Jenny A.

Cruz Level IV Block 1 Group 4B Blood transfusion therapy involves transfusing whole blood or blood components
(specific portion or fraction of blood lacking in patient). One unit of whole blood consists of 450 mL of blood collected into 60 to 70 mL of preservative or anticoagulant. Whole blood stored for more than 6 hours does not provide therapeutic platelet transfusion, nor does it contain therapeutic amounts of labile coagulation factors (factors V and VIII). Blood components include: 1. Packed RBCs (100% of erythrocyte, 100% of leukocytes, and 20% of plasma originally present in one unit of whole blood), indicated to increase the oxygen-carrying capacity of blood with minimal expansion of blood. 2.Leukocyte-poor packed RBCs, indicated for patients who have experience previous febrile no hemolytic reactions. Platelets, either HLA (human leukocyte antigen) matched or unmatched. Granulocytes ( basophils, eosinophils, and neutrophils ) 3.Fresh frozen plasma, containing all coagulation factors, including factors V and VIII (the labile factors). Single donor plasma, containing all stable coagulation factors but reduced levels of factors V and VIII; the preferred product for reversal of Coumadin-induced anticoagulation. 4.Albumin, a plasma protein. 5.Cryoprecipitate, a plasma derivative rich in factor VIII, fibrinogen, factor XIII, and fibronectin. 6.Factor IX concentrate, a concentrated form of factor IX prepared by pooling, fractionating, and freeze-drying large volumes of plasma. 7.Factor VIII concentrate, a concentrated form of factor IX prepared by pooling, fractionating, and freeze-drying large volumes of plasma. 8.Prothrombin complex, containing prothrombin and factors VII, IX, X, and some factor XI. Principles of blood transfusion therapy Whole blood transfusion Generally indicated only for patients who need both increased oxygen-carrying capacity and restoration of blood volume when there is no time to prepare or obtain the specific blood components needed. Packed RBCs Should be transfused over 2 to 3 hours; if patient cannot tolerate volume over a maximum of 4 hours, it may be necessary for the blood bank to divide a unit into smaller volumes, providing proper refrigeration of remaining blood until needed. One unit of packed red cells should raise hemoglobin approximately 1%, hemactocrit 3%. Platelets Administer as rapidly as tolerated (usually 4 units every 30 to 60 minutes). Each unit of platelets should raise the recipients platelet count by 6000 to 10,000/mm3: however,

poor incremental increases occur with alloimmunization from previous transfusions, bleeding, fever, infection, autoimmune destruction, and hypertension. Granulocytes May be beneficial in selected population of infected, severely granulocytopenic patients (less than 500/mm3) not responding to antibiotic therapy and who are expected to experienced prolonged suppressed granulocyte production. Plasma Because plasma carries a risk of hepatitis equal to that of whole blood, if only volume expansion is required, other colloids (e.g., albumin) or electrolyte solutions (e.g., Ringers lactate) are preferred. Fresh frozen plasma should be administered as rapidly as tolerated because coagulation factors become unstable after thawing. Albumin Indicated to expand to blood volume of patients in hypovolemic shock and to elevate level of circulating albumin in patients with hypoalbuminemia. The large protein molecule is a major contributor to plasma oncotic pressure. Cryoprecipitate Indicated for treatment of hemophilia A, Von Willebrands disease, disseminated intravascular coagulation (DIC), and uremic bleeding. Factor IX concentrate Indicated for treatment of hemophilia B; carries a high risk of hepatitis because it requires pooling from many donors. Factor VIII concentrate Indicated for treatment of hemophilia A; heat-treated product decreases the risk of hepatitis and HIV transmission. Prothrombin complex-Indicated in congenital or acquired deficiencies of these factors. 1.Definition Is the introduction of whole blood or component of the blood, e.g. plasma or erythrocytes into venous circulation. 2.Blood Group Human blood is classified in to four main groups (A, B, AB and O) on the basic of polysaccharide antigen on the erythrocyte surface. These antigens type A and Type B, commonly cause antibody reaction and are called agglutinogens. In other words group A blood contain type A agglutinogen, group B blood contain type B agglutinogen, group AB contain both A & B agglutinogens, and group O blood containe neither agglutinogen. In addition to agglutinogens on the erythrocytes agglutinin (antibody) are present in the blood plasma. No individual can have agglutinin and agglutinogen of the same type, that person's system would attack its own cells. Then group A blood does not contain agglutinin A but does contain agglutinin B. Group B blood does not contain agglutinin B but does contain agglutinin A. Group AB blood contain neither agglutinin and group O contain both anti A and anti B agglutinin. Blood transfusion must be match to the patient blood type in term of compatible agglutinogen mismatch blood will cause hemolytic reaction.

