When do you transfer blood

1. FUNDAMENTALS OF NURSING
BLOOD TRANSFUSION

2. GENERAL OBJECTIVE
At the end of the lecture/discussion
students should be able to gain an
understanding and knowledge of
management of blood transfusion.

3. SPECIFIC OBJECTIVES
Define blood transfusion
Outline the indications of blood
transfusion.
Identify the blood components for
transfusion
State the special procedures for blood
donation.
Describe the care of patient receiving

4. INTRODUCTION
Blood is a straw- coloured transparent
fluid in which different types of cells are
suspended. (Anne and Allison 2008).
Blood provides a means of communication
between cells and other parts of the body.
 Lost blood from the body during trauma,
child birth or surgery may require to be
replaced through blood transfusion.

5. Introd. cont
Blood transfusion is done in order to
increase the capacity of blood to carry
oxygen , improve immunity and restore
blood volume(Merck manual 1999).
 A blood transfusion is the transfer of
blood or blood products from one( a donor
) person to another directly through a vein.
(Merck manual 1999)

6. INDICATIONS
oTo correct anaemia resulting from
cancer and marrow aplasia
Severe burns: To make up for the
fluid shift through burns.
To prevent shock in operations such
as hysterectomy, rectal resection.
To counteract the effects of
haemorrhage and replace the blood
lost.

7. Blood components for transfusion
The following blood components may
be administered:
-Whole blood –transfusion where
blood is given in the form in which it is
collected. All cells and fluid are
administered.

8. Packed cells:
The transfusion of cellular components
of blood after removal of plasma.
Packed Red blood cells: Commonly
used in treating chronic anaemia and
in cardiac failure

9.  Fresh Frozen Plasma: Contains normal
plasma levels of stable clotting factors,
albumin and immunoglobulin: Replacement
of multiple coagulation factor deficiencies:
e.g.
 Liver disease
 Warfarin (anticoagulant) overdose
 Disseminated intravascular coagulation (DIC)
 Thrombotic thrombocytopenic purpura
(TTP)

10. Platelet concentrate: leukemia,
aplastic anemia, congenital or acquired
platelet dysfunction.

11.  Cryoprecipitate: Contains about half of the
Factor VIII and fibrinogen in the donated whole
blood: e.g. Factor VIII, fibrinogen. As an
alternative to Factor VIII concentrate in the
treatment of inherited deficiencies of:
 von Willebrand Factor (von Willebrand’s disease)
 Factor VIII (haemophilia A)
 Factor XIII
 As a source of fibrinogen in acquired
coagulopathies: e.g. disseminated intravascular
coagulation (DIC)

12. Special donation procedures
a) Autologous transfusion.
 Blood transfusion in which the donor
is also the recipient.
This blood transfusion is safe as it
eliminate the risks of incompatibility
and blood-borne diseases.
One donates blood which will be given
back to him later during a major
operation.(Merck manual 1999).

13. Special procedure cont.
(b) Homologous:
 The collection of blood from the donor
of the same species and may be
distributed via blood bank.

14. The surfaces of erythrocytes contain a
genetically determined assortment of
antigens composed of glycoproteins
and glycolipids. These antigens, called
agglutinogens. Based on the presence
or absence of various antigens, blood is
categorized into different blood
groups.

15.  Agglutins are antibodies that are found in the
plasm, they react with the A or B antigens on the
membrane of the RBC.
 These are the anti-A antibody, which reacts with
antigen A, and the anti-B antibody, which reacts
with antigen B. There antibodies present in each of
the four blood type.
 For example, if your: blood type is B, you have B
antigens on your red blood cells, and you have
anti-A antibodies in your blood plasma.
 .

