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2. What is blood transfusion ?
Blood transfusion is a safe common procedure in
which blood is given through intravenous line in
one of the blood vessels.
Blood transfusions are done to replace blood loss
during surgery or a serious injury.

3. BLOOD GROUPS
❖A
❖ B
❖AB-UNIVRSAL RECIPIENT
❖O-UNIVERSAL DONOR

4. PURPOSE
❖Restoration of O2 carrying capacity
❖Restoration of blood volume
❖To replace plasma factors
❖To improve hemostasis

5. INDICATIONS
◼Anaemia
◼Major Surgical Operation
◼Major blood loss
◼Cancer patients requiring therapy
◼Women in childbirth and newborn babies in
certain cases.
◼Patients of hereditary disorders like
Hemophilia and Thalassemia & Severe burn
victims

6. BLOOD & BLOOD PRODUCTS
❖Whole fresh blood(WFB)
❖Packed Red blood cells(PRBC)
❖Fresh Frozen Plasma(FFP)
❖Cryoprecipitate blood
❖Platelets
❖Platelet pheresis

7. TYPES OF BLOOD TRANSFUSION
RED BLOOD CELL
TRANSFUSION
Red blood cells are the most
commonly transfused blood
product.

8. PLATELETS & CLOTTING FACTORS
Platelets and clotting factors
help to stop bleeding,
including internal bleeding.
eg., thrombocytopenia's.

9. PLASMA TRANSFUSION
◼Plasma is the liquid part of
blood. It contains proteins,
clotting factors, hormones,
vitamins, cholesterol, sugar,
sodium, potassium, calcium
& more.

10. PRESERVATION
Component Contents Shelf Life Preparation
Fresh whole
blood (FWB)
RBC, plasma
proteins, all
coagulation factors,
WBC, platelets
Less than 8 hours
after initial collection
Use immediately following
collection
Stored whole
blood (SWB)
RBC, plasma
proteins
Greater than 8 hours
old & up to 35 days
(dependent on anticoagulant-
preservative solution used);
refrigerate at 1-6°C
Allow to come to room temp
(temps exceeding 37ºC will result
in hemolysis & bacterial
proliferation)
Packed red
blood cells
(PRBC)
RBC, reduced
plasma
Dependent on anticoagulant-
preservative
solution used;
refrigerate at 1-6° C
Allow to come to room temp
(temps exceeding 37°C will result
in hemolysis & bacterial
proliferation); may reconstitute
with 0.9% NaCl prior to
administration

11. CONT…
Component Contents Shelf Life Preparation
Platelet-rich
plasma/platelet
concentrate
Platelets, few RBC
and WBC, some
plasma
5 days at 22°C;
intermittent agitation
required
Should administer immediately
following collection and preparation
Fresh frozen
plasma (FFP)
Plasma, albumin, all
coagulation factors
12 months frozen
at -20°C or below
Thaw in 37°C warm water bath
(temps exceeding 37°C will result in
protein denaturation & bacterial
proliferation)
Frozen plasma
(FP)
Plasma, albumin,
stable coagulation
factors
5 years frozen
at -20°C or below
Thaw in 37°C warm water bath
(temps exceeding 37°C will result in
protein denaturation & bacterial
proliferation)
Cryoprecipitate
(CRYO)
Factor VIII, vWF,
fibrinogen,
fibronectin
12 months frozen
at -20°C or below
Thaw in 37°C warm water bath
(temps exceeding 37°C will result in
protein denaturation & bacterial
proliferation)

12. Homologous transfusion: (Allogenic)
Transfusion using the stored blood of
others.
Autologous transfusion:
one’s own blood is collected & reserved
for his treatment (e.g..surgery).
Preservatives:
60-70 ml of preservative (anticoagulant)
e.g Citrate.

13. Transportation of blood
◼According to
hospital
policy

14. Responsible Person
◼Doctor
◼Nurse

15. Articles Required
❖Things for starting an IV line.
❖ Blood administration set - primed
❖ Normal Saline

❖ Informed consent

❖Non-sterile Gloves and an apron
❖Pre med if ordered
❖Case file

16. PRE TRANSFUSION PROCEDURE
◼Check the written order.
◼Ensure that the consent for blood transfusion is
obtained by the physician.
◼ Ensure if there is any previous history of allergic
reactions.
◼Send for Blood grouping and cross
matching(Edta,Plain tube)
◼Send the sample with requisition slip to blood bank
along with the donor.
◼ Check whether the blood is reserved

17. Before starting transfusion
◼Check the order.
◼The nurse who receives the blood from the
blood bank will check the PATIENT
NAME,UHID NO BLOOD GROUP,
DATE OF EXPIRY, BAG NUMBER and
SEDIMENTATIONS.
◼Explain to the patient.
◼Ask the patient to void.
◼Check vital signs.

