
3. written consent for transfusion is required.
4.Know the purpose of the transfusion.
5.Note any premedication ordered by the primary care provider
(e.g., acetaminophen or diphenhydramine). Schedule their
administration (usually 30 minutes prior to the transfusion).

19. EQIUPMENT NEEDED
• Unit of whole blood, packed RBCs, or other
component
• Blood administration set
• IV pump, if needed
• 250 mL normal saline for infusion
• IV pole
• Venipuncture set containing a 14- to 22-gauge
catheter (if one
is not already in place)
• Alcohol swabs
• Tape
• Clean gloves

20. PREPARATION
 If the client has an IV solution infusing, check
whether the IV catheter and solution are appropriate
to administer blood.
 The IV catheter size ranges between 14 and 22
gauge, and the solution must be normal saline.
Dextrose (which causes lysis of RBCs), Ringer’s
solution, medications and other additives, and
hyperalimentation solutions are incompatible.
 If the client does not have an IV solution infusing,
check agency policies. In this case, will need to
perform a venipuncture on a suitable vein and start
an IV infusion of normal saline.

21. STEPS OF
PROCEDURE

22. 1. Prior to performing the procedure, introduce self
and verify the client’s identity using agency
protocol.
2. Explain to the client what you are going to do, why
it is necessary, and how he or she can participate.
Instruct the client to report promptly any sudden chills,
nausea, itching, rash, dyspnea, back pain, or other
unusual symptoms.
3. Provide for client privacy and prepare the client.
Expose the IV site but provide for client privacy.
4. Assist the client to a comfortable position, either
sitting or lying.
5. Perform hand hygiene and observe other appropriate
infection

23. 6. Prepare the infusion equipment.
• Ensure that the blood filter inside the drip
chamber is suitable for the blood components to
be transfused.
• Attach the blood tubing to the blood filter, if
necessary.
Rationale: Blood filters have a surface area large
enough to allow the blood components through
easily but are designed to trap clots.
• Wear gloves. Close all the clamps on the Y-set: the
main flow rate clamp and both Y-line clamps.
• Insert the piercing pin (spike) into the saline
solution. Hang the container on the IV pole about
1 m (39 in.) above the venipuncture site.

24. 7. Prime the tubing.
• Open the upper clamp on the normal saline
tubing, and squeeze the drip chamber until it
covers the filter and one third of the drip
chamber above the filter.
• Tap the filter chamber to expel any residual
air in the filter.
• Open the main flow rate clamp, and prime the
tubing with saline.
• Close both clamps.

25. 8. Start the saline solution.
 If an IV solution incompatible with blood is
infusing, stop the infusion and discard the solution
and tubing according to agency policy.
 Attach the blood tubing primed with normal saline
to the IV catheter.
 Open the saline and main flow rate clamps and
adjust the flow rate. Use only the main flow rate
clamp to adjust the rate.
 Allow a small amount of solution to infuse to make
sure there are no problems with the flow or with
the venipuncture site.
 Rationale: Infusing normal saline before initiating
the transfusion also clears the IV catheter of
incompatible solutions or medications.

26. 9. Obtain the correct blood component for the client.
 Check the primary care provider’s order with the
requisition.
 Check the requisition form and the blood bag label
with a laboratory technician or according to agency
policy.
 Specifically, check the client’s name, identification
number,blood type (A, B, AB, or O) and Rh group,
the blood donor number, and the expiration date of
the blood.
 Observe the blood for abnormal color, RBC
clumping, gas bubbles, and extraneous material.
 Return outdated or abnormal blood to the blood
bank.

27. 10.
VERIFY
Order
Transfusion
consent
form
Client
identification
Blood Type
Expiration
Compatibility
Appearance
Unit
identification
Number

28.  If any of the information does not match exactly,
notify the charge nurse and the blood bank.
 Do not administer blood until discrepancies are
corrected or clarified.
 Sign the appropriate form with the other nurse
according to agency policy.
 Make sure that the blood is left at room temperature
for no more than 30 minutes before starting the
transfusion.
Rationale: As blood components warm, the risk of
bacterial growth also increases. If the start of the
transfusion is unexpectedly delayed, return .
 Do not store blood in the unit refrigerator.
Rationale: The temperature of unit refrigerators is not
precisely regulated and the blood may be damaged.

