Blood transfusion

blood transfusion is a life saving procedure. so role of nurse here while transfused the blood in the ward is important. in this slide role of nurse is given here. if you like kindly give your comment and share it to others. follow my account to know more.

1. BLOOD TRANSFUSION

2. INTRODUCTION A blood transfusion is  a routine medical procedure in which donated blood is provided to you  through a narrow tube placed within a vein in your arm. This potentially life-saving procedure can help replace blood lost due to surgery or injury. This involves two procedures - the collection of blood from the donor and the administration of blood to the recipient

3. PURPOSES To restore the blood volume when there is sudden loss of blood due to haemorrhage , trauma or burns. To raise the haemoglobin level in cases of severe anaemia which are not corrected by the administration of vitamins and iron therapy. To treat deficiencies of plasma proteins, clotting factors and hemophilic globulin, etc. To provide antibodies ( Immunotransfusions ) to those persons who are sick and having lowered immunity by giving blood or plasma taken from persons who has just recovered from the same disease.

4. CONTI… To replace the blood with hemolytic agents with fresh blood (exchange blood transfusions) as in case of erythroblastosis foetalis , haemolytic anemia etc. To improve the leukocyte count of blood as in agranulocytosis . To combat infection in patients with leukopenia .

5. GROUPING AND CROSS MATCHING The individual from whom the blood is transferred is called the donor . The individual to whom the blood is transferred is known as the recipient . Indiscriminate transfusion may lead to serious conditions and even death. This consequence is due to the process of clumbing or agglutination or breaking up ( haemolysis ) of red corpuscles.

6. Conti.. Agglutination is due to the interaction between substances in red blood corpuscles known as agglutinogens and those in the plasma called agglutinins. Types of blood which get agglutinated in the transfusion is said to be incompatible

7. ABO BLOOD GROUPING Human blood is classified into 4 main groups ( A, B, AB, and O) based upon the type of antigens ( agglutinogens ) present in the erythrocytes, as well as the type of antibodies (agglutinins) present in the plasma. Two major agglutinogens which have been identified are the 'antigen A' and 'antigen B'. The persons with A type of blood have 'A' antigens in their red cells; and persons with B type of blood have B' antigens.

8. Conti.. Persons with 'AB' blood have both A and B antigens while those with 'O' type of blood do not have either A or B antigens in their red cells The agglutinogen and the agglutinins of the same type will not be found in the same person. Otherwise the person's own cells would have been attacked by the antibodies found in his plasma. Thus group A blood contains beta agglutinins and group B contains only alpha agglutinins. Group AB contains neither alpha nor beta agglutinins and group O contains both alpha and beta agglutinins.

9. The possible combinations are : SR. NO. BLOOD GROUP AGGLUTINOGENS IN TH RED CARPUSCLES AGGLUTININS IN THE PLASMA 1 AB A & B NO AGGLUTININS 2 A A BETA AGGLUTININS 3 B B ALPHA AGGLUTININS 4 O NO AGGLUTINOGENS BOTH ALPHA & BETA

10. The Haemolytic Reactions When similar agglutinins and agglutinogens come in contact with each other, clumbing (agglutination) and rupture ( haemolysis ) of the red cells occurs. e.g ., when type A agglutinogen and alpha agglutinin or type B agglutinogen and beta agglutinin come in contact with each other, agglutination and haemolysis will take place. This produces a fatal response called haemolytic reaction.

11. In order to avoid haemolytic reactions in blood transfusions, the blood cells of the donor is cross matched with the plasma of the recipient and the plasma of the donor with the cells of the recipient. If no agglutination is taking place, the blood is said to be compatible. COMPATIBLE MEANS able to exist or occur together without problems or conflict.

12. The results of mixing the red cells of the donor with the plasma of the recipient are shown ahead. (The capital letters indicate the antigens and the small letters indicate the antibodies). Donors blood cells (Antigens) Recipients plasma (Antibodies) o b a ab AB - + + + A - - + + B - + - + O - - - - group O is known as 'Universal donor". group AB is known as 'Universal recipient'.

13. Rh Factor 85 per cent of the world population is having the antigen D ' of the Rh blood group system. Those persons who possess this antigen is called ' Rh positive ' and those who do not inherit this antigen is called ' Rh negative'. The name Rh factor comes form the Rhesus monkeys whose blood contains this antigen. This antigen was discovered in 1940 by Landsteiner and Wiener. POSITIVE(+) NEGATIVE(-)

14. What is Auto transfusion of blood ? It is the collection, anticoagulation, filtration and reinfusion of blood from an active bleeding site. Because the reinfused blood is the clients own.

