BLOOD

TRANSFUSION
Prepared by: Xerczhiel Faye C. Rio, RN
DEFINITION
Blood Transfusion is the
introduction of whole blood
or blood components into
venous circulation.
HISTORY
Blood transfused in humans
since mid-1600s
1628 - physician WILLIAM
HARVEY fully described
circulation and properties
of blood
1665 - The first successful
blood transfusion was done
by physician RICHARD
LOWER in England on a
DOG.
HISTORY
1795 - The first human
blood transfusion was
performed by Dr. Philip
Syng Physick

1818 - The first transfusion

of human blood for the
treatment of hemorrhage
was performed by Dr.
James Blundell in London
HISTORY
1900 – Landsteiner
described ABO groups
1913 - The Kimpton-Brown
transfusion appratus was
commonly used before
citration
1916 – First use of blood
storage
1939 – Levine described the
Rh factor
Blood is a familiar red fluid in
the body that contain white
blood cells, red blood cells,
platelet, proteins, and other
elements.
Each part of the blood has
special function and can be
separated from each other.
BLOOD COMPONENTS
Donor blood is converted into various products,
including:

Packed red blood cells (RBCs)

Whole blood
Platelets
Fresh frozen plasma
Albumin
Cryoprecipitates
Red blood cell (RBC)
Also known as an erythrocyte,
this cell contains hemoglobin,
which binds to oxygen in the
lungs, and carries the oxygen
throughout the body by way of
the circulatory system.
Packed RBCs, a type of blood
product, are used to replace
erythrocytes lost as a result of
trauma or surgical intervention
or in clients with bone marrow
suppression.
Whole blood
Blood, unaltered, as it is
taken from the donor.
Composed of RBCs,
plasma, and plasma
proteins.
It is administered primarily
to treat hypovolemic
shock resulting from
hemorrhage.
Platelet
A type of blood cell that is
involved in the clotting
process.
Platelets are administered to
clients with low platelet
counts as a means of
preventing hemorrhage and
to thrombocytopenic clients
who are actively bleeding or
scheduled for invasive
procedures.
Fresh-frozen plasma
A type of blood
component administered
to augment clotting
factors in clients who are
deficient in such factors.
Albumin
A type of plasma protein
that is used to treat
hypovolemic shock or
hypoalbuminemia.
Cryoprecipitates
Various blood
components used to
remedy deficiencies of
clotting factors in
conditions such as
hemophilia or von
Willebrand disease.
BLOOD GROUPS (ABO SYSTEM)
ABO
A type of antigen system. The ABO type of the
donor should be compatible with the recipient's.

Human blood is commonly classified into four

main groups: A, B, AB, and O.
BLOOD GROUPS (ABO SYSTEM)
Antigens (agglutinogens)
1. The surface membrane of the red blood cell
(RBC) is characterized by glycoproteins
known as antigens.
2. More than 400 different antigens have been
identified on the RBC membrane.
3. Yet, A, B, and Rh antigens are the most
important in determining blood group or type.
BLOOD GROUPS ( ABO SYSTEM)
Antibodies (or immunoglobulins)
1. These are proteins produced by B lymphocytes;
they consist of two light and two heavy chains
that form a Y shape.
2. These antibodies are often called agglutinins.
BLOOD GROUPS (ABO SYSTEM)
RHESUS (Rh) FACTOR
Rh positive (Rh+) - Blood that contains the Rh
factor

Rh negative (Rh− ) - Blood that does not contain

the Rh factor.
RHESUS (Rh) FACTOR
Unlike the ABO system, Rh− blood does not naturally
contain Rh antibodies.

Exposure to blood containing Rh factor (e.g., an

Rh− mother carrying a fetus with Rh+ blood, or
transfusion of Rh+ blood into a client who is Rh− )

Rh antibodies develop
DETERMINING COMPATIBILITY
Client blood samples are drawn and labeled at
the bedside; the client is asked to state his or
her name, which is compared with the name on
the client's identification band or bracelet.
The recipient’s ABO and Rh types are identified.
An antibody screen is performed to determine
whether antibodies other than anti-A and anti-B
are present.
DETERMINING COMPATIBILITY
Crossmatching is performed: Donor red blood
cells (RBCs) are combined with the recipient’s
serum and Coombs’ serum.
-The crossmatch is compatible if no RBC
agglutination occurs = no antibodies are
present

The universal RBC donor is O-negative; the

universal recipient is AB-positive.
TRANSFUSION REACTIONS
Transfusion of ABO- or Rh- incompatible blood can
result in a hemolytic transfusion reaction, which
causes destruction of the transfused RBCs and
subsequent risk of kidney damage or failure.
TRANSFUSION REACTIONS
Reaction: Cause Clinical Signs Nursing Interventions

