BLOOD TRANSFUSION.pptx

When do you transfer blood

1. FUNDAMENTALS OF NURSING BLOOD TRANSFUSION

2. GENERAL OBJECTIVE At the end of the lecture/discussion students should be able to gain an understanding and knowledge of management of blood transfusion.

3. SPECIFIC OBJECTIVES Define blood transfusion Outline the indications of blood transfusion. Identify the blood components for transfusion State the special procedures for blood donation. Describe the care of patient receiving blood State the complications of blood transfusion. Outline the management of complications of blood transfusion

4. INTRODUCTION Blood is a straw- coloured transparent fluid in which different types of cells are suspended. (Anne and Allison 2008). Blood provides a means of communication between cells and other parts of the body. Lost blood from the body during trauma, child birth or surgery may require to be replaced through blood transfusion.

5. Introd . cont Blood transfusion is done in order to increase the capacity of blood to carry oxygen , improve immunity and restore blood volume(Merck manual 1999). A blood transfusion is the transfer of blood or blood products from one( a donor ) person to another directly through a vein. (Merck manual 1999)

6. INDICATIONS To correct anaemia resulting from cancer and marrow aplasia Severe burns : To make up for the fluid shift through burns. To prevent shock in operations such as hysterectomy, rectal resection. To counteract the effects of haemorrhage and replace the blood lost.

7. Blood components for transfusion The following blood components may be administered: -Whole blood –transfusion where blood is given in the form in which it is collected . All cells and fluid are administered.

8. Packed cells : The transfusion of cellular components of blood after removal of plasma. Packed Red blood cells : Commonly used in treating chronic anaemia and in cardiac failure

9. Fresh Frozen Plasma : Contains normal plasma levels of stable clotting factors, albumin and immunoglobulin: Replacement of multiple coagulation factor deficiencies : e.g. Liver disease Warfarin (anticoagulant) overdose Disseminated intravascular coagulation (DIC) Thrombotic thrombocytopenic purpura (TTP)

10. Platelet concentrate: leukemia, aplastic anemia, congenital or acquired platelet dysfunction .

11. Cryoprecipitate: Contains about half of the Factor VIII and fibrinogen in the donated whole blood: e.g. Factor VIII, fibrinogen. As an alternative to Factor VIII concentrate in the treatment of inherited deficiencies of: von Willebrand Factor (von Willebrand’s disease) Factor VIII ( haemophilia A) Factor XIII As a source of fibrinogen in acquired coagulopathies: e.g. disseminated intravascular coagulation (DIC)

12. Special donation procedures a) Autologous transfusion . Blood transfusion in which the donor is also the recipient. This blood transfusion is safe as it eliminate the risks of incompatibility and blood-borne diseases. One donates blood which will be given back to him later during a major operation.(Merck manual 1999).

13. Special procedure cont. (b) Homologous: The collection of blood from the donor of the same species and may be distributed via blood bank.

14. The surfaces of erythrocytes contain a genetically determined assortment of antigens composed of glycoproteins and glycolipids. These antigens, called agglutinogen s. Based on the presence or absence of various antigens, blood is categorized into different blood groups.

15. Agglutins are antibodies that are found in the plasm, they react with the A or B antigens on the membrane of the RBC. These are the anti-A antibody, which reacts with antigen A, and the anti-B antibody, which reacts with antigen B. There antibodies present in each of the four blood type. For example, if your: blood type is B, you have B antigens on your red blood cells, and you have anti-A antibodies in your blood plasma. .

16. Two major blood groups ABO and Rh. The Rh blood group is so named because the antigen was discovered in the blood of the Rhesus monkey. People whose RBCs have Rh antigens are designated Rh+ (Rh positive); those who lack Rh antigens are designated Rh- (Rh negative)

17. Summary of ABO Blood Group Interactions BLOOD TYPE CHARACTERISTIC A B AB O Agglutinogen A B Both A Neither A ( antigen) on and B nor B RBCs Agglutinin anti-B anti-A Neither Both anti-A ( antibody) in anti-A and anti-B plasma nor anti-B Compatible A, O B, O A, B, AB, O O donor blood types ( no hemolysis ) I ncompatible B, AB A, AB — A, B, AB donor blood types ( hemolysis )

18. ABO incompatibility between a mother and her fetus. Development of hemolytic disease of the newborn (HDN). (a) At birth, a small quantity of fetal blood usually leaks across the placenta into the maternal bloodstream. A problem can arise when the mother is Rh- and the baby is Rh+, having inherited an allele for one of the Rh antigens from the father .

19. (b) Upon exposure to Rh antigen, the mother’s immune system responds by making anti-Rh antibodies. ( c) During a subsequent pregnancy, the maternal antibodies cross the placenta into the fetal blood. If the second fetus is Rh+, the ensuing antigen–antibody reaction causes agglutination and hemolysis of fetal RBCs.

20. CARE BEFORE TRANSFUSION Obtain written consent. Inform the client the reason for transfusion and obtain history of any transfusions. Note allergic reactions. If occurred, note type of the reactions Increased number of pregnancies increase chances of allergic reaction.

21. MANAGEMEN CONT.T Instruct the patient to report any side effects of blood transfusion when it begins. These include chills, fever respiratory distress, lower back pain or dizziness. Obtain the signed consent form and Obtain the clients baseline vital signs. Before transfusion, check that the blood pack details match with the client’s name and blood group.

22. Management cont. Check expiry date on the blood pack. Two nurses confirm the blood pack details with client’s records Reassure patient blood is safe as it is tested with the patient’s own blood to reduce the likelihood of untoward reactions.

