BLOOD TRANSFUSION REACTION.pptx

A LECTURE NOTE ON BLOOD TRANSFUSION REACTION FOR ADVANCED NURSING STUDENT

1. BLOOD TRANSFUSION ADVANCED NURSING RM GERVASE FANG-IB (RN, BSC.NP)

2. Learning objectives By the end of this discussion, the student midwife will be able to; Identify the various blood groups Describe the precautions to take during blood transfusion Demonstrate skills in preparing for, setting up and monitoring blood transfusion Discuss strategies to manage transfusion reaction

3. KEY TERMS Auto/autologous Homologous/allogenic Antigens/agglutinogens Antibody/agglutinin Blood group Rhesus factor typing Cross-matching Transfusion reactions Incompatibility/compatibility etc

4. Pre-test Which blood type is known as the “universal donor” a. A b. B c. AB d. O What is the average lifespan of an erythrocyte(red blood cell)? a. 30days b. 40days c. 90days d. 120days When drawing blood, the client tells the nurse that she is a universal recipient. The nurse knows this to mean that the patient has which type of blood. a. O- b. AB- c. AB+ d. A+

5. Introduction Blood transfusion is an effective and potentially life-saving treatment for many patients. Using blood and blood components is a common therapeutic procedure in hospitals. However, the practice of blood transfusion has been found to be associated with some risks, like infections and transfusion reactions. Nurses and midwives on the front line of patient care, must therefore be adept at administering blood products safely and managing adverse reactions with speed and confidence.

6. Introduction Blood transfusion is the introduction of whole blood or component of the blood, e.g. plasma or erythrocytes into venous circulation. Blood transfusion is an important procedure and it is dangerous and can be life threatening to overlook any aspects of the procedure.

7. Classification of Blood Transfusion Blood transfusion can be broadly classified into two categories, namely; Auto Transfusion or Autologous Blood Transfusion . It is the collection, sieving and re-infusion of patient’s own blood. In practice, this occurs when a client’s for elective surgery are required to donate units of their own blood preoperatively for possible transfusion either during or after the surgery.

8. Ctd… 2. Homologous or Allergenic Blood Transfusion . This is the collection and infusion of compatible blood from another person to a patient

9. Purpose To restore blood volume after haemorrhage (hemoptysis, hematemesis, ante partum and postpartum hemorrhage, etc.). To maintain haemoglobin levels in severe anemia To replace specific blood component such as blood proteins and clotting factors During exchange transfusion, transfusion seeks to replace blood with hemolytic agents with fresh blood.

10. Overview of Blood Grouping Human blood is classified in to four main groups; Type A Type B Type AB Type O Antigens, type A and Type B, commonly cause antibody reaction and are called agglutinogen

11. Ctd… Thus, group: A blood contain type A agglutinogen, B blood contain type B agglutinogen, AB contain both A & B agglutinogens, O blood contain neither agglutinogen

12. Ctd… 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.

13. Ctd… Thus, 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

14. Ctd… 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 haemolytic reaction.

15. BLOOD GROUP NAME OF BLOOD ANTIGEN PRESENT ANTIBODIES PRESENT Type O Nil Anti A and Anti B Type A A antigen Anti B Type B B antigen Anti A Type AB A and B antigen Nil

16. BLOOD GROUP AND COMPATIBILITY BLOOD TYPE GIVES RECEIVES A+ A+, B+ A+, A-, O+, O- O+ O+, A+, B+, AB+ O+, O- B+ B+, AB+ B+, B-, O+, O- AB+ AB+ EVERYONE A- A+, A-, AB+, AB- A-, O- O- EVERYONE O- B- B+, B-, AB+, AB- B-, O- AB- AB+, AB- AB-, O-, B-, O-

17. Transfusion of Blood and Blood Components Whole blood or specific components of blood may be prescribed for patients depending on their specific needs. Whole blood contains all the components of blood, i.e. Plasma, RBCs, WBCs, and Platelets

18. COMPONENTS OF BLOOD RBCs, and Platelets Plasma Platelet Granulocytes are a type of white blood cells

19. NURSES RESPONSIBILITIES PRIOR TO BLOOD TRANSFUSION The midwife handling the transfusion has several responsibilities to ensure that the procedure is performed correctly and to ensure the patient's safety and health. Verify that a physician’s order exists from patient’s folder for the specific blood or blood product to be transfused, appropriate date, time, and duration for transfusion, and pre-transfusion or post transfusion medications to be given.

