BLOOD TRANSFUSION

BLOOD TRANSFUSION – Purpose, Principle, Usual Timing, Factors Affecting, Types, General Instructions, Preliminary Assessment, Preparation, Procedure, Equipment and Post-Procedure Care

Blood transfusion is the transfusion of whole blood or its components, such as blood cells and plasma from one person (donor) to another person (recipient)

PURPOSE

• To replace blood volume and blood pressure during hemorrhage (hemoptysis, hematemesis, antepartum, and postpartum hemorrhage, operations, etc) trauma or burns
• To increase the O₂ carrying capacity or hemoglobin level in cases of severe anemia which are not corrected by the administrations of vitamins and iron therapy
• To provide antibodies and leukocytes (immune transfusions) to severally ill patients and persons having lowered immunity by giving blood or plasma taken from persons who has just recovered from the same disease deficiency
• To correct or treat defiance of plasma proteins clotting factors and hemophilic globulin, etc
• To combat infection in patients with leucopenia
• To replace the blood with hemolytic agents with fresh blood (exchange blood transfusions) as in case of erythroblastosis fetalis, hemolytic anemia, etc
• To improve the leukocyte count of blood as in agranulocytosis

GENERAL INSTRUCTIONS

• Blood should be fresh
• Donors should not have any history of jaundice, cancer, malaria, and hepatitis, tuberculosis, syphilis, AIDS, or any transmissible diseases
• Donor must be tested for AIDS. His grouping and cross matching should be done, and it should be compatible to the recipient’s blood. Any error in the labeling of blood can lead to serious consequences
• Blood must be stored at 1-6 degree F.
• Donors must have a normal temperature, pulse and blood pressure
• Use an appropriate, sterile, pyrogen-free transfusion set containing a fitter for administration of blood one filters will remove clots and lagers aggregates of leukocytes and platelets
• Use 18 gauge needles for infusion. It will prevent damage to the red cells and will provide adequate rate of flow
• Maintain TPR chart prior to blood transfusion to find on any complication
• Do not add any medications to be blood or administer through the same intravenous needle, because they may cause damage to the red cells
• Adjust the rate of flow to 5-10 ml per minute during first half an hour of transfusion to detect any complications as early as possible. Because signs usually appear during the first half an hour of the transfusion. The subsequent flow rate depends upon the condition of the patient and the need for rapid transfusion
• Check the expiration date on the blood bag, and observe for color
• The blood should be given at a slower rate if the patient is elderly suffering from heart and lung diseases, anemia, etc
• Whole blood and packed cells are administered cold. Avoid shaking the container, if needed the blood may be allowed to stand in the room temperature for 30-45 minutes, before administering to the patient

PREPARATION

• Collection of blood from the donor is done in the laboratory by the laboratory technicians
• All the articles used for the collection of blood should be sterile
• Each donor unit must be labeled in clear, readable letters
• The donor blood immediately after it is withdrawn should be placed in the refrigerator
• Stored blood shall be inspected daily
• The transportation of the blood in the hospital should be done within 30 minute
• Freezing, heating of the blood will destroy the blood cells
• When sending the recipient’s blood sample for grouping and cross matching, it must be carefully labeled at the bedside of the recipient with identification
• Care is to be taken to prevent introduction of air into the apparatus
• It is recommended to use 18 gauge needles for infusion, to prevent damage to the red cells of to provide an adequate rate of flow
• No medications, antibiotics, vitamins, calcium
• Rinse the infusion set with normal saline before starting the solution
• Before the administrations of blood, the vital signs should be recorded correctly
• Adjust the rate of flow to 5-10 ml per minute during the first 30 minutes of transfusion (raised complications)
• Whole blood and packed cells are administered cold; blood may be allowed to stand in the room temperature for 30 to 45 minutes before it is administered
• Once the blood is exposed to the atmosphere, it should be discarded
• Watch the patient carefully for the onset of any complication any reactions developed, it should be reported to the charge nurse and the physician immediately
• Keep the patient warm and comfortable with blankets (if necessary)
• Offer bed part before the procedure
• Record in the nurse’s record with date and time (amount of blood administered, group, rate of flow, any reactions seen, any medications)

PROCEDURE

• Explain the procedure to the patient and his relatives to get cooperation
• Make him comfortable
• Take the equipment to the bedside
• Needle or casual should be inserted in the vein with complete aseptic technique
• Keep the needle in position with adhesive tape
• In small children, or in case of difficult patient splint must be used. It should be securely placed bandage
• Regulate the rate of flow from 40-45 drops per minute or according to physicians order
• Observe the patient constantly inspect the bottle frequently, if chill or shivering any other occurs at the time of infusion, stop it immediately and irrigate the tubing with sterile fluid and inform it to the physician

AFTER CARE OF PATIENT

• After the infusions have been started, the nurse should see that it is secured carefully by using the arm board, bandages, adhesive plaster, etc
• The movement of the patient in bed should not dislodge the IV cannula
• The cut down site is inspected frequently to detect infiltration of fluid the dislodgement of the cannula, etc
• The incision site should be cleaned and dressed daily to help in the healing of the wound
• After a week, the sutures are removed

COMPLICATIONS

• Incompatibility: when the donor’s blood is not compatible with the recipient’s blood, it is known as hemolytic reactions. In a hemolytic reaction, there is clumping of the erythrocytes which blocks the capillaries. It causes the erythrocyte to disintegrate and release hemoglobin into the blood. It eventually gets into the kidney tubules. Their blockage produces kidney failure. The symptoms of hemolytic reaction are chills, fever, and headache of back pain, then dyspnea, cyanosis, chest pain, and oliguria
• Pyrogenic reactions: it is due to the bacterial contamination of the blood or of the administration set. The symptoms are fever, shaking chills warm flushed skin, headache, black pain and nausea which progress on to hematemesis, diarrhea and delirium
• Allergic reactions: the patient may be sensitive to substances in the plasma. The symptoms are urticaria, occasional wheezing, joint, pains, generalized itching, nasal congestion, and circulatory collapse
• Circulatory overload: it is due to the rapid flow; also it may occur by giving whole blood to the severe chronic anemic patient, a patient with heart failure. The symptoms are bounding pulse, engorged peripheral veins, dyspnea,  cough slow the transfusion or step the transfusion and inform the doctor
• Transmission of infection diseases: if donors are not carefully screened for diseases like jaundice, syphilis, malaria, filarial and AIDS, he may get untoward reactions and he may suffer from above diseases