BLOOD TRANSFUSION : SHORT NOTES FOR NURSES

BLOOD TRANSFUSION

TYPES OF BLOOD COMPONENTS  

RBC

Used to replace erythrocytes.   one bag contain 250 or, 300,or 350ml.  Each units increases the HB by 1 gldl and Hematocrit by 2% to 3%.

Whole blood

 Rarely used.  Used to resolve hypovolemic shock resulting from hemorrhage.  Contain RBC,Plasma, and Plasma proteins.  Each unit contain 500 ml.

Platelets

  Platelets are used to treat thrombocytopenia and platelets dysfunctions.  Cross matching is not required but it usually done.  (Platelet concentrates contain few RBC only).  One unit of platelet may vary from 50 to 70 ml per unit to 200 to 400 ml/unit.  Platelets are administered immediately up on receipt form the blood bank and are given rapidly, usually over 15 to 30 minutes.  Evaluation of platelets count is done 18 to 24 hours after administration.





FFP (Fresh –Frozen plasma)

May be used to provide clotting factor or volume expansion.  It contain No Platelets.  It  is infused within 6 hours of thawing, while clotting factors are still viable, and is infused as rapidly as possible.  Rh compatibility and ABO compatibility are required for the transfusion of plasma.  A unit normally contains 200 to 250 ml.  Monitor coagulation study after administration for the assessment of effectiveness.

TYPES OF BLOOD DONATIONS

  Autologus  A

donation of the clients own blood.  It reduce the risk of diseases transmission and potential transfusion complication.  Not a option for a client with leukemia or bacteremia.  A donation can be made every 3 day if the hemoglobin remains at or above 11gldl.

 Blood Salvage

 It is an autologous donation that involves suctioning blood from body cavities,jointspaces, or other closed body sites.  Blood may need to be washed a special process that removes tissues debris before reinfusion.

  Designated donation

Occur when recipients select their own compatible donors.

 Nurses Responsibilities

  • Do not administer refrigerated blood product before warming, which may cause cardiac arrhythmia.
  • No solution other than NS should be added to blood components.  Medication are never added to blood transfusion.
  • Infusion of one unit should not exceed 4 hours to prevent septicemia.
  • The blood administration set should be changed ever 4 to 6 hourly.
  •  Always check the blood bag for the date of expiration.
  • Inspect the blood bag for leaks, abnormal color, clots, excessive air or bubbles.
  • Blood must be administred within 30 minut , from it is being received from blood bank.
  • Vital signs and Lung sound should be assessed before the transfusion and again after first 15 minuts, and every hour.
 While administering
  •  Maintain standard precaution.
  • Insert an IV and infuse normal saline.
  • Maintain at a keep vein open rate.
  • An 18 or 19 gauge IV needle will be needed to prevent damage of RBC.
  •   If history of adverse reaction admninster Benadryl and Tylenol before 30 minute orally.
  • Begin the transfusion slowly, if no reaction noted with in first 15 minuts the flow can be increased at prescribed rate.
  • Monitor for S/S of transfusion reaction fo 1st 15 minuts and nurse must stay with him admission of blood.
 If Reaction Occur
  • Stop the transfusion.
  • Remove the IV tubing.
  •   Keep the IV line open with NS.
  • Notify the physician and blood bank.
  • Return the blood bags, and tubing to the blood bank.
  • Do not leave the client alone.
  • Monitor for any life threatening symptoms .

Complication 

  1. Transfusion reaction

 Immediate transfusion reaction.  Delayed Transfusion reaction.

Signs and symptoms of Immediate transfusion reaction

Fever, chills,diaphoresis.  Muscle aches, back pain or chest pain.  Rashes,hives,itching, and swelling.  Rapid thread pulse.  Dyspnea,cough,wheezing or rales.  Pallor and cyanosis.  Apprehension.  Tingling and numbness.  Head ache,Nausea,Vomiting, abdominal cramping, and diarrhea.

Signs and symptoms in unconscious client

 Fever, weak pulse Tachycardia, or bradycardia.  Hypotension.  Visibile hemoglobinuria.  Oliguria or anuria.

Delayed Transfusion reactions symptoms 

Reaction can occur days to years after a transfusion.



 Signs and symptoms include

Feaver,Jaundice,Decreased Hematocrit.

  1. Circulatory overload

Caused by infusion of blood at a rate too rapid for the client to tolerate,

Signs and symptoms

Hypervolemia,Hypertension,Bounding Pulse, Tachycardia, rapid pulse,distended neck veins,Headache, Cough,dyspnea, chest pain, rales, and pulmonary edema.

Management

Slow the rate of infusion.  Place the patient in upright position with feet in dependent position.  Notify the physician.  Administer oxygen.  Administer diuretics, and morphin sulfate.  Monitor for dysarhythmias.  Phlebotomy to remove prescribed amount of blood.

  1. Septicemia

Occur with the transfusion of blood contaminated with microorganism.

Signs and symptoms

Rapid onset of fever with chills.  Vomiting,Diarrhea, Hypotension,Shock.

Management

Notify the physician,Obtain blood culture and sensitivity.  Administor Oxygen, IVF, Vasporessors, and steroids.

  1. Iron over load

can occur in a client receiving more than 100 units of blood over a period of time.

Signs and symptoms

Alted Hematological value,  Vomiting, diarrhea,hypotension.

Management

Monitor Iran level frequently.  Adminster Iron chealating agent IV or S/C   ex: Dexferal.

  1. Disease transmission  

The most common disease are HIV and HCV.

  1. Hypocalcemia and Citrate toxication

Citrate in transfused blood binds with Calcium and is excreted.  Monitor S.Calcicum before and after administration.  Monitor the signs and systems of Hypocalemia.  Slow the transfusion and notify the doctor.

  1. Hyperkalemia 

Stored blood liberates potassium through hemolysis.  The older the blood, the greater the risk of hyperkalemia.  Monitor S. Potassium before and after blood administration.  If high giver fresh blood only.  Slow the transfusion and notify the doctor if symptoms of hyperkelemia occur.
ONE OF THE BEST BOOK FOR STAFF NURSE EXAM PREPARATION

Nursing Consideration in administration of blood   

  • Check the compatibility.
  • Cross match is done with  donor and recipients blood.
  • Infusion controller and pumps may be used to administer blood product.
  • Always consult manufactures guidelines for the controller or pump.
  • Blood warmer may be used to prevent hypothermia,  and adverse the reaction when several units of blood are being administered.
  • Do  not warm blood product in a microwave or in hot water.
Client identity and Compatibility   
  • Two RN needs to check the physician order, The client’s identity, and ID band and number.
  • Verifying that the name and number, are identical to those on the blood component tag.

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