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Blood transfusion
- 1. Blood Transfusions MR.SURENDRA KUMAR Msc.Microbiology Faculty of IPHI
- 2. Overview What isa blood transfusion? Purpose Indications Blood products Nursing implications Administering a blood transfusion (skill)
- 3. What is aBlood Transfusion? Administration of blood or one of its components through an intravenous line (IV) Reaches patient’s blood vessels and enters the circulatory system
- 4. Purpose of aBlood Transfusion Restore blood volume Replace clotting factors Improve oxygen carrying capacity Restore blood elements that are depleted Prevent complications
- 5. Question What wouldindicate the need for a blood transfusion?
- 6. Lab Tests Lab TestNormal Results Why is this ordered? Type and crossmatch Based on ABO system Positive = incompatibility Negative = probable compatibility To determine the primary blood group, screen for antibodies and determine donor-recipient compatibility. Hbg (hemoglobin) Male 140-175 g/L Female 123-153 g/L Critical Value: Male <130 g/L Female <110 g/L Hbg carries oxygen in the blood. It can decrease due to blood loss. Hct (hematocrit) Male 41.5%-50.4% Female 25.9%-44.6% Critical Value: <18% or >54% Hct measures the proportion of blood volume occupied by RBCs. It decreases with blood loss and anemia. Platelet count 150,000-400000 cells/uL Critical Value: <50,000 cells/uL Platelets initiate the coagulation process. A decreased amount increases the risk for hemorrhage.
- 7. 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)
- 8. Packed Red BloodCells (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
- 9. 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
- 10. White Blood Cells(WBCs) Composition: - WBCs or leukocytes suspended in 20% of the plasma Purpose: - Increase number of WBC’s - Replaces WBC’s that are functioning abnormally Indications: - Sepsis (not responsive to antibiotics) - Persistent fever - Granulocytopenia
- 11. 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
- 12. Albumin Composition: - Albumin Purpose: - Volume expansion leading to increased blood volume Indications: - Hypoproteinemia - Burns - Shock - Trauma - Surgery - Infections
- 13. 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
- 14. Nursing Implications Con’t Beforetransfusion (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
- 15. Nursing Implications Con’t Duringthe transfusion: Monitor vital signs closely during the blood transfusion Inspect condition of IV site Observe for signs and symptoms of a reaction
- 16. Nursing Implications Con’t Afterthe transfusion: Dispose of materials/equipment Observe patient for clinical improvements Assess the laboratory values for effectiveness of transfusion
- 17. Documentation Verification procedure Type of blood Amount administered Vital signs Patient’s response to therapy
- 18. Mechanism Onset Signsand Symptoms ABO, Rh incompatibili ty 5-15 minutes following initiation of blood transfusion Increased temperature, increased heart rate, heat and pain surrounding vein, chills, headache, nausea, chest or back pain, chest tightness, dyspnea, bronchospasm, hypotension, anxiety, vascular collapse, hemoglobinemia, hemoglobinuria, disseminated intravascular coagulation Acute haemolytic reaction
- 19. Delayed haemolytic reaction Mechanism OnsetSigns and Symptoms Immune response against non- ABO donor antigens 2-14 days Fever, decrease in Hgb/Hct, increased bilirubin levels, jaundice
- 20. Febrile, nonhaemolytic reaction Mechanism OnsetSigns and Symptoms Sensitivity to leukocytes or platelets in donor’s blood 30 minutes after initiation to 6 hours after completion of transfusion Fever, flushing, chills, headache, muscle pain
- 21. Allergic reaction Mechanism OnsetSigns and Symptoms Allergy to a plasma protein or antigen in donor’s blood 5-15 minutes following initiation of blood transfusion, up to 1 hour after Local erythema, gives, urticaria, pruritus, coughing, nausea, vomiting, respiratory distress, wheezing, hypotension, loss of consciousness, cardiac arrest
- 22. Graft-versus-host disease Mechanism OnsetSigns and Symptoms Attack of transfused lymphocytes on host lymphocytes Days to weeks Skin rash, fever, jaundice, liver dysfunction, bone marrow suppression
- 23. Circulatory overload Mechanism OnsetSigns and Symptoms Transfused at an excessive volume or rate Any time during or within 1-2 hours after transfusion Dyspnea, cough, crackles, tachypnea, headache, hypertension, tachycardia, increased central venous pressure, distended neck veins
- 24. Sepsis Mechanism Onset Signsand Symptoms Bacterial contaminatio n During transfusion to 2 hours after transfusion Fever, chills, abdominal cramping, vomiting, diarrhea, hypotension
- 25. Lab Tests Lab TestNormal Results Why is this ordered? Antiglobulin (DAT) Negative Direct use is for post transfusion work-up to detect RBC incompatibility. Positive result = hemolytic transfusion reaction. Bilirubin Indirect: 0.1-1.0 mg/dL An elevated indirect value may indicate ABO incompatibility. Urinary Hemosiderin Negative Used to measure hemoglobin in urine resulting from intravascular hemolysis. Positive reaction = blood transfusion reaction. CBC (Complete Blood Count) WBC 4.8-10.8 x10 9/L RBC 4.2-5.4x10 12/L HGB 120-160G/L HCT 0.370-0.470 MCV 78-98 FL MCH 25-24 PG MCHC 320-360 G/L RDW 0.110-0.150 Platelets 130-400 x10 MPV 7.0-11.0 FL Lymphocyte 0.15-0.41 x10 Neutrophil 0.6-0.7 x10 Monocyte 0.06-0.41 x10 Esoinophil 0-0.04 x10 Basophil 0-0.2 x10 Luc 0-0.4 x10 9/L To assess cellular characteristics of blood cells in response to transfusion i.e. ABO compatibility through WBC.
- 26. Nursing Implications ina 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