18. Cont….
◼The blood will be double checked by the
Doctor and two nurses.
◼Insert i.v. cannula adult [18 gauge] paediatric
[20G, 22G depending on size of the vein, and
administer normal saline according to the
doctors advice for patency of iv line.
◼Administer pre medication.(if ordered)
◼Using aseptic precaution connect the
transfusion set to the blood. Expel the air.
◼Start the blood with the 5-10drops/mt for first
15 min.

19. During Transfusion
◼Once the blood is started, the nurse has to stay
near the patient for 15min & observe for any
reactions & also check the vital signs.
◼Documentation is done simultaneously in the
nurses chart and vital signs to be checked
every 15 minutes for the first hour and then
half for an hour and then once an hour for the
rest of the transfusion.
◼The nurse has to observe the patient
frequently.

20. After Transfusion
◼Once the blood is finished flush the line with 30ml of
normal saline to keep the line patent.
◼Make sure that patient is comfortable after the transfusion.
◼Discard the blood bag and transfusion set according to the
waste management policy.
◼Replace the articles and document the procedure.

21. Blood Reaction and Stages
Signs &
Symptoms
Urticaria/rash, Pruritis
Possible CauseAllergic
Immediate
Management
•Stop transfusion, inform the physician,check the vital
signs
•Assess patient
•An antihistamine may be required
•Transfusion may be restarted if no other
signs/symptoms are present
If signs/symptoms worsen treat as Category 2
Mild

22. Cont…..
Signs &
Symptoms
Flushing, Urticaria, Rigors, Fever, Restlessness, Tachycardia, Anxiety,
Pruritis, Palpitations, Mild dyspnea, Headache
Possible Cause•Allergic (moderately-severe)Febrile non-haemolytic
•transfusion reaction:-antibodies to white cells or platelets, antibodies to
proteins including IgA
•possible contamination with pyrogens and /or bacteria
Immediate
Management
•Stop transfusion, inform the doctorcheckthe vital signs and maintain IV line
with
•N. Saline
•Inform Medical Officer
•Administer antihistamine or paracetamol as per order.
•Further investigation and management according to clinical features
If investigation required: complete Transfusion Reaction Form and send blood pack
with tubing’s, form and post transfusion samples of blood and urine to blood
bank.
Follow the transfusion reaction investigation report. Raise the incident report.
Moderate

23. Cont…..
Signs &
Symptoms
Rigors, Fever, Restlessness, Hypotension, Tachycardia, Dark Urine, Unexplained
bleeding, Anxiety, Chest pain, Pain at infusion site, Respiratory distress, Loin/back
pain, Headache, Dyspnoea
Possible Cause•Acute intravascular haemolysis (wrong blood)
•Bacterial contamination and septic shock
•Fluid overload
•Anaphylaxis
•Transfusion related acute lung injury
Immediate
Management
oStop transfusion, inform the doctor,
ocheck the vital signs maintain IV line with N. Saline
oInform Medical Officer
oManage immediate needs:
▪fluid for hypotension
▪oxygen
▪adrenaline for anaphylaxis
▪diuretic for fluid overload
oComplete Transfusion Reaction Form and send blood pack with tubing’s,
form and post transfusion samples of blood and urine to blood bank
Further management according to likely cause.
Follow the transfusion reaction investigation report. Raise the incident report.
Severe

24. COMPLICATION
◼Virus & infectious diseases
- HIV
- Hepatitis B & C
◼Iron overload
◼Lung injury
◼Acute Immune Hemolytic reaction
◼Delayed Hemolytic reaction
◼Citrate toxicity

25. PATIENT OUT COME
◼ Biggest benefits of transfusions are increased
blood flow to nourish the organs and improved
oxygen levels in the body.
◼This can keep them from feeling extreme fatigue
and help give them enough energy for the
activities of daily life.
◼Benefits like this are often felt fairly quickly.

26. Evidence based practice
❖Blood products should be administered with the
same regard and caution as high risk medications.
❖ Many of the established transfusion administration
safety standards have been applied to improve the
safety of high alert/high risk medication
administration: Double check.
❖As nurses must know the eight rights of blood
administration.

27. Documentation
❖Time and date of transfusion.

❖Type and amount of blood infused
❖Clinical signs and symptoms
❖Complete set of vital signs and frequency
interventions provided
If any reactions :
❖ complete transfusion reaction form completely
filled by the doctor and send it to the blood
bank
❖ Date and time physician was notified and
orders received

28. Our responsibility
◼Hand hygiene
◼Double check
◼Consent
◼DO NOT store blood in ward refrigerator or allow it to set out at
room temperature.
◼Do not add any medicine to the blood product
◼Patient can be allow to take food during transfusion.
◼Do not discontinue the blood and hang it at the bed side.
◼Watch for reaction.
◼Monitor vital signs
◼Document all events.