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
How many liters of blood are in your body?
- There are 5L of blood in your body or 70ml/Kg = 7% of body weight

5. Question What would indicate the need for a blood transfusion?
Replace blood losses due to serious injury or surgeries, inadequate components, view lab values

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 g/L
Female 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%
<18% or >54%
Hct measures the proportion of blood volume occupied by RBCs. It decreases with blood loss and anemia.
Platelet count
150, cells/uL
<50,000 cells/uL
Platelets initiate the coagulation process. A decreased amount increases the risk for hemorrhage.

7. Whole Blood Composition: Purpose: Indications: 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: Purpose: Indications: 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)
- helps to stop bleeding - including internal bleeding

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: Purpose: Indications: 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: Purpose: Indications: Albumin
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. Acute haemolytic reaction
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

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: mg/dL
An elevated indirect value may indicate ABO incompatibility.
Urinary Hemosiderin
Used to measure hemoglobin in urine resulting from intravascular hemolysis. Positive reaction = blood transfusion reaction.
CBC (Complete Blood Count)
WBC x10 9/L
RBC x10 12/L
HGB G/L
HCT
MCV FL
MCH PG
MCHC G/L
RDW
Platelets x10
MPV FL
Lymphocyte x10
Neutrophil x10
Monocyte x10
Esoinophil x10
Basophil x10
Luc 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
See checklist

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.
Be Transfusion Smart. (2010). Screening and diagnosis. Retrieved from
Blood Book. (2005). Common blood products. Retrieved from
Brundage, S., Curet, M., Dicker, R., Greco, R., Gregg, D., Morton, J., Nguyen, T., Norton, J., Shelton, A., Spain, D., Tavana, L., & Welton, M. (2004). Blood transfusion protocol at Stanford surgery ICU. Retrieved from
Cincinnati Children’s Association. d(2010). Hematology and blood tests and procedures. Retrieved from
Day, R. A., Paul, P., Williams, B., Smeltzer, S. C., & Bare, B. (2007). Brunner and Suddarth’s textbook of medical-surgical nursing (1st Canadian Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Malarkey, L., & McMorrow, M. (2005). Nursing guide to laboratory and diagnostic tests. St. Louis, MI: Elsevier Saunders.
National Heart Lung and Blood Institute. (n.d). Types of blood transfusions. Retrieved from
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.
Watson, D., & Hearnshaw, K. (2010). Understanding blood groups and transfusion in nursing practice. Nursing Standard, 24 (30),