20. Ctd… Safe transfusion practice starts with accurate collection of pre-transfusion blood samples for typing and cross-matching. Conduct a thorough physical assessment of the patient (including vital signs) to help identify later changes, and document findings Confirm that the patient has given informed consent

21. Ctd… Teach the patient about the procedures associated risks and benefits, what to expect during the transfusion, signs and symptoms of a reaction, and when and how to call for assistance Check for an appropriate and patent vascular access. Make sure necessary equipment is at hand for administering the blood product and managing a reaction, such as an additional free I.V. line for normal saline solution, oxygen, suction etc

22. Ctd… Must be familiar with the specific product to be transfused, the appropriate administration rate, and required patient monitoring. They should be mindful of the fact that the type of blood product and patient’s condition usually dictates the infusion rate. For example, blood must be infused faster in a trauma victim who's rapidly losing blood than in a 75-year-old patient with heart failure, who may not be able to tolerate rapid infusion

23. Ctd…. Know what personnel will be available in the event of a reaction, and how to contact them. Resources should include the on-call physician and a blood bank representative. Before hanging the blood product, the nurse must thoroughly double-check the patient’s identification and verify the actual product. Check the unit to be transfused against patient identifiers, per facility policy.

24. Ctd… Ensure that air is never introduced into the blood component container or into the administration set, because of risk of air embolism. The midwife is responsible for ensuring that the right unit of blood is to be administered to the right patient after grouping and cross-matching by the lab. This is done by checking the lot/batch, serial numbers, blood type, and expiration date with another midwife or qualified lab personnel. Then the unit of blood must be checked off with another midwife before administration.

25. Ctd… Symptoms for adverse reactions include ; breathing problems, chills fever itching/hives rash nausea apprehensive feelings, tingling or numbness, heat pain or swelling at the site where the IV is inserted lower back pain

26. TRANSFUSION REACTIONS Blood transfusion reactions typically occur when the recipient’s immune system launches a response against blood cells or other components of the transfused product. These reactions may occur within the first few minutes of transfusion (classified as an acute reaction ) OR may develop hours to days later ( delayed reaction ).

27. Ctd… Signs of an acute reaction include; sudden chills or fever low back pain drop in blood pressure nausea flushing agitation or respiratory disorders. Signs of less severe allergic reaction include; hives and itching but no fever

28. Note If red blood cells are destroyed, the reaction may be classified further as haemolytic reaction All other types of reactions are broadly classified as non-haemolytic. Some reactions result from infectious, chemical, or physical forces or from human error during blood-product preparation.

29. DETECTING AND MANAGING TRANSFUSION REACTIONS (GENERAL NURSING MANAGEMENT) During the transfusion, nurses must stay alert for signs and symptoms of a reaction, such as fever or chills, flank pain, vital sign changes, nausea, headache, and dyspnea . Optimal management of reactions begins with a standardized protocol for monitoring and documenting vital signs. As dictated by the transfusion guideline, nurses must obtain the patients vital signs before, during, and after the transfusion

30. Ctd… If a transfusion reaction is suspected, the following actions must be taken immediately; Identify/observe that patient is having transfusion reaction Stop the transfusion immediately. Maintain the intravenous line with normal saline solution through new intravenous tubing, administered at a slow rate

31. Ctd… Asses the patient carefully: check the vital signs, comparing with those from the base line assessment. Notify the ward manager/physician of the assessment findings and implement any order obtained. Intervene for signs and symptoms as appropriate :

32. Ctd… Administer prescribed medications Give oxygen as required to increase oxygen saturation Reassure and educate patient on the condition Re-check all labels and forms on the blood Confirm patient’s identity Monitor vital signs every 15 minutes till condition is stable

33. Ctd… Report any abnormality immediately to the ward manager and the doctor in charge Monitor patient very closely Notify the blood bank that a suspected transfusion reaction has occurred: Fill the blood transfusion reaction form/book Record the amount of blood transfused

34. Ctd… Send the remaining blood and tubing (attached giving set) to the blood bank for repeat typing and culture, the identifying tag and number are verified. Take patient’s blood and urine samples Carefully document transfusion-related incident/events according to facility policy; be sure to include the patient’s vital signs, other assessment findings, and nursing interventions/care given in the nurses’ notes

35. Ctd… Continue to monitor the patient’s vital signs till the condition is stable. If and when clinically necessary, resume the transfusion after obtaining a physician order.

36. DOCUMENTING & REPORTING COMPLICATIONS OF BLOOD TRANSFUSION Documenting and reporting complications of blood transfusion involve many aspects and interrelationships. Policies and procedures will vary from site to site. Where applicable, please find examples of the types of reporting that are required.

37. Responsibilities of Nursing Staff Midwives attending to patients who experience suspected transfusion complications should perform the following documentation and reporting functions: Report suspected reactions immediately to the attending physician and the blood bank personnel. Document the patient's signs and symptoms and implicated donor units and send them to the transfusion service/blood bank. Maintain records of the complication in the patient’s medical record, including the report of the investigation completed by the transfusion service.

