2. Presentation Outline
Definition
Purpose of blood transfusion
Blood groups
Selection of blood donors
Routine tests before transfusion
Blood components/ products
Nursing considerations during blood transfusion
Transfusion reactions
3. Introduction
Intravenous fluids can replace fluid volume, but they do
not restore oxygen-carrying capacity or replace clotting
factors
When red or white blood cells, platelets, or blood
proteins are lost because of haemorrhage or disease, it
may be necessary to replace these components to
restore the blood’s ability to transport oxygen and
carbon dioxide, clot, fight infection, and keep
extracellular fluid within the intravascular compartment
4. Blood Transfusion Defined
A blood transfusion is the introduction of
whole blood or blood components into
venous circulation.
5. Purpose of blood transfusion
To restore blood volume or blood components lost
through trauma, surgery, or a disease process
To increase the number of Red Blood Cells (RBCs) and
maintain haemoglobin levels in patients with severe
anaemia
To provide selected cellular components as
replacement therapy (e.g., clotting factors, platelets,
albumin).
6. Blood groups
Human blood is classified into four main groups (A, B, AB, and O)
based on the presence or absence of certain antigens and antibodies.
The antigens are found in RBCs membranes while the plasma
contains antibodies against specific RBC antigens.
Blood group A, has A antigens on the surface of the red blood cells
(RBCs), and B antibodies in the plasma .
Blood group B has B antigens on the surface of the RBCs, and A
antibodies in the plasma
Blood group AB has A and B antigens on the surface of the RBCs and
no antibodies at all in the plasma.
Blood group O has neither A nor B antigens on the surface of the red
blood cells but has both A and B antibodies in the blood plasma
7. Blood groups (cont’d)
The antibodies are responsible for the rapid and severe
reaction that occurs when ABO-incompatible blood is
administered
Anti-A antibodies destroy A antigens, and Anti-B antibodies
destroy B antigens.
People with blood group O negative blood are often referred
to as universal donors because the O blood type has neither
A nor B antigens.
Likewise patients with AB positive blood are often referred to
as universal recipients because they lack antibodies
8. Blood groups (cont’d)
An additional antigen, known as Rhesus (Rh)
factor, is also important with blood typing.
If the antigen is present, the blood group is
referred to as Rh positive (Rh+). If it is absent, the
blood group is Rh negative (Rh–).
Thus, one can belong to one of the following
eight blood groups:
A Rh+ B Rh+ AB Rh+ O Rh+
A Rh– B Rh– AB Rh– O Rh–
10. Selection of Blood Donors
Criteria have been established to protect the donor from possible ill effects
of donation and to protect the recipient from exposure to diseases
transmitted through the blood.
Potential donors are eliminated by a history of hepatitis, HIV infection (or risk
factors for HIV infection e.g. people who engage in anal sex, people with
multiple sexual partners, IV/injection drug users, sexual partners of people at
risk for HIV, and people with haemophilia), heart disease, most cancers,
severe asthma, bleeding disorders, or seizures.
Donation may be deferred for people who have malaria, have been exposed
to malaria or hepatitis, are anaemic, have received blood in past 12 months,
whole blood donation within the past 56 days, have high or low BP, have low
body weight; <50kgs, young or very old (donors to be between 17-65 years),
or who are pregnant, have had recent surgery, or take certain medications
11. Selection of Blood Donors
All donors are expected to meet the following minimal
requirements:
Body weight should exceed 50 kg for a standard 450-mL
donation.
More than 17 years of age.
The oral temperature should not exceed 37.5 degrees Celsius
The pulse rate should be regular and between 60 and 100 bpm.
The systolic arterial blood pressure should be 90 to 180 mm Hg,
and the diastolic pressure should be 50 to 100 mm Hg.
The haemoglobin level should be at least 12.5 g/dL for women
and 13.5 g/dL for men.
12. Types of Donations
a) Directed Donation
This is where friends and family of a patient
donate blood for that person
b) Standard Donation
Done by usual blood donors
13. Types of Donations
c) Autologous Donation
This is where a patient’s own blood may be
collected for future transfusion.