Rhesus (Rh) and other factors Rh antigen also on the surface of erythrocytes are present in about 85% of the population are can be a mayor cause of hemolytic reaction. Persons who possess the Rh factor are referred to as Rh positive those who do not are referred to as Rh negative. Unlike the A and B agglitinogen, the Rh factor cannot cause a hemolytic reaction on the first exposure to mismatched blood, because the Rh antibody is not normally present in the plasma of Rh negative person. 3.Transfusion reaction Transfusion reaction can be categorized as hemolytic, febrile, circulatory over load and allergic. The nurse must asses a client closely for reactions. Sign of an acute reaction include sudden chills or fever, low back pain, drop in blood pressure, nausea, flushing agitation or respiratory disorders. Sign of less severe allergic reaction include hives and itching but no fever. Nursing management for transfusion reaction: Stop the transfusion. Maintain the intravenous line with normal saline solution through new intravenous tubing, administered at a slow rate. Asses the patient carefully, compare the vital sign with those from the base line assessment. Notify the physician of the assessment findings and implement any order obtained. Notify the blood bank that a suspected transfusion reaction has occurred. Send the blood container and tubing to the blood bank for repeat typing and culture, the identifying tag and number are verified. Before commencing a blood transfusion determine: 1.Base line data regarding blood pressure, temperature, pulse and respiration. 2.Any previous reaction to a blood transfusion. 3.The request for blood transfusion form has been completed and send specimen for typing and cross matching, 3 ml in plain tube/red without wax or gel and 2 ml in CBC tube. 4.Purpose 1.Restore blood volume after hemorrhage 2.Maintain hemoglobin levels in severe anemia 3.Replace specific blood component. 5. Assessment focus Clinical signs of reaction (e.g. sudden chills, nausea, itching rash, dyspnea) status of infusion, site, any unusual symptoms. Equipment 1.Unit of whole blood 2.Blood administration set either a straight line or a Y set ( Y set is preferred) 3.Normal saline solution 4.IV dressing 5.Vena puncture set containing a 18 needle or catheter, or if blood is to be administered quickly no 16 needle or a larger. 6.Alcohol swab

7.Tape 8.Disposable gloves (Sterile) 6.Initiating, Maintaining and Terminating a Blood Transfusion * Nursing Intervention a.Pre Procedure 1.Obtain patients base line data before the transfusion. Asses base line data: Temp, Pulse, Respiration and Blood Pressure. Determine any known allergies or previous adverse reaction to blood. Note specific signs related to the client's pathology and reason for transfusion (e.g. an anemic client, note the hemoglobin level less than 10g/L). 2.Obtain the correct blood component for the patient. Check the physician's order with the requisition. See that doctor check and write to start. Check the requisition form and the blood bag label with a specially check the patient name, identification number, blood type and Rh group the blood donor number, and the expiration date of blood. Ensure that doctors counter check and sign With another nurse (RN) compare the laboratory blood type round with : The client's name and identification number. Ask the patient to state the full name as a double check. The number on the blood bag label The patients blood group and label, amount of blood, calculate and adjust. Check blood for any abnormalities, gas bubles dark color or cloudiness, clots and excess air Make sure that the blood is left at room temperature for no more than 30 minutes before starting the transfusion. RBCs deteriorate and lose their effectiveness after 2 hours at room temperature. Agencies may designate different times at which the blood must be returned to the blood bank if it has not been started. As blood component warm, the risk of bacterial growth also increases. Rational : If the patients Clinical status permits, delay transfusion if baseline temperature is greater than 38.50 C b.Procedure 1.Wash and dry hands 2.If any pre medication order, give before transfusion 3.Prepare the patient Identify the patient and explain the procedure and its purpose to the patient such as blood product to be transfused, approximate length of time, and desired outcome of transfusion. 4.Assemble the equipment and bring to the patient 5.Wear gloves. 6.Positioning the patient comfortably

7.Prime the tubing with saline solution. Establish the saline infusion See that the set used in appropriate, as sometimes attached filteris not suitable for some product 8.If the patient has an intravenous solution infusing check whether the needle and solution are appropriate to administer blood. The needle should be no. 18 gauge or larger and the solution must be saline. If solution is not compatible remove it and dispose of it according to hospital policy. Dextrose which causes lysis of RBCs, Ringer's Solution, medication and other additives and hyper alimentation solution are incompatible. 9.If patient does not have an intravenous solution infusing, in the case you will need to perform veni puncture on a suitable vein. Select a large vein that allows patient some degree of mobility and place bed protector under the site. Start the prescribed intravenous infusion 10.Establish the blood transfusion. Invert the blood bag gently several times to mix the cell within the plasme 11.Start infusion slowly at 2 ml/mnt. Remain at bed side for 5-30 minutes. If there are not sign of circulatory overloading, the infusion rate may be increased 12.Observe the patient closely for chilling, nausea, vomiting, skin rashes tachycardia as they early sign and symptom reaction and check vital sign at least hourly until 1 hour post transfusion. Report sign and symptoms of reaction immediately to physician to minimize consequences. Acute reaction may occur at anytime during the transfusion.If any reaction: close clamp & run normal saline, report to doctor, save urine and observe. Rational : The majority of acute fatal transfusion reaction are caused by clerical errors. Patient and product verification is the single most important fucntion of the nurse. It is strongly recommended that two qualified individuals perform this task. Do not proceed with the transfusion if there is any discrepancy. Contact the blood bank immediately c. Post procedure Obtain vital sign and compare with base line assessment. Document procedure in patient's medical record including: Product , blood type Rh, volume transfused, rate, site infused. Product identification number Name of individual verifying, patient ID, name of person starting and ending transfusion. Patient assessment findings and tolerance to procedure. Monitor patient for response to and effectiveness of the procedure. Terminate the transfusion Discard administration set according to policy procedure. (i.e. If any reaction, save the set for further investigations) Rational : Rationale it must be possible to trace each transfusion product to the original blood donor.