BLOOD TRANSFUSION

Definition
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).

1. Most donated red blood cells can be stored for Forty-two days. 2. Most donated platelets can be stored for Five days 3. Frozen plasma can be stored for One year.

Selection of Donor:
Should not be suffering from disease of heart, kidneys, liver, lungs, cancer, jaundice, tuberculosis, hepatitis, AIDS, allergies etc. Should not have donated blood within the previous 90 days. Should be healthy and in the age group of 18-65 years. Should not be pregnant. Should have Hb level above 12 gm%. Should have normal vital signs. Should not be empty stomach.

Procedure
Preparation of the recipient * * * * Explain the procedure to the patient, blood product which is to be given, approximate length of time and desired outcome of the transfusion. Determine whether the patient has undergone prior transfusion and reactions, if any. Get an informed consent from the patient/relation. Prior to administration of blood, the patient`s vital signs should be recorded correctly on the nurse`s record to provide a base line for further observation. 1

* * *

Ask the patient to report chills, headaches, itching, or rash immediately so that prompt reporting and discontinuation of transfusion can help in minimizing reactions.

Provide a comfortable position.

Preparation of articles: A tray containing

Articles

Rationale

A blood transfusion set. A mackintosh and towel. A tourniquet. Cotton swabs with antiseptic (iodine/ spirit) 18 gauge needle Adhesive tape and scissors Gloves A kidney tray, a paper bag IV stand Normal Saline. Blood or any of its components with cover received from the Blood Bank with the name of the recipient.

To transfuse blood. To protect the bed. To constrict the blood vessel To clean the site of infusion. To start IV line. To secure the tubings and needle. To prevent infection. To discard the waste. To hold the blood bottle. To start the blood transfusion line. To make sure that the blood sent from the Blood Bank is meant only for this particular patient. Avoid mistake in identification.

Performance of Procedure: Steps of Procedure Rationales

Check physician`s orders, patient`s condition, and history of Obtains specific data and initiates patient transfusion/ infusion reaction, reason for present transfusion etc. education if required. Identify patient. Check availability of blood with the blood bank. Explain the procedure to the patient, need for transfusion, blood product to be given, approximate length of time, desired outcome, etc. Emphasize the need for patient to report unusual symptoms immediately. Obtain informed consent from patient. Obtain blood from blood bank in accordance with agency policy. If transfusion cannot begin immediately, return product to blood bank. Blood which is out of refrigerator for more than 30 minutes, above degree centrigrade cannot above 10 degree centrigrade cannot be re-issued. Never store blood in unauthorized area-like ward refrigerator. Blood must be stored in refrigerator until at carefully controlled temperature. Encourage patient to empty bowel and bladder and assist to a comfortable position. Ensure privacy Faulty techniques in storing blood products can cause hemolysis. Provides reassurance and facilitates cooperation. Early identification of transfusion reactions aids in instituting prompt corrective measures. Prevents errors and thus eliminates possibility of transfusion reactions.

Ensures comfort of the patient. Urine specmen collected before transfusion if temperature is more than 101.8 degree farenhiet. Prevents cross infection.

Wash and dry hands. Check vital signs and record.

Reduces risk of infection. Obtains baseline data to compare with changes post transfusion. Delay transfusion if temperature is more than 101.8degree 3

Farenhiet. Reduces risk of infection.

If the patient has an IV infusion, check whether the needle and solution are appropriate to administer blood. The needle should be 18 gauge and the solution must be normal saline.

Large gauge needle permit infusion of whole blood. Normal saline prevents hemolysis.

Identify accessible veins. Select a large vein which allows the patient`s mobility. Open the sterile packing of the blood transfusion set aseptically. Insert the infusion set into the bag of blood to be transfused.

Prolonged restriction of arm movement is uncomfortable and inconvenient for the patient. Maintain sterility of the blood.

Check for any complications or allergic reactions.

Adjust rate to 2ml/mt for the first 15 minutes and remain with the patient. If any reaction is suspected, notify the blood bank and the physician. Monitor vital signs every five minutes for the first 15 minutes and every hour thereafter. Observe for flushing, itching, dyspnoea, or rash. Stop transfusion immediately, if any reaction is suspected.

Allows detection of reaction while infusing the smallest possible volume of the blood product. Any change in vital signs indicates an early sign of reaction.

After Care: Remove and dispose gloves, wash hands. Record administration of blood, date, time, blood group, any adverse reaction and the amount of blood infused. Reduces transmission of micro-organism. Documents administration of the blood components is necessary for accuracy in treatment and also for legal purposes.

Complications of Blood Transfusion: The complications can be broadly classified into two categories: * * Immune Complications Non-immune Complications

Immune Complications Immune complications can further be classified into two categories:
o o

Hemolytic (acute and delayed) Non-Hemolytic (includes febrile, urticarial, anaphylactic, purpura, etc.)

These are primarily due to the sensitization of the recipient to donor blood cells (either red or white), platelets or plasma proteins. Less commonly, the transfused cells or serum may mount an immune response against the recipient. The immune complications are easily classified into hemolytic and non-hemolytic reactions. Hemolytic reactions usually involve the destruction of transfused blood cells by the recipient's antibodies. Less commonly, the transfused antibodies can cause hemolysis of the recipient's blood cells. There are acute (also known as intravascular) hemolytic reactions and delayed (also known as extravascular) hemolytic reactions. Acute hemolytic reactions are usually due to ABO blood type incompatibility - in other words, human error plays a large part in these reactions. Blood given to the wrong patient has been attributed to physician error approximately 20% of the time, the operating room is the most common site of this error, and the anesthesiologist is the most commonly implicated physician. This type of reaction has been reported to occur approximately 1 in 25,000 transfusions - but it is often very severe and accounts for over 50% of reported deaths related to transfusion. The severity of the reaction often depends in the amount of blood given. Symptoms of acute hemolytic reactions include chills, fever, nausea, chest pain and flank pain in awake patients. In anesthetized patients, we should look for rise in temperature, unexplained tachycardia, hypotension, hemoglobinuria, oozing in the surgical field, DIC, shock and renal shutdown. Management of acute hemolytic reactions mandates that the transfusion be stopped immediately. The unit should be re-checked. Blood from the recipient patient should be drawn to test for hemoglobin in plasma, repeat compatibility testing and coagulation tests. A Foley catheter should be placed to check for hemoglobin in the urine. Osmotic diuresis with mannitol and fluids should be utilized (low-dose dopamine may help renal function and support blood pressure). With rapid blood loss, platelets and fresh frozen plasma may be indicated. Delayed hemolytic reactions are generally mild in comparison. These are caused by antibodies to non-D antigens of the Rh system or to foreign alleles in other systems such as the Kell, Duffy or Kidd antigens. Following a normal, compatible transfusion there is a 1-1.6% chance of developing antibodies to these foreign antibodies. This takes weeks or months to happen - and by that time, the original transfused cells have already been cleared. Re-exposure to the same foreign antigen can then cause an immune response. Thus the reaction is typically delayed from two to twenty-one days after transfusion. Symptoms are generally mild and include malaise, jaundice, fever, a fall in hematocrit despite transfusion, and an increase in unconjugated bilirubin. Diagnosis may be facilitated by the direct Coombs test which can detect the presence of antibodies on the membranes of red cells. Treatment is generally supportive. These reactions occur in approximately 1 in 2,500 transfusions and most often in females with previous exposure secondary to pregnancy. Non-Hemolytic reactions are due to sensitization of the recipient to donor white cells, platelets or plasma proteins. These reactions include:
o

Febrile 6