BLOOD TRANSFUSION BLOOD TRANSFUSION - PowerPoint Presentation

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BLOOD TRANSFUSION

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BLOOD TRANSFUSION

Infusion of

blood products

for the purpose of restoring circulating volume.Administration of blood and blood components requires knowledge of correct administration techniques and possible complications. A single unit of whole blood contains 450 mL of blood and 50 mL of an anticoagulant

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BLOOD TRANSFUSION

May be whole Blood or blood components

(

Platelets, Plasma , PRBC, Albumin )The procedure usually takes 1 to 4 hours, depending on how much blood is needed.A unit (bag) of red blood cells usually takes two to three hours to give. If needed, a unit can be given more rapidly – for example, to treat severe bleeding. A unit of platelets or plasma is given in 30 to 60 minutes.

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Blood Components

BLOOD

DESCRIPTION

INDICATION Leukocyte-free PRBC:

Most WBCs removed to reduce risk of reaction

Whole blood:

Most common blood product given in the hospital

shock, low blood volumes, low hematocrit and hemoglobin, hemorrhage

Packed RBCs:

Separated from plasma

Used to treat anemia, and reduce risk of volume overload

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BLOOD

DESCRIPTION

INDICATION

Fresh frozen plasma (FFP):

separated from whole blood by a centrifuge process

Used to restore plasma volume, treat some bleeding problems

Cryoprecipitate

thawing fresh frozen plasma and collecting the precipitate

contains high concentrations of factor VIII and fibrinogen

used in cases of

hypofibrinogenemia

, which most often occurs in the setting of massive hemorrhage or consumptive coagulopathy. PlateletsMaintain normal coagulability of bloodUsed to treat some bleeding disorders, and to compensate when marrow can not produce enough

Blood Components

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SOURCES OF

BLOOD

1. Autologous

transfusion - A patient’s own blood may be collected for future transfusion; elective surgeries where the potential need for transfusion is high (eg, orthopedic surgery). Preoperative donations are ideally collected 4 to 6 weeks before surgery. If the blood is not required, it can be frozen until the donor needs it in the future (for up to 10 years).

The

blood is never returned to the general donor supply of blood products to be used by someone else

.

Patients with cancer may donate for themselves.

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Advantages of Autologous Transfusion :

Prevention

of viral infections from another person’s

bloodsafe transfusion for patients with a history of transfusion reactionsprevention of alloimmunizationavoidance of complications in patients with alloantibodies.

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Contraindications

for Autologous Transfusion

acute

infection, severely debilitating chronic disease, hemoglobin level less than 11 g/dL,hematocrit less than 33%, unstable angina, Acute cardiovascular or cerebrovascular disease. A history of poorly controlled epilepsy may be considered a contraindication in some centers.

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SOURCES OF

BLOOD

2. allogenic

or homologous transfusion. - using another's blood.Blood is most commonly donated as whole blood intravenously and collecting it with an anticoagulant.Donors should be in good health and

without any

of the following:

history

of

urticaria

, or allergy to

medications,

receiving a blood transfusion or an infusion of any blood derivative , viral hepatitis, Malaria, syphilis, drug abuse, skin infection, asthma, possible exposure to HIV, at any time in the past, or a history of close contact with a hepatitis or dialysis patient within 6 months, Pregnancy within 6 months, history of tooth extraction or oral surgery within 72 hours, A history of exposure to infectious disease within the past 3 weeks, Recent immunizations , recent tattoo, Cancer, history of whole blood donation within the past 56 days

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Blood Donor’s Requirement

Body weight: more than 50

kg (110 pounds) for a standard 450-mL donation. Donors weighing less than 50 kg donate proportionately less blood.

17 years old and above Oral temperature not more than 37.5°C (99.6°F). Pulse rate: regular and between 50 - 100 beats per minute. Systolic arterial pressure:

90 to 180 mm Hg,

Diastolic

pressure

:

50 to 100 mm Hg.

The

hemoglobin level

: at least 12.5 g/dL for women and 13.5 g/dL for men.

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Blood Storage Life

BLOOD

Storage

STORAGE LIFE

PRBC

4°C

With special preservatives, they can be stored safely for up to 42 days

PLATELETS

ROOM TEMPERATURE

only 5 days ; platelets are gently agitated while stored

PLASMA

IMMEDIATELY FROZEN lasts for 1 year if it remains frozen; Plasma can be further pooled and processed into blood derivatives, such as albumin, immune globulin, factor VIII, and factor IX.