29. 11. PREPARE THE BLOOD BAG.
 Invert the blood bag gently several times to mix
the cells with the plasma.
Rationale: Rough handling can damage the cells.
 Expose the port on the blood bag by pulling back
the tabs.
 Insert the remaining Y-set spike into the blood bag.
 Suspend the blood bag.

30. 12. ESTABLISH THE BLOOD
TRANSFUSION.
• Close the upper clamp below the IV saline solution container.
• Open the upper clamp below the blood bag. The blood will
run into the saline-filled drip chamber. If necessary, squeeze
the drip chamber to reestablish the liquid level with the drip
chamber one third full. (Tap the filter to expel any residual
air within the filter.)
• Readjust the flow rate with the main clamp.
• Remove and discard gloves. Perform hand hygiene.

31. 13.OBSERVE THE CLIENT
CLOSELY FOR THE FIRST 15
MINUTES.
 “transfusions of RBCs be started at 1–2 mL/min
for the first 15 minutes of the transfusion”
 Rationale: This small amount is enough to produce
a severe reaction but small enough that the
reaction could be treated successfully.
 Note adverse reactions, such as chills, nausea,
vomiting, skin rash, dyspnea, back pain, or
tachycardia.
 Rationale:The earlier a transfusion reaction occurs,
the more severe it tends to be. Promptly
identifying such reactions helps to minimize the
consequences

32.  Check the vital signs. If there are no
signs of a reaction, establish the required
flow rate. Most adults can tolerate
receiving one unit of blood in 1.5 to 2
hours.
 Do not transfuse a unit of blood for
longer than 4 hours.
 If the client has a reaction and the blood
is discontinued, send the blood bag and
tubing to the laboratory for investigation
of the blood.

33. 14. DOCUMENT RELEVANT DATA.
 Record starting the blood, including vital signs,
type of blood, blood unit number, sequence
number (e.g., 1 of three ordered units), site of
the venipuncture, size of the catheter, and drip
rate.
AFTER TERMINATION :
 Record completion of the transfusion, the
amount of blood absorbed, the blood unit
number, and the vital signs.
 If the primary IV infusion was continued,
record connecting it. Also record the
transfusion on the IV flow sheet and intake and
output record.

34. 15.TERMINATE THE TRANSFUSION.
 Apply clean gloves.
 If no infusion is to follow, clamp the blood
tubing. Check agency protocol to determine if
the blood component bag needs to be returned
or if the blood bag and tubing can be disposed
of in a biohazard container.
 The IV line can be discontinued or capped with
an adapter or a new infusion line and solution
container may be added.
 If another transfusion is to follow, clamp the
blood tubing and open the saline infusion arm.
Check agency protocol.
 A new blood administration set is to be used
with each component

35.  If the primary IV is to be continued, flush the
maintenance line with saline solution.
Disconnect the blood tubing system and
reestablish the IV infusion using new tubing.
 Adjust the drip to the desired rate. Often a
normal saline or other solution is kept
running in case of delayed reaction to the
blood.
 Measure vital signs.

36.  Definition- Blood transfusion reaction is a
systemic response by the body to blood
incompatible with that of recipient It is mainly
caused due to-
 ABO incompatibility
 Allergic reactions to the WBCs, platelets, or
plasma protein components of the transfused
blood
 Potassium or citrate preservative in the blood
ADVERSE REACTION

37. ADVERSE REACTION
 Acute hemolytic transfusion reaction
 Delayed hemolytic transfusion reaction
 Pyrogenic reaction
 Allergic reaction
 Anaphylactic reaction
 Transmission of infectious diseases
 Circulatory overload
 Infiltration and Hematoma
 Thrombophlebitis
 Pulmonary embolism

38. SUMMARY

40. ASSIGNMENT
 Note on the management of ADVERSE
REACTION due to blood transfusion.

41. EVALUATION

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Chintamani Lewis”MEDICAL SURGICAL NURSING ”South Asia
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Clinical Nursing Procedures: The Art of Nursing Practice, 3rd Edition,
Published by Annamma Jacob, Rekha R and Jadhav Sonali Tarachand,
page no.187 & 561.
Smeltzer S . Sumanzme “BARE AND BRENDA HINKLE I JANICE
BRUNNER AND SUDDHARTHS TEXTBOOK OF MEDICAL
SURGICAL NURSING” 13TH Edition,Volume 2 ,2015,Wolter
Kluwer pvt.ltd , New Delhi
The Trained Nurses Association of India (TNAI), Books of Fundamentals of
Nursing (A Procedure Manual), page no.175-182.
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