Hemolytic reaction: Fever or chills, flank 1. Discontinue the transfusion

immediately.
incompatibility between pain, and reddish or
2. Maintain vascular access with
client’s blood and donor’s brown urine, normal saline, or according to
blood tachycardia, agency protocol.
hypotension 3. Notify the primary care
provider immediately.
4. Monitor vital signs.
5. Monitor fluid intake and
output.
6. Send the remaining blood,
bag, filter, tubing, a sample of
the client’s blood, and a urine
sample to the laboratory.
TRANSFUSION REACTIONS
Reaction: Cause Clinical Signs Nursing Interventions

Febrile reaction: Fever; chills; warm, 1. Discontinue the transfusion

immediately.
sensitivity of the client’s flushed skin;
2. Keep the vein open with a
blood to white blood headache; anxiety; normal saline infusion.
cells, platelets, or nausea 3. Notify the primary care
plasma proteins; does provider.
not cause hemolysis 4. Give antipyretics as ordered.
1. Stop the transfusion
Allergic reaction (mild): Flushing, urticaria, immediately. Keep vein open
sensitivity to infused with or without with normal saline.
plasma proteins itching 2. Notify the primary care
provider.
3. Administer medication
(antihistamines, steroids) as
ordered.
TRANSFUSION REACTIONS
Reaction: Cause Clinical Signs Nursing Interventions

Allergic reaction Dyspnea, stridor, 1. Stop the transfusion

(severe): antibody– decreased oxygen immediately.
antigen reaction saturation, chest 2. Keep the vein open with a
pain, flushing normal saline solution.
3. Notify the primary care
provider immediately.
4. Monitor vital signs.
Administer
cardiopulmonary
resuscitation if needed.
5. Administer medications
and/or oxygen as
ordered.
TRANSFUSION REACTIONS
Reaction: Cause Clinical Signs Nursing Interventions

Circulatory overload: Dyspnea, hypotension, 1. Stop the transfusion

blood administered orthopnea, crackles immediately.
faster than the (rales), distended neck 2. Place the client upright.
circulation can veins, tachycardia, 3. Notify the primary care
accommodate hypertension provider.
4. Administer diuretics and
oxygen as ordered.
TRANSFUSION REACTIONS
Reaction: Cause Clinical Signs Nursing Interventions
Sepsis: contaminated High fever, chills, 1. Stop the transfusion.
blood administered vomiting, diarrhea, 2. Keep the vein open with
hypotension, oliguria a normal saline infusion.
3. Notify the primary care
provider.
4. Administer IV fluids,
antibiotics.
5. Obtain a blood
specimen from the
client for culture.
6. Send the remaining
blood and tubing to the
laboratory
TYPES OF BLOOD DONATION
An autologous donation reduces the risk of
disease transmission and potential transfusion
complications but is not an option for a client
with leukemia or bacteremia.

Autologous donation
Donation of the client's own blood before
a scheduled procedure or in anticipation
of some other future need.
TYPES OF BLOOD DONATION
Blood obtained through blood salvage may need
to undergo “washing,” a process that removes
tissue debris, before being infused.

Blood salvage
A type of autologous donation in which
blood is suctioned from a client’s body
cavities, joint spaces, and other closed
body sites during a procedure.
TYPES OF BLOOD DONATION
Infusion of blood taken from a designated donor
does not reduce the risk of bloodborne infection,
but recipients often feel more comfortable about
taking blood from a donor they know and
approve of.

Designated donor
A compatible donor who has been selected
by the recipient or, in a procedure also known
as directed donation, volunteers to donate on
behalf of the client.
PRECAUTIONS & NURSING RESPONSIBILITIES

Never store blood in a refrigerator other than

those used in blood banks (blood bank
refrigerators are equipped with controlled
temperatures designed for blood storage);

Make sure that the blood is left at room

temperature for no more than 30 minutes before
starting the transfusion. Blood must be returned
to the blood bank if it has not been started.
PRECAUTIONS & NURSING RESPONSIBILITIES

A transfusion should be completed within 4

hours of initiation. The maximum time for use of
a blood filter is 4 hours (Phillips & Gorski, 2014).

No fluid other than normal saline solution should

be added to blood components, nor should
medications be added to a blood transfusion.
PRECAUTIONS & NURSING RESPONSIBILITIES
PRECAUTIONS & NURSING RESPONSIBILITIES
The recommended rate of infusion varies with the blood
component being transfused and the client's condition, but
generally blood is infused as quickly as the client's condition
will allow.

Blood products containing few RBCs, such as platelets, may

be infused rapidly (over 15 to 30 minutes), but care should
be taken to avoid circulatory overload.