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Type and Crossmatch

Blood undergoes “type and

crossmatch

”: Typing to determine ABO and Rh factorCrossmatching to determine compatibility between donor and recipient bloodBlood Types: A, B, AB, OThe Rh factor is made up of numerous complex antigens

When it is present, the person is Rh positive (Rh+); if not present, the person is Rh negative (Rh–)

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Blood Typing

An Rh positive person may receive either – or + blood

An Rh negative person must receive only Rh– blood

If an Rh– person receives Rh+ blood, antibodies will formIf another transfusion of Rh+ blood is given, the antibodies will agglutinate with the Rh antigens of the blood being transfused

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Blood compatibilities

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Blood typing for transfusion

Universal donor= O-

Does not contain A, B, or Rh antigens

Universal recipients= AB+Blood contains A, B, and RH antigensUsually blood banks exactly match the pt blood

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Blood Screening

Prior to be being released for patient use

testing for:

Hepatitis CHuman immunodeficiency virus (HIV)

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Y-type blood tubing

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INDICATIONS OF BLOOD

TRANSFUSION

Severe

blood loss during major surgery, childbirth or a severe accident anemia that has failed to respond to other treatmentsinherited blood disorders, such as thalassaemia or sickle cell anaemiaAn illness that causes bleeding, such as a bleeding ulcer.An illness that destroys blood cells, such as hemolytic anemia or

thrombocytopenia

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Infusion Therapy Risks

Risk factors:

Disease transmission

Hepatitis B, Hepatitis C, Hepatitis A, HIV , Syphillis)Bacterial contaminationAcute or delayed transfusion reactions

Allergic reactions

Mismatched ABO

Incompatible Death

Circulatory overload

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Infusion Therapy Hazards

Some risks specific to massive transfusion (replacement of > one blood volume in 24 hours):

Hypothermia

HemodilutionPlatelet dysfunction Electrolyte problems

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ADMINISTRATION PROCESS

PRE TRANSFUSION PHYSICAL ASSESSMENT

Systematic

physical assessment and measurement of baseline vital signs Respiratory system: auscultation of the lungs, use of accessory muscles. Cardiac system: edema, other signs of cardiac failure (eg, jugular venous distention). Skin: Rashes, petechiae

, and

ecchymoses

.

EENT: sclera

should be examined for icterus.

ASSESS

Transfusion history

Previous transfusions, allergies and reactionsType of transfusion reaction, manifestations, and treatment

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Interventions

Once the blood has been taken from the blood bank, it must be administered within 30 minutes

Use 18 or 20 gauge IV cannula

Check vital signs prior to administrationUse BT Set for administration

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Interventions

The nurse must ensure:

Positive patient identification

Appropriateness of blood componentVerification of donor – recipient compatibilityBlood product

inspection (

checked

by 2 licensed nurses.

)

Verify product expiration date ,

name

, medical record number, type of blood, blood band id,

pt age

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administration of blood

Monitor for blood reactions, vital signs continuously during administration

For

first 15 minutes, run the transfusion slowly—no faster than 5 mL/min. If no adverse effects occur during the first 15 min, increase the flow rate unless the patient is at high risk for circulatory overload. Signs of adverse reaction: restlessness, hives, nausea, vomiting, torso or back pain, shortness of breath, flushing, hematuria, fever, or chills.

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Administration

time

does not exceed 4

hr because of the increased risk for bacterial proliferation. Be alert for signs of adverse reactions (Post Transfusion) circulatory overload, sepsis, febrile reaction, allergic reaction, and acute hemolytic reaction.Change blood tubing after every 2 units transfused, to decrease chance of bacterial contamination. A platelet count may be ordered 1 hr after platelet transfusion to facilitate this evaluation.

Administration of blood

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NURSING MANAGEMENT FOR TRANSFUSION REACTIONS

If

a transfusion reaction is suspected,

Stop the transfusion. Maintain the intravenous line with normal saline solution through new intravenous tubing, administered at a slow rate.Assess the patient carefully. Compare the vital signs with those from the baseline assessment. Assess the patient’s respiratory status carefully. Note

the presence of adventitious breath sounds, use of accessory muscles, extent of

dyspnea (if

any), and changes in mental status, including anxiety and confusion.

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NURSING MANAGEMENT FOR TRANSFUSION REACTIONS

Note

any chills, diaphoresis, complaints of back pain,

urticaria, and jugular vein distention.Notify the physician of the assessment findings, and implement any orders obtained. Continue to monitor the patient’s vital signs and respiratory, cardiovascular, and renal status.Notify the blood bank that a suspected transfusion reaction has occurred.

Send

the blood container and tubing to the blood bank for repeat typing and culture. The identifying tags and numbers are verified.

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Transfusion

Complications

Noninfectious

Complications (up to 1,000 times more likely than an infectious complication)Acute complications -

occur within minutes to 24 hours of the transfusion,

(

Acute hemolytic

reaction, Allergic reaction, Anaphylactic reaction,

TRANSFUSION-ASSOCIATED CIRCULATORY OVERLOAD

Delayed complications

-

may develop days, months, or even years later. (Delayed hemolytic reaction , Iron overload, Overtransfusion or undertransfusion Infectious Complications (Hepatitis B, C virus)