Dr. Kareema Ahmed Hussein 2017 -2018 Blood Transfusion Dr. Kareema Ahmed Hussein 2017 -2018

Blood Transfusion. is the infusion of whole blood from a healthy person in to a recipient's vein of sick person . Administration of blood or one of its components through an intravenous line (IV) Reaches patient’s blood vessels and enters the circulatory system

Type of blood transfusion Recipient : The person who receive the blood from another person Donor : The person who give the blood { donates } to another person Type of blood transfusion 1-Indirect type : Blood is infused after it has been collected from donor and processed this method is used most commonly . it's similar to giving I.V. in . 2- Direct type : Blood is infused as it's taken from donor this method is rarely except in emergencies

Typing and cross matching: [Blood compatibility] Before blood can be given to person it must be determined that the blood of the donor and the recipient are compatible. If they are no: clumping and hemolytic of the recipients blood cells will result . Typing The laboratory examination to determine person's blood type ABO. Cross matching: The process of determining compatibility between blood specimens . Antibody A substance that causes the formation of antibodies . Agglutinin An antibody that causes a clumping of specific antigens

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

4 types A B AB O

Blood Typing Most people have two related inherited antigens – A and B – that form the basis for the ABO blood typing Individuals with A antigen have type A blood Individuals with B antigen have type B blood Individuals with both A and B have type AB blood Individuals with no antigen have type O blood

Antibodies with each blood type: Blood type A: Has B antibodies Blood type B: Has A antibodies Blood type AB: Has no antibodies Blood type O: Has both antibodies( A&B) The Rh factor is made up of numerous complex antigens When it is present, the person is Rh positive (Rh+); if not present, the person is Rh negative (Rh–)

Blood compatibilities

Blood typing for transfusion Universal donor= O- Does not contain A, B, or Rh antigens Universal recipients= AB+ Blood contains A, B, and RH antigens Usually blood banks exactly match the pt blood

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

Packed Red Blood Cells (RBCs) Composition: RBCs with little plasma 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 anaemia Blood loss due to injury or surgery

Platelets Composition: Platelets Plasma Some of RBCs Some of 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)

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 Granulo-cytopenia

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

Albumin Composition: Albumin Purpose: Volume expansion leading to increased blood volume Indications: Hypo-protein-anemia Burns Shock Trauma Surgery Infections

selection of blood donors I -The accurate type . 2-The donor must be free from diseases ( hepatitis ) 3-The donor must be free from allergies . 4-The donor must be free from chronic diseases 5-Some banks don't accept blood donor who has been immunized recently because of possible allergic reaction to the blood .

typing and cross matching: [Blood compatibility] Before blood can be given to person it must be determined that the blood of the donor and the recipient are compatible. If they are no: clumping and hemolytic of the recipients blood cells will result

Nursing Implications Before transfusion: Check physician’s orders Review hospital policy Ensure informed and written consent is provided Check laboratory values Compatibility of blood type and Rh factor Understand the indications and rationale Verification procedure occurs with two nurses Inspect the blood product for discolouration, clots, leaking, or presence of bubbles

Before transfusion (con’t): 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 Use a 16-18 or 19 gauge needle or catheter to transfusion to prevent damage of red cells . During the first 15 min. of transfusion the blood should be administered slowly about 10-20 drop/mL to avoid complications Stay with the pt. at first 15 min . to observe complications that may occur.

During the transfusion: Monitor vital signs closely during the blood transfusion Inspect condition of IV site Observe for signs and symptoms of a reaction The rate is increased after the 15 in according to the physician's orders . Don't administer medications through the blood line { it may cause hemolytic).

After the transfusion: Dispose of materials/equipment Observe patient for clinical improvements Assess the laboratory values for effectiveness of transfusion The nurse must check the pt. For at least 5-1 0 min . after finshing

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

Infusion Therapy Risks Risk factors: Disease transmission Hepatitis B 1:140,000 Hepatitis C 1: 225,000 Hepatitis A 1:1 million HIV 1: 1.5 million Syphilis 1: 1 million Bacterial contamination Acute or delayed transfusion reactions Mis-matched ABO 1: 35,000 Incompatible Death Rate 1:600,000 Circulatory overload

COMPLICATION 1-Febrile Reaction: Recipients hypersensitivity to the blood S/S fever ,chill, headache ,malaise, Onset after first 30 min. —6hr Management: Stop immediately IV. Continue IV normal saline. Notify the physician Monitor vital signs.(antipyretics as order.)

2-Allergic reaction: Sensitivity to the plasma protein s/s rash, itching onset during or I hr after management: Stopping the IV and continue IV normal saline Antihistamine may be order. Comfortable

3-Hemolytic reactions: onest immediately donors blood is incompatible with the recipient blood s/s facial flushing ,fever ,chills ,headache tachycardia,low BP ,blood in urine↑ 4-Sepsis:blood contamination by bacteria or dioxin onset within 2hrs. s/s chill ,vomiting ,diarrhea, low BP, shock

5-circulatory overload: To rapid infusion expands the vascular volume more than patient heart can tolerate. S/s dyspnea, cough ,anxiety ,tachycardia, tachypnea ,cracorthopnea ,high BP . Management I -Elevate patient head. 2-Notify physician . 3-Stop or slow IV 4-Give morphine and diuretics ,oxygen as order

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