This method is useful for many elective surgeries
where the potential need for transfusion is high
(e.g., orthopaedic surgery).
Preoperative donations are ideally collected 4 to 6
weeks before surgery
14. Types of Donations
d) Intraoperative Blood Salvage
This transfusion method provides replacement for
patients who cannot donate blood before surgery and
for those undergoing vascular, orthopaedic, or thoracic
surgery.
During a surgical procedure, blood lost into a sterile
cavity (e.g., hip joint) is suctioned into a cell-saver
machine.
The whole blood or PRBCs are washed, often with
saline solution; filtered; and then returned to the
patient as an IV infusion.
15. Types of Donations
e) Hemodilution
This transfusion method may be initiated before or after
induction of anaesthesia.
About 1 to 2 units of blood are removed from the patient
through a venous or arterial line and simultaneously replaced
with a colloid or crystalloid solution.
The blood obtained is then reinfused after surgery.
16. Routine tests
Once blood is donated, several tests are performed on
the sample:
ABO group (blood type) and Rh type
Screening tests : hepatitis B and C, HIV 1 and 2,
human T-lymphotropic viruses, and syphilis.
If all disease screens are negative, the blood is
acceptable for transfusion and is placed in the pool of
available products
17. Routine tests
Blood Typing and Cross matching
To avoid transfusing incompatible red blood cells, both blood donor
and recipient are typed and their blood crossmatched.
Blood typing is done to determine the ABO blood group and Rh factor
status.
Cross matching is done to identify possible interactions of minor
antigens with their corresponding antibodies.
RBCs from the donor blood are mixed with serum from the recipient; a
reagent is added, and the mixture is examined for visible
agglutination.
If agglutination does not occur, the risk of a transfusion reaction is
small
18. Blood Products
Whole blood
It contains all blood components
Mostly indicated for patients who need both RBCs and volume
replacement to reverse the effects of hypothermia, acidosis and
coagulopathy or after significant blood loss
Red blood cells
They are prepared from whole blood by removing the plasma.
Indicated where there is need to raise the client’s haematocrit
and haemoglobin while preventing fluid overload
RBCs are available for transfusion as packed RBCs (PRBCs).
19. Blood Products
Platelets
Consists of platelet concentrates and platelet rich plasma.
The major function is to help in blood clotting and haemostasis
Platelets are used to treat clients who have a shortage of platelets or have
abnormal platelet function
White blood cells (WBCs)
Administered to patients with a low or abnormal WBC count
It may be indicated for infections that are unresponsive to antibiotic therapy
Also given to patients with cancer who have low white cell counts due to
chemotherapy or the effects of cancer
20. Blood Products
Fresh frozen plasma (FFP)
It is a plasma protein rich in fibrinogen and blood clotting factor
VIII
FFP is administered to provide clotting factors to patients with
coagulation deficiencies who are bleeding or about to undergo
an invasive procedure
Albumin
It is a plasma protein contained within plasma
It is used to restore intravascular volume and maintain cardiac
output in patients with hypoproteinemia
21. Nursing considerations during blood transfusion
Special precautions are necessary when administering blood:
Blood to be collected in plastic bags (cooler) from the blood
bank just before starting the transfusion.
Do not store the blood in the refrigerator on the nursing unit;
lack of temperature control may damage the blood.
Once blood or a blood product is removed from the blood bank
refrigerator, it must be administered within a limited amount of
time (e.g., packed RBCs should not hang for more than 4 hours
after being removed from the blood bank refrigerator).
22. Nursing considerations during blood transfusion
With the exception of 0.9% sodium chloride, no drug or
medication should be added to blood or blood components
If an additional unit needs to be transfused, a new blood
administration set is to be used
Transfusion of blood or blood components is a nursing
procedure but usually requires an order from a doctor/ clinician.
Patient safety is a nursing priority and patient assessment,
verification of health care provider’s order, and verification of
correct blood products for the correct patient are imperative
23. Nursing considerations during blood transfusion
Perform a thorough patient assessment before initiating a
transfusion and monitor carefully during and after the
transfusion.
