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Blood Transfusions

Blood Transfusions. By Emily and Jodie Learning Outcomes: Refresher on blood Compatibility Cross-matching Procedure of blood transfusion Adverse reactions. Components of Blood (refresher). Whole Blood - natural state, not used as often as constituent parts

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Blood Transfusions

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  1. Blood Transfusions • By Emily and Jodie • Learning Outcomes: • Refresher on blood • Compatibility • Cross-matching • Procedure of blood transfusion • Adverse reactions

  2. Components of Blood (refresher) • Whole Blood - natural state, not used as often as constituent parts • RBC’s - used to treat shock and anaemia (contain haemoglobin for 02 transportation) • WBC’s - used when depleted in a pt or if antibiotics are not fighting off an infection

  3. Components of Blood • Platelets - used if clotting of pt is impaired. Mainly used for leukaemia, post transplants and chemotherapy treatments. • Plasma - Fluid that carries blood cells, yellow in colour. Used after obstetric blood loss, during cardiac surgery and to reverse anti-coagulant therapy • Immunoglobulins - proteins made by WBC’s, antibodies which attack big or specific infections

  4. Components of Blood - extracted from Plasma • Albumin - protein used if someone has been severely shocked, burned or in hypovolaemic shock (contributes to blood viscosity, osmotic pressure and blood volume) • Clotting Factors - Factor VIII = haemophilia. Factor IX = Christmas disease • Processed plasma also helps to produce stronger antibodies against diseases such as tetanus, hepatitis, chicken pox and rabies

  5. Blood use information • Biggest use of blood is general surgery 23% • Followed by medical uses such as anaemia 15% • Cardiothoracic surgery 13% • A and E use 8% • ITU use 4%

  6. Compatibility

  7. Cross Matching • Compatibility test and antibody screening tests • Serological crossmatch - CT and AT • Indirect antiglobulin test - detects IgG, but filtered out • Antibody screening test - safety has improved (about 0.07% false -ve’s now)

  8. Cross Matching - Electronic Selection and Issue • Replaced Serological • Fully automated selection and labelling of blood • Safe as long as followed guidelines from BCSH (2000) • Carries out ABO and Rh gp, antiglobulin test, enzyme antibody screen. • Takes 5 mins of scientist’s time rather than Serological crossmatch = 20 mins

  9. Blood Transfusion • Inform the patient about the procedure • Document reason for transfusion • Take sample for pre transfusion testing • Label the tube at the patients bedside

  10. Blood unit The compatibility label on each unit should show: • Surname of the patient • First name • Date of birth • Gender

  11. Blood unit cont…… • Patient identification number • Location of patient • Patients ABO and Rh D group • Unique donation number • ABO and Rh D group of the unit • Time for which the blood is requested

  12. Pre procedure checks • Are the patients identification details identical? • Do these details match who the patient says he/she is? • Are the ABO and Rh D group and donation number all identical? • Do the details of the pack and form match any requirements?

  13. Transfusion Procedure • Before starting the transfusion record the blood pressure, pulse and temperature • Check pulse and temperature 15 minutes after starting each pack • Observe the patient throughout the transfusion

  14. Transfusion procedure cont….. • Repeat blood pressure, pulse and temperature when the transfusion is completed • An unconscious patient should have pulse and temperature checked at intervals during the transfusion

  15. Adverse reactions • It is very important to pay attention to any symptoms or signs – often occurring during the first 15 minutes of the infusion • Distress • Pain at or near the transfusion site • Loin pain

  16. Adverse reactions cont…. • Backache • Fever • Flushing • Urticaria A patient with a severe reaction can deteriorate rapidly, with hypotension, respiratory distress and collapse

  17. Adverse reactions cont….. • Acute haemolytic transfusion reaction • Infusion of the contents of a blood pack contaminated by bacteria • Transition-related acute lung injury (TRALI) • Fluid overload • Severe allergic reaction or anaphylaxis

  18. Scenario relation Some patients, e.g., those with blunt chest trauma, do not benefit from full restoration of blood volume and blood pressure before surgical control of bleeding. Bleeding and coagulation problems may be worsened by aggressive fluid resuscitation in these particular groups of patients.

  19. References • Atterbury, C. and Wilkinson, J. (2000) Blood transfusion. Nursing Standard 14(34) p47-52 • Department of Health (2001) Handbook of Transfusion Medicine: Blood Transfusion Services of the United Kingdom [online]. London: The Stationary Office. Available from: <http://www.transfusionguidelines.org.uk> [Accessed on 07/07/06]

  20. References cont…. • National Blood Service and NHS (2002) Hospitals and Science Website: Blood matters [online] Available at: <www.blood.co.uk/hospitals/library/bm.htm> [Accessed on: 6/7/06]

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