by Dr elhadi

1. Blood Transfusions
By Christina Baier, Crystal Davidson, Dayna Legge,
Christine Leblond, Jessica Luckett, and McKenzie Quevillion

2. Overview
 What is a blood transfusion?
 Purpose
 Indications
 Blood products
 Nursing implications
 Administering a blood
transfusion (skill)

3. What is a Blood Transfusion?
 Administration of blood or one of its
components through an intravenous line (IV)
 Reaches patient’s blood vessels and enters the
circulatory system

4. Purpose of a Blood Transfusion
 Restore blood volume
 Replace clotting factors
 Improve oxygen carrying capacity
 Restore blood elements that are depleted
 Prevent complications

5. Question
 What would indicate the need for a blood
transfusion?

6. Lab Tests
Lab Test Normal Results Why is this ordered?
Type and crossmatch Based on ABO system
Positive = incompatibility
Negative = probable
compatibility
To determine the primary blood group,
screen for antibodies and determine
donor-recipient compatibility.
Hbg (hemoglobin) Male 140-175 g/L
Female 123-153 g/L
Critical Value:
Male <130 g/L
Female <110 g/L
Hbg carries oxygen in the blood. It can
decrease due to blood loss.
Hct
(hematocrit)
Male 41.5%-50.4%
Female 25.9%-44.6%
Critical Value:
<18% or >54%
Hct measures the proportion of blood
volume occupied by RBCs. It decreases
with blood loss and anemia.
Platelet count 150,000-400000 cells/uL
Critical Value:
<50,000 cells/uL
Platelets initiate the coagulation
process. A decreased amount increases
the risk for hemorrhage.

7. Whole Blood
 Composition:
- Red Blood Cells
- White Blood Cells
- Plasma
- Platelets
- Hematocrit
- Clotting Factors
 Purpose:
- Volume replacement
- Increase oxygen-carrying capacity
 Indications:
- Significant blood loss (>25% blood lost, i.e. hemorrhage)
- Newborn babies with hemolytic disease

8. Packed Red Blood Cells (RBCs)
 Composition:
- RBCs with little plasma (hematocrit about 75%)
- Some platelets and WBCs remain
 Purpose:
- Increase RBC mass and oxygen-carrying capacity
- Assists the body to rid carbon dioxide and other waste products
 Indications:
- Symptomatic and chronic anemia
- Blood loss due to injury or surgery

9. Platelets
 Composition:
- Platelets
- Plasma
- RBCs
- WBCs
 Purpose:
- Helps to stop bleeding (restore clotting ability)
- Essential for coagulation of blood
 Indications:
- Decreased platelet count
- Hemophilia
- Thrombocytopenia
- Platelet dysfunction (End stage renal disease, DIC)

10. White Blood Cells (WBCs)
 Composition:
- WBCs or leukocytes suspended in 20% of the plasma
 Purpose:
- Increase number of WBC’s
- Replaces WBC’s that are functioning abnormally
 Indications:
- Sepsis (not responsive to antibiotics)
- Persistent fever
- Granulocytopenia

11. Fresh Frozen Plasma
 Composition:
- Plasma
- All coagulation factors
 Purpose:
- Increase blood plasma
- Replenish clotting factors
 Indications:
- Bleeding in patients with coagulation factor deficiencies;
plasmapheresis
- Burn
- Liver Failure
- Severe Infection

12. Albumin
 Composition:
- Albumin
 Purpose:
- Volume expansion leading to increased blood volume
 Indications:
- Hypoproteinemia
- Burns
- Shock
- Trauma
- Surgery
- Infections

13. Nursing Implications
Before transfusion:
 Check physician’s orders
 Review hospital policy
 Ensure informed and written consent is provided
 Check laboratory values
 Understand the indications and rationale
 Verification procedure occurs with
two nurses

14. Nursing Implications Con’t
Before transfusion (con’t):
 Compatibility of blood type and Rh factor
 Inspect the blood product for discolouration, clots, leaking, or
presence of bubbles
 Check the unit number on the unit of blood and on the form
 Check the expiration date and time on unit of blood
 Ask client to state first and last name
 Check patient’s identification number on wristband and record

15. Nursing Implications Con’t
During the transfusion:
 Monitor vital signs closely during the blood
transfusion
 Inspect condition of IV site
 Observe for signs and symptoms of a
reaction

16. Nursing Implications Con’t
After the transfusion:
 Dispose of materials/equipment
 Observe patient for clinical
improvements
 Assess the laboratory values for
effectiveness of transfusion

17. Documentation
 Verification procedure
 Type of blood
 Amount administered
 Vital signs
 Patient’s response to therapy