Pre-transfusion assessment includes establishing the following:
whether the patient knows the reason for the blood
transfusion
History of previous transfusion
History of transfusion reaction
Baseline vital signs 5-15 minutes before initiating the
infusion
Intravenous site is patency
24. Nursing considerations during blood transfusion
Before beginning a transfusion, explain the procedure and
instruct the patient to report any side effects (e.g., chills, dizziness,
or fever) once the transfusion begins
Ensure that he or she has signed an informed consent
Check the blood for any abnormalities e.g. clots
For patient safety always verify three things:
that blood components delivered are the ones that were
ordered;
that blood delivered to the patient is compatible with the
blood type listed in the medical record;
that the right patient receives the blood
25. Nursing considerations during blood transfusion
At least two nurses (check agency policy and procedures) must
verify the details of the blood against patients’.
If even a minor discrepancy exists, do not give the blood; notify
the blood bank immediately
When administering a transfusion use a bigger intravenous
catheter and blood administration tubing that has a special in-
line filter
Prime the tubing with 0.9% sodium chloride (normal saline) to
prevent haemolysis or breakdown of RBCs.
Initiate a transfusion slowly to allow for the early detection of a
transfusion reaction.
26. Nursing considerations during blood transfusion
Maintain the ordered infusion rate, monitor for side effects
assess vital signs, and promptly record all findings
Stay with the patient during the first 15 minutes, the time when
a reaction is most likely to occur.
After the initial time period, continue to monitor the patient and
obtain vital signs at least every 30 minutes through out the
transfusion.
If a transfusion reaction is anticipated or suspected, obtain vital
signs more frequently
A unit of RBCs is usually administered over 2-4 hours
Document observations in the medical record
27. Transfusion Reactions
A transfusion reaction is an immune system reaction to the
transfusion that ranges from a mild response to severe
anaphylactic shock or acute intravascular haemolysis, both of
which are life threatening.
There are different types of transfusion reactions :
a) Haemolytic reaction
b) Febrile reaction
c) Allergic reaction
d) Circulatory overload
e) Septic reaction
f) Transfusion-related acute lung injury (TRALI)
28. Transfusion Reactions
Haemolytic reaction
Can occur due to incompatibility between client’s blood and
donor’s blood.
It is the most serious of the acute complication, and it’s life
threatening
The haemolysis results in agglutination of RBCs, which then
obstructs the capillaries, disrupting the flow of blood and
oxygen to vital organs.
Clinical Signs
Facial flushing, fever, chills, headache, low back pain, tachycardia,
dyspnoea, hypotension and blood in urine
29. Transfusion Reactions
Haemolytic reaction (cont’d)
Nursing Intervention
Discontinue the transfusion immediately, discard the blood
tubing, and use new tubing for the normal saline infusion.
Maintain vascular access with normal saline, or according to
agency protocol.
Notify the primary care provider immediately.
Monitor patient closely: vital signs, fluid intake and output.
Treat shock
Send the remaining blood, bag, filter, tubing, a sample of the
client’s blood, and a urine sample to the laboratory.
30. Transfusion Reactions
Febrile reaction:
Can occur if the recipient is hypersensitive to antigens on cell components,
particularly the leukocytes
Clinical Signs
Fever and chills; and also; headache; malaise, anxiety; nausea, warm, flushed
skin
Nursing Intervention
1. Discontinue the transfusion immediately.
2. Keep the vein open with a normal saline infusion.
3. Notify the primary care provider and the blood bank
4. Monitor vital signs
5. Give antipyretics as ordered.
31. Transfusion Reactions
Allergic reaction (mild)
May occur due to recipients’ sensitivity to infused plasma
proteins
Clinical Signs
Flushing, urticarial (hives), with or without itching, wheezing
Nursing Intervention
1. Stop the transfusion immediately. Keep vein open with normal
saline.
2. Notify the primary care provider.
3. Administer medication (antihistamines, steroids) as ordered
32. Transfusion Reactions
Allergic reaction (severe):
May occur due to antibody–antigen reaction
Clinical Signs
Dyspnea, stridor, decreased oxygen saturation, chest pain, Flushing
Nursing Intervention
1. Stop the transfusion immediately.
2. Keep the vein open with a normal saline solution.
3. Notify the primary care provider immediately.
4. Monitor vital signs. Administer cardiopulmonary resuscitation if
needed.