16. Two major blood groups ABO and Rh.
The Rh blood group is so named because
the antigen was discovered in the blood
of the Rhesus monkey.
People whose RBCs have Rh antigens
are designated Rh+ (Rh positive); those
who lack Rh antigens are designated Rh-
(Rh negative)

17.  Summary of ABO Blood Group Interactions
BLOOD TYPE CHARACTERISTIC A B AB O
 Agglutinogen
 A B Both A Neither A (antigen) on and B nor B
RBCs
 Agglutinin
 anti-B anti-A Neither Both anti-A (antibody) in
anti-A and anti-B plasma nor anti-B
 Compatible A, O B, O A, B, AB, O O donor blood
types (no hemolysis)
 Incompatible B, AB A, AB — A, B, AB donor
blood types (hemolysis)

18. ABO incompatibility between a mother
and her fetus. Development of hemolytic
disease of the newborn (HDN).
(a) At birth, a small quantity of fetal blood
usually leaks across the placenta into the
maternal bloodstream. A problem can
arise when the mother is Rh- and the baby
is Rh+, having inherited an allele for one of
the Rh antigens from the father.

19. (b) Upon exposure to Rh antigen, the
mother’s immune system responds by
making anti-Rh antibodies.
(c) During a subsequent pregnancy, the
maternal antibodies cross the placenta into
the fetal blood. If the second fetus is Rh+,
the ensuing antigen–antibody reaction
causes agglutination and hemolysis of fetal
RBCs.

20. CARE BEFORE TRANSFUSION
Obtain written consent.
 Inform the client the reason for
transfusion and obtain history of any
transfusions.
 Note allergic reactions.
If occurred, note type of the reactions
Increased number of pregnancies increase
chances of allergic reaction.

21. MANAGEMEN CONT.T
Instruct the patient to report any side
effects of blood transfusion when it
begins.
These include chills, fever respiratory
distress, lower back pain or dizziness.
Obtain the signed consent form and
Obtain the clients baseline vital signs.
 Before transfusion, check that the
blood pack details match with the
client’s name and blood group.

22. Management cont.
Check expiry date on the blood pack.
 Two nurses confirm the blood pack
details with client’s records
oReassure patient blood is safe as it is
tested with the patient’s own blood to
reduce the likelihood of untoward
reactions.

23. CARE DURING TRANSFUSION
Monitor the condition of the patient while
blood transfusion is running for reactions.
Record vital signs 1/4hrly for the first hour
of transfusion and increase the interval.
Check the rate of flow of blood and
observe the site of the infusion for
infiltration.
 Observe for urine output, if urine is less
than 30ml/hr.

24. Care cont.
If a transfusion reaction is suspected,
transfusion must be stopped immediately
and medical officer should be notified.
Assess the patient thoroughly because
many complications have similar signs and
symptoms.
 The following should be done in case of a
transfusion reaction is suspected

25. Care cont.
Assess patient carefully,
Do vital signs with those of the baseline
assessment
Keep vein open with normal saline 0.9%
Notify the lab that a suspected
transfusion reaction has occurred send
blood and urine samples.
Send remaining blood unit and tubing
to the lab.

26. Care cont.
If a haemolytic transfusion reaction or
bacterial infection is suspected, do the
following:
(a) Obtain the blood from the patient.
(b) Collect urine sample as soon as
possible for haemoglobin
determination.
(c) Document the reaction

27. COMPLICATIONS
Haemolytic reactions
(Incompatibility reaction).
 This occurs immediately after
blood transfusion.
 The signs and symptoms are
shivering, arise temperature,
oliguria and hypotension ,may
progress to shock and renal
failure.
.

28. Complication mgt
MANAGEMENT
(a) Monitor blood pressure
(b) Treat shock as indicated by the patient
condition using intravenous infusions,
oxygen, adrenaline and diuretic
(c) Obtain post transfusion reaction blood
sample
 Urine specimen for evaluation

29. Mgt of complications cont.
(d) Observe the signs of haemorrhage
due to disseminated intravascular
coagulation
PREVENTION
(i) Before, blood transfusion, check
donor’s and recipient’s blood types to
ensure blood compatibility.
identify patient with another nurse or
doctor present transfuse blood slowly
for 15minutes to 20 minutes.