15. Conti.. The advantages of auto transfusion are : The risk of technical errors of blood typing and crossmatching eliminated Possible adverse effects associated with homologous blood transfusion can be avoided. Dependence on homologous blood blanks can be reduced. Reduce the incidence of exposure to blood-borne infections such as HIV, serum hepatitis and others

16. GENERAL INSTRUCTIONS FOR GIVING BLOOD TRANSFUSIONS How to select donor ?

17. GENERAL INSTRUCTIONS FOR GIVING BLOOD TRANSFUSIONS How to select donor ?

18. GENERAL INSTRUCTIONS FOR GIVING BLOOD TRANSFUSIONS How to select donor ?

19. GENERAL INSTRUCTIONS FOR GIVING BLOOD TRANSFUSIONS How to select donor ?

20. GENERAL INSTRUCTIONS FOR GIVING BLOOD TRANSFUSIONS How to select donor ?

21. COLLECTION, STORAGE & TRANSPORTATION OF BLOOD

22. COLLECTION, STORAGE & TRANSPORTATION OF BLOOD Name of the donor. Donor number ABO grouping Rh typing Date of drawing blood Date of expiry Results of tests for hepatitis and syphilis etc.

23. COLLECTION, STORAGE & TRANSPORTATION OF BLOOD

24. COLLECTION, STORAGE & TRANSPORTATION OF BLOOD

25. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. When sending the recipient's blood sample for grouping and cross matching, it must be carefully labelled at the bedside of the recipient with the following identifications Recipient's name, Hospital number, Bed number, Ward number etc. Fresh samples, taken within 4 hours should be used for typing and cross matching.

26. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. A request form should accompany the specimen and it should contain the following data : The recipient's name Hospital number Bed number Ward number Name of the physician Exact amount of blood component requested. Diagnosis of the patient Any blood transfusions given earlier, if so, the group and type of the blood administered, any reactions observed etc.

27. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. It is essential that the physician writes all orders for typing, crossmatching and administration of whole blood and blood products. When blood or blood products have to be administered, it is recommended that two registered nurse or a physician and a registered nurse should independently verify all identifying informations on the report of the cross match, unit lable and the patient's identifications. Any error in the identification, results in the major adverse reactions. Should there be any discrepancy, the unit should be returned to the blood bank with the remarks.

28. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. Whole blood and the blood products should be administered through an appropriate, sterile, pyrogen free transfusion set containing a filter which will remove clots and larger aggregates of leucocytes and platelets

29. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. Care is to be taken to prevent introduction of air into the apparatus.

30. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. It is recommended to use 18 gauge needle for infusion, to prevent damage to the red cells and to provide an adequate rate of flow.

31. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. No medication - antibiotics, vitamins, calcium etc. should be added to the unit of blood or administered through the same intravenous system as they may cause damage to the red cells.

32. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. If I.V. infusions are to be given immediately before, during or after the blood transfusions, always use physiologic saline to prevent haemolysis of the blood in the tubing. Dextrose should be avoided. If another I.V. fluid is to be given, rinse the infusion set with normal saline before starting the solution.

33. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. Prior to administration of blood, the patient's vital signs should be recorded correctly on the nurse's record to provide a baseline for further observation. Adjust the rate of flow to 5 to 10 ml per minute during the first 30 minutes of transfusion, to detect any complications as early as possible. The subsequent flow rate depends upon the condition of the patient and the need for rapid infusion. Give the blood at a slower rate if the patient is elderly, suffering from heart and lung disease, anaemia , etc.

34. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. Whole blood and packed cells are administered cold. No attempt is made to heat the blood. However, blood may be allowed to stand at the room temperature for 30 to 45 minutes before it is administered to the patient. Once the blood is exposed to the atmosphere (the unit is opened), it should be discarded.

35. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. The procedure involved in the administration of the blood is the same as that of administration of I.V. infusions. Watch the patient carefully for the onset of any complications. Any reactions developed in the patient should be reported to the charge nurse and the physician immediately. Early detection of complications and the steps taken to counteract them, save the life of the patient

36. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. Rate of flow. Signs of circulatory overload. Urinary output (Maintain intake and output chart over 24 hours). The needle site for signs of infiltration, haematoma , and dislodgement of needle etc. Blood level in the container. Never allow the blood bottle to be completely empty to prevent the entry of air. Reaction to the blood transfusion. Patency of the infusion set. The following observations are made throughout the procedure:

37. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. Keep the patient warm and comfortable with blankets if necessary. Offer bedpan before starting the procedure and as necessary.

38. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. Record on the nurse's record with date and time : The amount of blood administered. The group and the type of blood administered. The rate of flow. Any reactions observed. Any medications administered e.g ., antihistamins .

39. REGARDING ADMINISTRATION OF BLOOD TO THE RECIPIENT. When leaving the ward, the charge nurse should report the following to the relieving nurse. The name and the bed number of the patient receiving the blood transfusions. The time at which the drip has started. The type of blood that is given. Amount of blood that is administered and the quantity to be given more

40. Conti. Any specific precautions to be followed. The specified rate of flow. Any reactions observed. Any medications administered. General condition of the patient.

41. COMPLICATIONS OF BLOOD TRANSFUSIONS Several types of reactions can result from the blood transfusions. General adverse reactions include : Acute Haemolytic Transfusion Reaction In haemolytic transfusion reaction, the circulating red cells are ruptured with the release of free haemoglobin . Errors made in the laboratory tests, clerical errors and the administration of blood to the wrong patient are the most common causes

42. COMPLICATIONS OF BLOOD TRANSFUSIONS The transfusion reaction is characterized by the Onset of fever with chills, Headache, Dyspnoea , Cyanosis, Chest pain, Nausea, Vomiting, Increased pulse rate and respiratory rate, Haemoglobinuria (red urine). These symptoms may progress to shock with a resultant drop in blood pressure. Oliguria followed by anuria may signal renal failure.

43. The Nursing Actions involved in transfusion reactions are : Observe the patient closely for the first ten minutes of transfusion. Since these reactions occur very rapidly, the rate of flow should be minimal. Discontinue the blood immediately when reaction is assessed. Inform the physician and implement treatment as prescribed by the physician.

44. The Nursing Actions involved in transfusion reactions are : Inform the physician and implement treatment as prescribed by the physician. Inform the laboratory to do grouping and cross matching of the blood. The donor blood is sent back to the laboratory and a specimen of the recipient's blood is retested to confirm the diagnosis. Maintain intravenous infusion with 5 per cent glucose or saline using a new I.V. set. Large quantities of fluid is given to promote diuresis and to counteract shock

45. The Nursing Actions involved in transfusion reactions are : Monitor vital signs every 15 minutes to assess shock and collapse. Record the fluid intake and output to assess the degree of kidney functions. Indwelling catheter is put into to monitor the urinary output. Oxygen inhalation is given to relieve dyspnoea . Allay patient's anxiety with reassurance.

46. The Medical Treatment may include the following :

47. The Medical Treatment may include the following :

48. 2. Delayed Hemolytic Transfusion Reaction It occurs due to incompatibility of RBC antigens other than ABO group. It develops days to weeks after transfusion and is characterised by decreasing haemoglobin level and persistent low grade fever. Mostly it develops in previous transfusion recipient or multiparous clients. Many a time this reaction is missed. If known, inform the physician and blood bank.

49. 3. Pyrogenic Reaction It develops immediately or within 6 hrs after transfusion. bacterial contamination may occur from improper preparation of the donor site, not following strict aseptic techniques and from improper refrigeration. It can also occur due to antigen antibody reaction to WBCs or platelets contained in blood product Pyrogenic reactions are characterized by fever with chills, nausea, vomiting, diarrhoea , headache, backache, delirium, shock and renal failure

50. 4. Allergic Reactions It develops any time during transfusion or within one hour after transfusion. Allergic reactions are thought to be sensitivity of the individual to a plasma protein in the transfused blood. It is characterized by rashes, itching, laryngeal oedema and bronchial spasm in severe cases. The treatment normally consists of an injection of antihistamin and corticosteroids as necessary.

51. Conti. 5. Anaphylactic Reaction. 6. Transmission of Infectious Diseases 7. other complications Circulatory Overload Hyperkalemia Hypocalcemia Thrombophlebitis Pulmonary embolism