38. EXAMPLES OF TRANSFUSION REACTIONS AND THEIR SPECIFIC INTERVENTIONS 1. CIRCULATORY OVERLOAD Circulatory overload begins within hours of transfusion. General symptoms include; headache, dry cough, crackles (rales), distended neck veins, chest pain, tachycardia, pulmonary oedema, and hypertension

39. Management Providing oxygen support and reducing plasma volume with diuretics (and phlebotomy if symptoms persist). Pulmonary edema should be promptly and aggressively treated and Infusion of colloid preparations, including plasma in cellular components, reduced to a minimum.

40. Nursing interventions Early recognition Stopping the transfusion and not transfusing further units Keeping the IV line open with saline Placing the patient in a sitting position Initiating early treatment based on symptoms under direction of a physician .

41. Prevention Of Circulatory Overload Prevention consists of transfusing at-risk patients slowly and with blood components in the most concentrated form. Except for replacement of acute, massive blood loss, infusion rates should ordinarily be no greater than 2 - 4 mL per kg body weight per hour, and for patients at known risk of hypervolemia, a rate no faster than 1 mL/kg/hr is advisable.

42. 2. ALLERGIC REACTION They are of two types: mild and severe. A. Mild Allergic Reaction : is as a result of sensitivity to infused plasma proteins. It is characterized by flushing, itching, urticaria, and bronchial wheezing. Nursing intervention Stop or slow the transfusion depending on facility protocol Notify the physician Administer medication (antihistamine) as ordered.

43. Ctd… B. Severe Allergic Reaction : is as a result of antigen-antibody reaction. It is characterized by dyspnoea, chest pain, circulatory collapse, and cardiac arrest Nursing intervention Stop the transfusion Keep the vein open with normal saline Notify the physician immediately Monitor vital signs. Administer cardiopulmonary resuscitation if needed. Administer medication and/or oxygen as ordered.

44. 3 . FEBRILE REACTION (pyrogenic reaction) Sensitivity of the client’s blood to white blood cells, platelets, or plasma proteins. It is characterized by; fever chills, warm flushed skin, headache, anxiety, and muscle pain

45. Nursing intervention Discontinue the transfusion immediately Give antipyretics as ordered Keep the vein open with normal saline Notify the physician Monitor vital signs

46. 4. HAEMOLYTIC REACTION This is as a result of incompatibility between client’s blood and donor’s blood. It is characterized by; fever, chills, backache, dyspnoea, cyanosis, chest pain, tachycardia, and hypotension .

47. Nursing intervention Discontinue the transfusion immediately. NOTE: when the transfusion is discontinued, the blood giving set must be removed as well. Use new tubing for the normal saline infusion. Keep the vein open with normal saline Recheck the blood to ensure patient is the right recipient Notify the lab of reaction Send the remaining blood, a sample of the client’s blood, and a urine sample to the laboratory.

48. Ctd… Notify the physician immediately Monitor vital signs. Monitor fluid intake and output Administer prescribed furosemide Documentation

49. COMPLICATIONS Incompatibility Allergy Pyrogenic reaction Circulating overload Transmission of infectious diseases Thrombophlebitis Citrate toxicity Pulmonary embolism (blockage of blood vessels in the lungs) Infiltration and haematoma (a swelling containing clotted blood)

50. CARE OF PATIENT FOR TRANSFUSION BEFORE PROCEDURE Explain procedure to the patient to win his cooperation Reassure client Provide privacy Allow client to empty bladder Prepare and sent trolley to patient bed side Make patient comfortable Check for patent line ensure all document are written on blood bag

51. DURING PROCEDURE Insect the needle/cannula in the vein with complete aseptically technique Keep needle in position with adhesive plaster Incase of difficult patient or children a splint or an arm board is needed which is securely placed with a proper bandage under the patient limb After transfusion or blood has set up regulate rate of flow as instructed by the physician Observe the patient frequently and inspect the bottle constantly If there is any chills or shivering or any other complication immediately stop the infusion and irrigate the tubing with infusion or sterile or N/S and inform the doctor

52. AFTER PROCEDURE Make patient comfortable after the procedure Discard trolley and collect all items to the treatment room Discard the used transfusion set Wash hand record and report finding

53. REFERENCE Bradbury M, Cruickshank J. P. (2000). Blood transfusion: crucial steps in maintaining safe practice. Br J Nurs 2000 Feb. 10-23;9(3):134-8. World Health Organization (2018). Clinical Transfusion Practice-Guidelines for medical Interns.

54. Thanks for your Attention DONATE BLOOD TO SAVE LIVES !