18. Mechanism Onset Signs and Symptoms
ABO, Rh
incompatibility
5-15 minutes
following
initiation of
blood
transfusion
Increased temperature, increased
heart rate, heat and pain surrounding
vein, chills, headache, nausea, chest
or back pain, chest tightness, dyspnea,
bronchospasm, hypotension, anxiety,
vascular collapse, hemoglobinemia,
hemoglobinuria, disseminated
intravascular coagulation
Acute haemolytic reaction

19. Delayed haemolytic reaction
Mechanism Onset Signs and Symptoms
Immune
response
against non-
ABO donor
antigens
2-14 days
Fever, decrease in Hgb/Hct, increased
bilirubin levels, jaundice

20. Febrile, nonhaemolytic reaction
Mechanism Onset Signs and Symptoms
Sensitivity to
leukocytes or
platelets in
donor’s blood
30 minutes
after initiation
to 6 hours
after
completion of
transfusion
Fever, flushing, chills, headache,
muscle pain

21. Allergic reaction
Mechanism Onset Signs and Symptoms
Allergy to a
plasma
protein or
antigen in
donor’s blood
5-15 minutes
following
initiation of
blood
transfusion, up
to 1 hour after
Local erythema, gives, urticaria,
pruritus, coughing, nausea, vomiting,
respiratory distress, wheezing,
hypotension, loss of consciousness,
cardiac arrest

22. Graft-versus-host disease
Mechanism Onset Signs and Symptoms
Attack of
transfused
lymphocytes
on host
lymphocytes
Days to weeks
Skin rash, fever, jaundice, liver
dysfunction, bone marrow
suppression

23. Circulatory overload
Mechanism Onset Signs and Symptoms
Transfused at
an excessive
volume or rate
Any time
during or
within 1-2
hours after
transfusion
Dyspnea, cough, crackles, tachypnea,
headache, hypertension, tachycardia,
increased central venous pressure,
distended neck veins

24. Sepsis
Mechanism Onset Signs and Symptoms
Bacterial
contamination
During
transfusion to
2 hours after
transfusion
Fever, chills, abdominal cramping,
vomiting, diarrhea, hypotension

25. Lab Tests
Lab Test Normal Results Why is this ordered?
Antiglobulin (DAT) Negative Direct use is for post transfusion work-up to detect RBC
incompatibility. Positive result = hemolytic transfusion
reaction.
Bilirubin Indirect: 0.1-1.0 mg/dL An elevated indirect value may indicate ABO incompatibility.
Urinary Hemosiderin Negative Used to measure hemoglobin in urine resulting from
intravascular hemolysis. Positive reaction = blood transfusion
reaction.
CBC (Complete Blood Count) WBC 4.8-10.8 x10 9/L
RBC 4.2-5.4x10 12/L
HGB 120-160G/L
HCT 0.370-0.470
MCV 78-98 FL
MCH 25-24 PG
MCHC 320-360 G/L
RDW 0.110-0.150
Platelets 130-400 x10
MPV 7.0-11.0 FL
Lymphocyte 0.15-0.41 x10
Neutrophil 0.6-0.7 x10
Monocyte 0.06-0.41 x10
Esoinophil 0-0.04 x10
Basophil 0-0.2 x10
Luc 0-0.4 x10 9/L
To assess cellular characteristics of blood cells in response to
transfusion i.e. ABO compatibility through  WBC.

26. Nursing Implications in a Reaction
 Stop transfusion
 Remove tubing that contains blood product
 Infuse with 0.9% normal saline
 Monitor vital signs
 Notify physician
 Notify blood bank and return blood component
 Administer medication depending on type of reaction
 Epinephrine, antihistamines, antibiotics, antipyretics,
analgesics, diuretics, corticosteroids

27. Nursing Skill: Administering a
Blood Transfusion

28. Questions?

29. References
Bare, B., Smeltzer, S. C., Williams, B., Paul, P., & Day, R. A. (2004). Medical-surgical nursing (10th Ed.).
Philadelphia, PA: Lippincott Williams & Wilkins.
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Blood Book. (2005). Common blood products. Retrieved from
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Tavana, L., & Welton, M. (2004). Blood transfusion protocol at Stanford surgery ICU. Retrieved from
www.scalpel.stanford.edu/ICU/.../Transfusion%20Medicine%20TICU.ppt
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National Heart Lung and Blood Institute. (n.d). Types of blood transfusions. Retrieved from
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North Bay General Hospital. (2006). Nursing practice manual: Transfusion, blood and blood products (Policy No.
NP 1-90).
Perry, A.G., & Potter, P. A. (2006). Clinical nursing skills & techniques (6th Ed.). St. Louis, MI: Mosby, Inc.
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Standard, 24 (30), 41-48.