23. CARE DURING TRANSFUSION Monitor the condition of the patient while blood transfusion is running for reactions. Record vital signs 1/4hrly for the first hour of transfusion and increase the interval. Check the rate of flow of blood and observe the site of the infusion for infiltration. Observe for urine output, if urine is less than 30ml/hr.

24. Care cont. If a transfusion reaction is suspected, transfusion must be stopped immediately and medical officer should be notified. Assess the patient thoroughly because many complications have similar signs and symptoms. The following should be done in case of a transfusion reaction is suspected

25. Care cont. Assess patient carefully, Do vital signs with those of the baseline assessment Keep vein open with normal saline 0.9% Notify the lab that a suspected transfusion reaction has occurred send blood and urine samples. Send remaining blood unit and tubing to the lab.

26. Care cont. If a haemolytic transfusion reaction or bacterial infection is suspected, do the following: (a) Obtain the blood from the patient. (b) Collect urine sample as soon as possible for haemoglobin determination. (c) Document the reaction

27. COMPLICATIONS Haemolytic reactions (Incompatibility reaction) . This occurs immediately after blood transfusion. The signs and symptoms are shivering, arise temperature, oliguria and hypotension ,may progress to shock and renal failure. .

28. Complication mgt MANAGEMENT   (a) Monitor blood pressure (b) Treat shock as indicated by the patient condition using intravenous infusions, oxygen, adrenaline and diuretic (c) Obtain post transfusion reaction blood sample Urine specimen for evaluation

29. Mgt of complications cont. (d) Observe the signs of haemorrhage due to disseminated intravascular coagulation PREVENTION ( i ) Before, blood transfusion, check donor’s and recipient’s blood types to ensure blood compatibility. identify patient with another nurse or doctor present transfuse blood slowly for 15minutes to 20 minutes.

30. Complications cont. Allergic reaction: Occurs due to sensitivity to foreign proteins in blood plasma. Symptoms range from mild reactions such as urticaria to severe ones such as dyspnoea or laryngeal oedema. Stop blood transfusion and inform medical officer. Adrenaline may be given in severe reactions and anti-histamines in mild reactions

31. Complications cont. PREVENTION Pre-medicate with the patient with anti-histamine. Observe the patient closely for the first 20minutes of blood transfusion

32. Febrile Reaction Fever may result from the introduction of contaminant with the blood. It occurs sometime after the blood transfusion has been started or even after it has been completed. Management The rate of flow is slowed and the doctor is informed

33. PREVENTION Pre-medicate with anti-histamine and antipyretic. Observe blood before blood transfusion for clots and colour . Infuse each unit of blood over 2-4hrs. Terminate the blood transfusion if the time exceeds 4hrs. Maintain Aseptic techniques during administration.

34. Circulatory overload Caused by infusion of blood at a rate too rapid for the size and cardiac status or condition of the recipient. The signs and symptoms include, cough, dyspnoea, pulmonary congestion, headache, tachycardia and distended neck veins. Management Place the patient in an upright position. Administer diuretics ( laxis 20mg) and oxygen

35. Delayed transfusion complications Delayed haemolytic reaction : Occurs after blood transfusion when the level of antibodies have been increased to the extent that a reaction can be mounted. Iron overload: his can occur in a client receiving more units of blood over a period of time such as client with sickle cell anaemia .

36. Complication cont. Citrate toxicity: may occur from expired blood. Potassium toxicity : This may leaky from the stored red blood cells to the blood stream. Diseases which can be transmitted from blood transfusion: Hepatitis B & C HIV which causes AIDS Syphilis.

37. Complications cont. Malaria Cytomegalovirus (CMV) Chagga,s disease, (American trypanosomiasis . Other complications which may arise during blood transfusion are difficulties in maintaining the flow of blood.

38. There are many reasons for a slow flow or stoppage of blood transfusion: Vein may go into spasms, warming the limb may help. The tubing may become kinked. The needle or tubing may become blocked by air. The apparatus should be disconnected from the needle. Blood should be allowed to through tubing freely before it is reconnected again.

39. Complications cont. The tubing may become blocked by a blood clot. The nurse may remove the clot from the tubing by attaching a syringe to the needle and sucking the clot into the syringe. The blood be allowed to flow freely through the tubing before it is reconnected later

40. CONCLUSION: We have now come to the end of our discussion on blood transfusion. we learnt that blood is very important fluid in our bodies as it transport oxygen to the tissues and from the tissues blood carries carbon dioxide to the lungs for excretion.

41. Conclusion cont. Haemorrhage and anaemia causes loss of blood which must be replaced via blood transfusion. Though blood transfusion is helpful, it has problems and complications which may arise. Hence the need for the nurses to be vigilant in order to avert problems relating to blood transfusion.

42. Synthetic colloid solutions Examples of solutions that may be administered as a substitute of blood. GELATINS ( Haemacel , Gelofusine ) DEXTRAN 60 and DEXTRAN 70 HYDROXYETHYL STARCH ( Hetastarch or HES ).

43. Infection risk Nil Indications: Replacement of blood volume Prophylaxis of postoperative venous thrombosis Precautions: Coagulation defects may occur. Platelet aggregation inhibited. Some preparations may interfere with compatibility testing of blood.

44. Contraindications : Do not use in patients with pre-existing disorders of haemostasis and coagulation. Side-effects : Minor allergic reactions Transient increase in bleeding time may occur. Hypersensitivity reactions may occur including, rarely , severe anaphylactic reactions.

45. References Waugh A & Grant, A Anatomy & Physiology in health and illness (2008) 10 th edition,Churchhill Livingstone,Elsevier . SmeltzSer SC & Bare, Medical-Surgical Nursing (2000) 7 th edition,J.B . Lippincott company. Berkow R & Beers , MK Manual Merck (1997) 4 th edition Merck &Co Inc.