30. Complications cont.
 Allergic reaction: Occurs due to sensitivity
to foreign proteins in blood plasma.
 Symptoms range from mild reactions such as
urticaria to severe ones such as dyspnoea or
laryngeal oedema.
 Stop blood transfusion and inform medical
officer.
 Adrenaline may be given in severe reactions
and anti-histamines in mild reactions

31. Complications cont.
PREVENTION
Pre-medicate with the patient with
anti-histamine.
 Observe the patient closely for the first
20minutes of blood transfusion

32. Febrile Reaction
Fever may result from the introduction
of contaminant with the blood.
It occurs sometime after the blood
transfusion has been started or even
after it has been completed.
Management
The rate of flow is slowed and the
doctor is informed

33. PREVENTION
Pre-medicate with anti-histamine and
antipyretic.
Observe blood before blood transfusion for
clots and colour.
Infuse each unit of blood over 2-4hrs.
Terminate the blood transfusion if the time
exceeds 4hrs.
Maintain Aseptic techniques during
administration.

34. Circulatory overload
 Caused by infusion of blood at a rate too rapid
for the size and cardiac status or condition of
the recipient.
 The signs and symptoms include, cough,
dyspnoea, pulmonary congestion, headache,
tachycardia and distended neck veins.
 Management
 Place the patient in an upright position.
 Administer diuretics (laxis 20mg) and oxygen

35. Delayed transfusion complications
Delayed haemolytic reaction:
Occurs after blood transfusion when
the level of antibodies have been
increased to the extent that a reaction
can be mounted.
Iron overload:
his can occur in a client receiving more
units of blood over a period of time such
as client with sickle cell anaemia.

36. Complication cont.
Citrate toxicity: may occur from expired
blood.
Potassium toxicity: This may leaky from
the stored red blood cells to the blood
stream.
Diseases which can be transmitted from
blood transfusion:
Hepatitis B & C
HIV which causes AIDS
Syphilis.

37. Complications cont.
Malaria
Cytomegalovirus (CMV)
Chagga,s disease, (American
trypanosomiasis .
Other complications which may arise
during blood transfusion are difficulties
in maintaining the flow of blood.

38. There are many reasons for a slow flow or
stoppage of blood transfusion:
 Vein may go into spasms, warming the
limb may help.
The tubing may become kinked.
The needle or tubing may become blocked
by air.
The apparatus should be disconnected
from the needle.
Blood should be allowed to through tubing
freely before it is reconnected again.

39. Complications cont.
The tubing may become blocked by a blood
clot.
The nurse may remove the clot from the
tubing by attaching a syringe to the needle
and sucking the clot into the syringe.
The blood be allowed to flow freely through
the tubing before it is reconnected later

40. CONCLUSION:
We have now come to the end of our
discussion on blood transfusion.
 we learnt that blood is very important
fluid in our bodies as it transport
oxygen to the tissues and from the
tissues blood carries carbon dioxide to
the lungs for excretion.

41. Conclusion cont.
Haemorrhage and anaemia causes loss of
blood which must be replaced via blood
transfusion.
Though blood transfusion is helpful, it has
problems and complications which may
arise.
Hence the need for the nurses to be vigilant
in order to avert problems relating to blood
transfusion.

42. Synthetic colloid solutions
Examples of solutions that may be
administered as a substitute of blood.
GELATINS (Haemacel, Gelofusine)
DEXTRAN 60 and DEXTRAN 70
HYDROXYETHYL STARCH (Hetastarch
or HES).

43. Infection risk Nil
Indications: Replacement of blood volume
 Prophylaxis of postoperative venous
thrombosis
Precautions: Coagulation defects may
occur.
 Platelet aggregation inhibited.
Some preparations may interfere with
compatibility testing of blood.

44. Contraindications: Do not use in patients
with pre-existing disorders of haemostasis
and coagulation.
Side-effects: Minor allergic reactions
Transient increase in bleeding time may
occur.
Hypersensitivity reactions may occur
including, rarely, severe anaphylactic
reactions.

45. References
Waugh A & Grant, A Anatomy &
Physiology in health and illness (2008)
10th edition,Churchhill
Livingstone,Elsevier.
SmeltzSer SC & Bare, Medical-Surgical
Nursing (2000) 7th edition,J.B. Lippincott
company.
Berkow R & Beers, MK Manual Merck
(1997) 4th edition Merck &Co Inc.