Blood Transfusion

1. Blood Transfusion Sasha Alexis Rarang, MSN, CCM, RN

2. Initiating Blood Therapy • A blood transfusion is a safe, common procedure in which blood is given to you through an intravenous (IV) line in one of your blood vessels. • Blood transfusions are done to replace blood lost during surgery or due to a serious injury. • A transfusion also may be done if your body can't make blood properly because of an illness. • During a blood transfusion, a small needle is used to insert an IV line into one of your blood vessels. Through this line, you receive healthy blood. The procedure usually takes 1 to 4 hours, depending on how much blood you need.

3. Components of Blood • Blood is made up of various parts, including red blood cells, white blood cells, platelets (PLATE-lets), and plasma. Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts.

4. What Are the Risks of a Blood Transfusion? • Allergic Reactions • Viruses and Infectious Diseases • Fever • Iron Overload – at risk are people suffering from Thallasemia • Lung Injury • Acute Immune Hemolytic Reaction • Delayed Hemolytic Reaction • Graft-Versus-Host Disease

5. Blood Type • Every person has one of the following blood types: A, B, AB, or O. • Also, every person's blood is either Rh-positive or Rh-negative. So, if you have type A blood, it's either A positive or A negative. • The blood used in a transfusion must work with your blood type. If it doesn't, antibodies (proteins) in your blood attack the new blood and make you sick. • Type O blood is safe for almost everyone. About 40 percent of the population has type O blood. People who have this blood type are called universal donors. Type O blood is used for emergencies when there's no time to test a person's blood type. • People who have type AB blood are called universal recipients. This means they can get any type of blood. • If you have Rh-positive blood, you can get Rh-positive or Rh-negative blood. But if you have Rh-negative blood, you should only get Rh-negative blood. Rh-negative blood is used for emergencies when there's no time to test a person's Rh type.

6. Who Needs a Blood Transfusion? • A severe infection or liver disease that stops your body from properly making blood or some parts of blood. • An illness that causes anemia, such as kidney disease or cancer. Medicines or radiation used to treat a medical condition also can cause anemia. There are many types of anemia, including aplastic, hemolytic, iron-deficiency, and sickle cell anemias and thalassemia. • A bleeding disorder, such as hemophilia or thrombocytopenia.

7. Administering Blood Through a Y-Set Equipment • Blood Unit (Packed RBC’s) or that meets pt.’s needs. RBCs, Plasma, platelets. • 250 ml bag normal saline • Y-Set blood tubing with filter • Venipuncture supplies if client does not have established site. 18 or 19 gauge needle. • Needleless injection cap (if not in place). • Needleless cannula • Antimicrobial swabs • Tape • Clean Gloves. • IV pumps that is designed for the infusion of whole blood and RBC maybe used. These tubes require the use of special tubing and filter. Other types of pumps may cause hemolysis of RBCs.

8. Clinical Alert • In emergency situations, when time does not allow ABO determination, group O neg RBCs maybe given. • Always determine patency of the IV line prior to obtaining blood from the blood bank. • Never warm blood bag in hot water or microwave. Use only a blood warming device. Once blood is warmed, it must be used or disposed of as it can not be returned to the blood bank. Hemolysis occur at above 104 degrees F. • Most Clients can tolerate flow rate of one unit of packed cells in 1 ½ - 2 hours. • Blood must be hung within 30 minutes after taking it from blood bank. Usually only 1 unit of blood is dispensed at a time.

9. To Expect Before a Blood Transfusion • Before a blood transfusion, a technician tests client’s blood to find out what blood type she/he have (that is, A, B, AB, or O and Rh-positive or Rh-negative). • He or she pricks client’s finger with a needle to get a few drops of blood or draws blood from one of client’s veins. • The blood type used in client’s transfusion must work with client’s blood type. If it doesn't, antibodies (proteins) in client’s blood attack the new blood and make you sick. • Some people have allergic reactions even when the blood given does work with their own blood type. To prevent this, the doctor may prescribe a medicine to stop allergic reactions. • If client have allergies or have had an allergic reaction during a past transfusion, the doctor will make every effort to make sure you're safe. • Most people don't need to change their diets or activities before or after a blood transfusion. The doctor will let client know whether client need to make any lifestyle changes prior to the procedure.

10. Intravenous Solutions • Only isotonic saline (0.9%) is recommended for use with blood components. • Other isotonic electrolyte solutions that have been approved by the FDA for this purpose may be used. • Other commonly used intravenous solutions will cause varying degrees of difficulty when mixed with red cells. For example, 5% dextrose in water will hemolyze red cells. Intravenous solutions containing calcium, such as Lactated Ringer's solution, can cause clots to form in blood. • Prior to blood transfusion, completely flush incompatible intravenous solutions and drugs from the blood administration set with isotonic saline.

11. Blood Warmers • Blood warmers may be used as long as the device has a temperature alarm and visible temperature monitor. • Blood warming devices are most appropriate for massive and rapid blood replacement, such as exchange transfusion of the newborn.

12. Patient Instructions and Preparation • Blood Bank personnel will notify patient unit personnel (nurses) by telephone when ordered blood is ready for transfusion. • Informed Consent • Informed consent for blood transfusion is a process in which the patient is informed of the medical indications for the transfusion, the possible risks, the possible benefits, the alternatives, and the possible consequences of not receiving the transfusion. • Informed consent may be obtained by a physician, a nurse, or a physician extender who is knowledgeable about blood transfusion and the patient’s condition so as to be able to explain the elements of informed consent above. • The risks of transfusion, including adverse symptoms and alternatives to homologous (allogeneic) transfusion, must be discussed with the patient well before the transfusion. The booklet, "Blood Transfusion, Your Options" describing transfusion options are available from Moore. This booklet should be provided to patients as early as possible before transfusion. • The patient is then given a choice to accept or decline transfusion. Consent should be obtained sufficiently in advance of the transfusion that the patient can truly understand what is said and have sufficient time to make a choice. • Consent should be documented in the medical chart using the form "Consent to Receive Blood Transfusion" (available on-line or from Moore). • A single informed consent may cover many transfusions if they are part of a single course of treatment. • It may be advisable, though, to obtain a new consent when there is a significant change in the patient's care status, such as a transfer for care to another service, an inpatient admission, or an outpatient transfusion. • In emergency situations the physician ordering the transfusion must make a reasonable judgment that the patient would accept the transfusion. Transfusion should not be delayed in a life-threatening situation if it is likely that the patient would agree to transfusion. After the event, the circumstances of the transfusion decision should be documented in the medical chart.

13. Preparation and Procedure • Watch video