BLOOD TRANSFUSION

BLOOD TRANSFUSION-
INTRODUCTION,PURPOSE,

1. INTRODUCTION

2. Whole Blood Composition: Red Blood Cells White Blood Cells Plasma Platelets Hematocrit Clotting Factors ONE UNIT OF WHOLE BLOOD CONTAINS - 450 ml OF DONOR BLOOD. 50 ml OF ANTICOAGULANT-PRESERVATIVE SOLUTION. HAEMOGLOBIN approx. 12g/ml & HAEMATOCRIT 35% - 45%. NO FUNCTIONAL PLATELETS

3. 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

4. Fresh Frozen Plasma Composition: 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

5. Whole Blood Composition: 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

6. Platelets Composition: 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)

7. CRYOPRECIPITATE • CRYOPRECIPITATE IS A SUPERNATANT PRECIPITATE OF FRESH FROZEN PLASMA AND IS RICH IN FACTOR VIII AND FIBRINOGEN. • IT IS STORED AT -30 DEGREES CENTIGRATE WITH A 2 YEARS SHELF LIFE. • INDICATED IN LOW FIBRINOGEN STATES (<1g/L) OR IN CASES OF FACTOR VIII DEFICIENCY (HAEMOPHILIA-A), VON WILLEBRAND’S DISEASE AND AS A SOURCE OF FIBRINOGEN IN DISSEMINATED INTRAVASCULAR COAGULATION. • POOLED UNITS CONTAINING 3-6 gms FIBRINOGEN IN 200-500 ml RAISES THE FIBRINOGEN LEVEL BY APPROX. 1g/L. • MUST BE INFUSED WITHIN 6 HOURS.

8. GENERAL INSTRUCTIONS FOR GIVING BLOOD TRANSFUSIONS Selection of the donor Donor shall be free of diseases of heart , kidneys,lungs,liver etc. There should not be any history of cancer, jaundice, hepatitis, tuberculosis ,allergies They should be physically healthy, and should be between 18 and 65 years of age with in average height and weight. Donors must have normal temperature ,pulse and blood pressure. They must not have been pregnant with in the last 6months.

9. CONT....... Before the blood is transfused,the donors blood must be cross matched with the recipients blood. Explain the procedure to the donor and reassure him/her to win his confidence and co- operation.explain the sequence of the procedure and tell him how we can co-operate in the procedure. Blood should not be collected empty stomach .the donor should not be dehydrated . following the donation of blood the donor should be given a sweetened drink and asked to take rest for one to two hr to prevent fainting attacks.

10. CONT....... -The donor is asked to complete a questionnaire detailing any history of infectious diseases and other medical issues before they are allowed to donate blood for transfusion. - The donor’s hemoglobin level is checked. - Once collected, the blood is examined and screened for possible infectious agents such as HIV and hepatitis .

11. CONT....... The blood is transfused through tubing that is connected to a needle or catheter supplying the vein. The amount of blood transfused depends on the individual patient’s needs. During blood transfusion, vital signs such as temperature, heart rate, and blood pressure are carefully monitored. Some patients may get a sudden fever during or within 24 hours of the transfusion, which may be relieved with acetaminophen or paracetamol . This fever is a common reaction to the white blood cells present in donated blood.

12. 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

13. 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

14. 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

15. . RECORD: TIME WHEN THE TRANSFUSION IS STARTED. TIME WHEN THE TRANSFUSION IN COMPLETED. VOLUME AND TYPE OF ALL PRODUCTS TRANSFUSED. BLOOD PACK NUMBERS. ANY ADVERSE EFFECTS. SEVERE REACTIONS MOST COMMONLY PRESENT IN THE FIRST 15-30 MINUTES OF A TRANSFUSION THEREFORE THEY SHOULD BE CLOSELY MONITORED DURING THIS TIME. -IF THE PATIENT APPEARS TO BE EXPERIENCING AN ADVERSE REACTION THE TRANSFUSION MUST BE IMMEDIATELY STOPPED AND URGENT MEDICAL ASSISTANCE SHOULD BE SEEKED FOR.

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. 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