Vital signs and lung sounds should be assessed before the

transfusion, again after the first 15 minutes of transfusion,
and every hour until 1 hour has passed since the transfusion
was completed.
PRECAUTIONS & NURSING RESPONSIBILITIES
Client Identity and Compatibility
PRECAUTIONS & NURSING RESPONSIBILITIES
Client Identity and Compatibility
With another nurse (most agencies require an RN), verify the
following before initiating the transfusion (Phillips & Gorski, 2014, p.
731):
Order: Check the blood or component against the primary care
provider’s written order.
Transfusion consent form: Ensure the form is completed per
facility policy.
Client identification: The name and identification number on
the client’s identification band must be identical to the name
and number attached to the unit of blood.
Unit identification: The unit identification number on the blood
container, the transfusion form, and the tag attached to the
unit must agree.
PRECAUTIONS & NURSING RESPONSIBILITIES
Client Identity and Compatibility
With another nurse (most agencies require an RN), verify the
following before initiating the transfusion (Phillips & Gorski, 2014, p.
731) (continuation)
Blood type: The ABO group and Rh type on the primary label of
the donor unit must agree with those recorded on the
transfusion form.
Expiration: The expiration date and time of the donor unit should
be verified as acceptable.
Compatibility: The interpretation of compatibility testing must
be recorded on the transfusion form and on the tag attached to
the unit.
Appearance: There should be no discoloration, foaming, bubbles,
cloudiness, clots or clumps, or loss of integrity of the container.
BLOOD ADMINISTRATION SET
Traditionally, blood has
usually been administered
through an
#18- to #20-gauge IV needle
or catheter.

Current practice guidelines

established by the AABB and
endorsed by the American
Red Cross and the INS
recommend that
a #14- to #22 gauge IV
catheter is acceptable for
transfusion of cellular blood
components in adults.
BLOOD ADMINISTRATION SET
Initiating, Maintaining, and Terminating a Blood
Transfusion Using a Y-Set
PURPOSES
• To restore blood volume after severe hemorrhage
• To restore the oxygen-carrying capacity of the blood
• To provide plasma factors, such as antihemophilic factor (AHF) or
factor VIII, or platelet concentrates, which prevent or treat bleeding

ASSESSMENT
• Vital signs
• Physical examination including fluid balance and heart and lung
sounds as manifestations of hypo- or hypervolemia
• Status of infusion site
• Blood test results such as hemoglobin value or platelet count
• Any unusual symptoms
Initiating, Maintaining, and Terminating a Blood
Transfusion Using a Y-Set

PROCEDURE:
1. Prior to performing the procedure, introduce self and verify the
client’s identity using agency protocol. Explain to the client what
you are going to do, why it is necessary, and how he or she can
participate. Instruct the client to report promptly any sudden
chills, nausea, itching, rash, dyspnea, back pain, or other unusual
symptoms.
2. Provide for client privacy and prepare the client.
3. Perform hand hygiene and observe other appropriate infection
prevention procedures.
4. Prepare the infusion equipment.
Initiating, Maintaining, and Terminating a Blood
Transfusion Using a Y-Set
5. Prime the tubing.
6. Start the saline solution.
7. Obtain the correct blood component for the client.
8. Prepare the blood bag. Invert the blood bag gently several times
to mix the cells with the plasma.
9. Establish the blood transfusion.
• Close the upper clamp below the IV saline solution container.
• Open the upper clamp below the blood bag.
10.Observe the client closely for the first 15 minutes.
• Phillips and Gorski (2014) report that the AABB recommends
that “transfusions of RBCs be started at 1–2 mL/min for the first
15 minutes of the transfusion” (p. 732).
Initiating, Maintaining, and Terminating a Blood
Transfusion Using a Y-Set
11. Document relevant data.
• Record starting the blood, including vital signs, type of blood,
blood unit number, sequence number (e.g., #1 of three ordered
units), site of the venipuncture, size of the catheter, and drip rate.
12. Monitor the client.
• Fifteen minutes after initiating the transfusion (or according to
agency policy), check the vital signs. If there are no signs of a
reaction, establish the required flow rate.
13. Terminate the transfusion.
When the blood product has infused, usually over 2 to 4 hr as
prescribed by the health care provider, begin infusing the 0.9%
normal saline to clear the tubing.
Initiating, Maintaining, and Terminating a Blood
Transfusion Using a Y-Set
14. Follow agency protocol for appropriate disposition of the used
supplies
15. Document relevant data.
• Record completion of the transfusion, the amount of blood
absorbed, the blood unit number, and the vital signs. If the primary IV
infusion was continued, record connecting it. Also record the
transfusion on the IV flow sheet and intake and output record.
THANK YOU.