2. BLOOD TRANSFUSION Ms.SARITHA MOHAN B.Sc.(N) Nursing Eductor Al-Ahsa Hospital Kingdom of Saudi Arabia

3. DEFINITION It is the administration of packed red blood products separated in the blood bank from collected whole blood.

4. TYPES OF BLOOD TRANSFUSION 1. AUTOLOGUS:- A donation of clients own blood before scheduled procedure. A donation of clients own blood before scheduled procedure. It reduces risk of transmission of diseases & potential transfusion complications. It reduces risk of transmission of diseases & potential transfusion complications.

5. 2. HOMOLOGUS:- It is the transfusion from another person. It is the transfusion from another person. There may be a chance of risk of infection

6. 3. BLOOD SALVAGE:- It is an autologus donation that involves suctioning blood from body cavities, joint spaces, or other closed body sites. blood may be need to be washed to remove the debris before re-infusion. blood may be need to be washed to remove the debris before re-infusion.

7. 4. DIRECTED:- Blood products donated by person for transfusion to specified recipient. Blood products donated by person for transfusion to specified recipient. Eg: Parent to child Eg: Parent to child

8. TYPES OF BLOOD COMPONENTS  RED BLOOD CELLS  WHOLE BLOOD  PLATELETS  FRESH FROZEN PLASMA  ALBUMIN  CRYOPRECIPITATES

9. ABO BLOOD GROUP DONORS UNIVERSAL DONOR UNIVERSAL ACCEPTOR

10. ABO BLOOD GROUPS ANTIBODYANTIGEN BLOOD GROUP BAA ABB NONEABAB ABNONEO

11. PACKED RED BLOOD CELLS  It is prepared by centrifugation of whole blood to remove 80% of plasma &add preservative citrate phosphate dextrose with adenosine, glucose & mannitol.  I unit PRBC increase hematocrit by 3% & Hb by 1g/dl in adults.  In children 15mg/dl PRBC will increase hematocrit by 6% &Haemoglobin by 2g/dl.

12.  PRBC infused when acute blood loss, profound anemia with impaired oxygen delivery.  In case of anemia transfusion recommended when Hb ‹7g/dl.  1unit can safely infuse over 1-2 hours.

13. FRESH FROZEN PLASMA  Used in case of multiple coagulation, deficiencies such as liver failure, warfarin OD, DIC, massive transfusion in bleeding patients, TTP, antithrombin III deficiency, hereditary angioma

14. CRYOPRECIPITATE  Contains 225mg fibrinogen, 80 units of factor VIII& Von-Willebrand factor (XIII & Fibronectin).  Infused when bleeding with fibrinogen level ‹100 & bleeding in Von-Willebrand disease unresponsive to desmopressin.

15. STAGES OF BLOOD TRANSFUSION  Before transfusion:- Ω Ask patient to state his full name & check Ω Ask patient to state his full name & check the record. the record. Ω When the blood products arrived check it Ω When the blood products arrived check it with clinician/2 nurses for the actual with clinician/2 nurses for the actual product, patient ID band, blood bank product, patient ID band, blood bank bracelet, blood bank requisition, medical bracelet, blood bank requisition, medical record & clinician order (patient name, record & clinician order (patient name, age, sex, file Number, MR no., blood age, sex, file Number, MR no., blood product name, blood bank donor no., blood product name, blood bank donor no., blood group, Rh-factor etc.) group, Rh-factor etc.)

16. Ω Units of blood stored in the “blood bank fridge or theatre fridge”. Ω Start Blood Transfusion within 30 minutes of blood being removed from the refrigerator.

17.  Injection Frusemide (Lasix) 40mg (IV or PO) often given with each or every other units to prevent the fluid overload.  It is not used if the patient is hypovolemic.  Give 100ml NS before after the unit to wash through the line.

18. Before transfusion Ω If the blood bracelet doesn ’ t match Ω If the blood bracelet doesn ’ t match with patient ID band or if the blood with patient ID band or if the blood bracelet doesn ’ t present DON ’ T bracelet doesn ’ t present DON ’ T INFUSE IT. INFUSE IT. Ω Check vitals prior to infusion Ω Check vitals prior to infusion

19.  Don ’ t put the blood bag in the microwave oven or in hot water to make it warm.  Use special warmers to prevent hypothermia & adverse reaction during the procedure

20. TYPES OF BLOOD TESTS  ABO & Rh typing  Routine lab investigations  Screening for infectious diseases.  Direct Coomb ’ s test  Indirect Coomb ’ s test  Cross-matching Antibody screening test

21.  DURING THE PROCEDURE:- Ω Note for the reactions. Ω Note for the reactions. Ω When starting each unit be with the Ω When starting each unit be with the patient and observe for the first 15 patient and observe for the first 15 minutes. minutes. Ω If a reaction occurs immediately stop Ω If a reaction occurs immediately stop the infusion and hang NS & inform to the infusion and hang NS & inform to the clinician. the clinician.

22. Ω If any adverse reaction occurs don ’ t discard the blood bag tubing and attached IV solution. Place them in a sealed bag, return to the blood bank & transfusion investigation form must be filled. (MR No102)

23. Ω All blood products must be infused Ω All blood products must be infused through proper administration set. through proper administration set. Packed cells through blood administration set. Packed cells through blood administration set. Platelets must be through the special administration set provided by blood bank. Platelets must be through the special administration set provided by blood bank. FFP administered through standard blood administration set. FFP administered through standard blood administration set.

24. RECORD THE VITALS DURING THE PROCEDURE BY TimeBPRespirationPulse temperatur e 5 Min 120/80207836.8°c 10 Min 120/70188036.9°c 15 Min 30 Min 45 Min 1 Hour 2 Hour 3 Hour 4 Hour

25. AAAAfter the procedure:- Ω Enter date & time stopped, amount given, any reaction occurs, final vitals, place the amount in I&O chart. Ω All the units and administration sets must be returned to blood bank. Place the original record in patient file. Ω Report the reaction in MR No.102.

26. INFUSION PUMPS  Don ’ t use the ARGUS Infusion pumps  Use TERUMO TE 171  Use BAXTER COLLEGUES-3

27. PRESSURE INFUSER BAGS  Place the blood bag covered with un- inflated pressure bag & hang to the IV pole  Use bulb to inflate the pressure bag for desired flow rate.  Don ’ t exceed beyond 300mm of Hg otherwise it may cause HEMOLYSIS