5. Administer medications and/or oxygen as ordered.
33. Transfusion Reactions
Circulatory overload
May occur if blood is administered faster than the circulation
can accommodate
Clinical Signs
Dyspnoea, coughing, orthopnoea, crackles (rales), distended
neck veins, tachycardia
Nursing Intervention
1. Stop the transfusion immediately.
2. Place the client upright with feet dependent
3. Notify the primary care provider.
4. Administer diuretics and oxygen as ordered
34. Transfusion Reactions
Septic reactions
Can occur if bacteria have contaminated the blood components being
administered
Common in patients receiving platelets, because they are stored at room T
(20-24 degrees Celsius) for as long as 5 days
Clinical Signs
High fever, chills, vomiting, diarrhoea, hypotension, oliguria
Nursing Intervention
1. Stop the transfusion.
2. Keep the vein open with a normal saline infusion.
3. Notify the primary care provider.
4. Administer IV fluids, antibiotics.
5. Obtain a blood specimen from the client for culture.
6. Send the remaining blood and tubing to the laboratory.
35. Transfusion Reactions
Transfusion-related acute lung injury (TRALI)
Thought to occur when the donor plasma contains an antibody against the
patients leukocyte-specific antigen
Occurs more frequently following transfusion with plasma, particularly FFP
Clinical signs
It is suspected when symptoms of dyspnoea, hypotension and fever
develops within 30 minutes to 6 hours following a blood transfusion, and a
chest radiograph shows diffuse infiltrates
Also patient has new-onset symptoms of noncardiac pulmonary oedema,
tachycardia, and severe hypoxia
Management
Ventilatory support
Oxygen therapy
Fluid resuscitation
36. Transfusion Reactions: General Management
Guidelines
If there are signs or symptoms of transfusion reaction, stop the
transfusion immediately. Do not flush the tubing.
Disconnect the administration set from the intravenous catheter.
Call for help and prepare for emergency care.
Obtain vital signs, and auscultate heart and breath sounds.
Maintain patency of the intravenous catheter by hanging a new
infusion of normal saline solution, using new tubing.
Notify the primary care provider.
37. Transfusion Reactions: General Management
Guidelines
Remain with the patient, observing signs and
symptoms and monitoring vital signs as often as every
5 minutes.
Prepare to administer emergency drugs such as
antihistamines, vasopressors, fluids, and corticosteroids
per health care provider order or protocol.
Prepare to perform cardiopulmonary resuscitation.
38. Transfusion Reactions: General Management
Guidelines
Place the administration set and blood product container, with
the blood bank form attached, inside a biohazard bag and send
the bag to the blood bank immediately.
Obtain blood (in the extremity opposite the transfusion site) and
urine specimens according to institution’s policy.
39. Prevention of blood transfusion reactions
Administering the transfusion at a sufficiently slow rate
Transfusing packed red blood cells rather than whole blood for patients at risk
of circulatory overload
Administering diuretics such as furosemide before commencement of
transfusion for patients at risk of circulatory overload
Paying meticulous attention to detail in labeling blood samples and blood
components
Ensuring that the right patients receive the right blood
Maintaining aseptic technique during the transfusion process
Close monitoring of patients on blood transfusion for early detection and
prompt management
Administering the blood within a 4 hour period because warm temperature
promotes bacterial growth
40. References
Craven, RF. & Hirnle, C.J. & Henshaw C.M. (2017).
Fundamentals of nursing: Human health and function. (8th Ed).
Philadelphia: JB Lippincott Company
Kozier & Erb’s et al; (2016). Fundamentals of nursing: concepts,
process and practice (10th Ed). Harlow, Essex Pearson
Education Limited
Smeltzer et al., (2010). Brunner and Suddarth’s textbook of
Medical-Surgical Nursing (12th Ed) Wolters Klover/ Lippincot
Williams & Wilkins.
