Blood Transfusion

The purpose of this module is to teach the clinical RN the basics of blood, how to administer a blood/blood component transfusion safely, and the hazards of transfusion related to blood administration. This module is indicated for teaching purposes based on the fact that the NHS requires at least quarterly review of blood usage, oversight of blood transfusion practices, documentation of blood transfusion errors, and evidence of corrective actions taken. Results of one study found that individuals lack of knowledge and training, along with inadequate policies and procedures, were the key elements in more than 350 blood transfusion-associated deaths (Bower amp; Craig, 1997) What is a Blood Transfusion? 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 is transfused either as whole blood (with all its parts) or, more often, as individual parts. The individual parts include red blood cells, platelets, clotting factors, and plasma. Each year, almost 5 million Americans amp; British need a blood transfusion. While most blood transfusions go well, mild complications can occur and serious problems may develop. The Individual Parts Defined Red Blood Cells -the most numerous blood cell, about 5,000,000 per microliter. Red blood cells make up about 40% of our total blood volume, a measure called the hematocrit. Their color is caused by hemoglobin, which accounts for nearly all of the red cell volume. Hemoglobin is the critical protein that transports oxygen from our lungs to the tissues. Red blood cells are normally shaped as round, biconcave discs. Red Blood Cells Image obtained from http://embryology. med. unsw. edu. au/Notes/heart20. htm) Platelets -the smallest of the three major types of blood cells, are only about 20% of the diameter of red blood cells and the normal platelet count is ~150,000-350,000 per microliter of blood. The principal function of platelets is to prevent bleeding. Platelets (Image obtained from http://ouhsc. edu/platelets/Platelets/platelets%20intro. html) Clotting Factors -proteins in the blood that control bleeding. Plasma -a pale yellow fluid that consists of about 92% water and 8% other substances, such as proteins, ions, nutrients, gases, and waste products. It is a colloidal solution which is a liquid containing suspended substances that do not settle out of solution. Most of the suspended substances are plasma proteins, which include albumins, globulins, and fibrinogen. Plasma volume remains relatively constant. Normally, water intake through the digestive tract closely matches water loss through the kidneys, lungs, digestive tract, and skin. Plasma (which is in the yellow) Image obtained from : http://www. mhhe. com/biosci/esp/2001_saladin/folder_structure/tr/m1/s2/ Brief History of Blood Transfusions 665 The first Blood transfusions of record take place. Animal experiments conducted by Richard Lower, an Oxford physician started as dog-to-dog experiments and proceeded to animal-to-human over the next two years. Dogs were kept alive by the transfusion of Blood from other dogs. 1795 In Philadelphia an American physician, Philip Syng Physick, performed the first known human Blood transfusion, although it was not published. 1818 James Blundell, a British obstetrician, performed the first successful transfusion of human Blood to a patient for the treatment of postpartum hemorrhage. Therefore, a group A individual can receive blood only from individuals of groups A or O (with A being preferable), and can donate blood to individuals with type A or AB. * Group B – has only the B antigen on red cells (and A antibody in the plasma). Therefore, a group B individual can receive blood only from individuals of groups B or O (with B being preferable), and can donate blood to individuals with type B or AB. * Group AB – has both A and B antigens on red cells (but neither A nor B antibody in the plasma). Therefore, an individual with type AB blood can receive blood from any group (with AB being preferable), but can donate blood only to another type AB individual. * Group O – has neither A nor B antigens on red cells (but both A and B antibody are in the plasma). Therefore, a group O individual can receive blood only from a group O individual, but can donate blood to individuals of any ABO blood group (i. e. A, B, O or AB). If anyone needs a blood transfusion in an extremely dire emergency, and if the time taken to process the recipients blood would cause a detrimental delay, O Negative blood can be issued. Blood Administration * Obtain Signed Consent for the administration of blood products * Check the Drs Order * Determine Clients Allergies and previous transfusion reactions (this can be assessed by simply asking the client if they have had a transfusion before and how they tolerated it) * Obtain baseline vitals and then per hospital/institution policy * Utilize #18 gauge needle * Check Crossmatch Record With 2 Nurses: * ABO- Group * RH Type * Clients Name, Date of Birth and Medical Number * Expiration Date * Administer Immediately- do not store the blood or leave it. If for any reason the blood/blood components are not to be hung, blood may be sent back to Blood Bank (check hospital policy and procedure as most institutions require that blood/blood products must be administered within 30 minutes upon receipt) * Do not warm the blood unless there is a risk of hypothermic response- Then Only by specific blood warming equipment * Never add any medications to blood products * Infuse each unit over 3-4 hours but no longer than 4 hours   Transfusion Reactions Occurs in the first 10-15 minutes or first 50 cc of Blood Reactions can be ALLERGIC, FEBRILE, or HEMOLYTIC (Utilize the Acronym AFH for memorization purposes)   ALLERGIC Signs and Symptoms include the following: * Facial flushing * Hives * Rash FEBRILE Signs and Symptoms include the following: * Fever * Chills * Anxiety * Headache * Tachycardia * Tachypnea HEMOLYTIC Signs and Symptoms include the following: * v Blood Pressure * Tachypnea * Fever * Chills * Apprehension * Headache * Tachycardia * Chest Pain or Lower Back Pain Recent Facts amp; Statistics Regarding Transfusions * Hemolytic transfusion reactions occur in 1 per 40,000 transfused units of packed RBCs. Nonhemolytic febrile reactions and minor allergic reactions are the most common transfusion reactions, each occurring in 3-4% of all transfusions. Nonhemolytic febrile reactions and extravascular hemolysis are observed more commonly in patients who have developed antibodies from prior transfusions. * Anaphylactic reactions occur in 1 per 20,000 transfused units. * Due to improved preventative measures, the incidence of GVH disease is less than 0. 15% * Transfusion-related acute lung injury complicates 0. 1-0. 2% of all transfusions. Risk of transfusion-related hepatitis B is 1 per 50,000 units transfused. Risk for hepatitis C is 1 per 3000-4000 units transfused. * Risk of transfusion-related HIV infection is 1 per 150,000 units transfused. (Kardon, 2009) What do you do if you suspect a Transfusion Reaction? STOP the transfusion immediately * Maintain the line with Normal Saline VERIFY patient identification * Hospital armband, Typenex band, and blood bag must be identical NOTIFY the patients physician STAT * Treat the signs per Drs order and Monitor Vitals * If requested by the physician, initiate transfusion reaction work up NOTIFY Blood Bank STAT Check the Policies/Procedures of the facility at which you are employed * You may have to bag the blood component, IV tubing, filters and all labels in a biohazard bag and it may have to be submitted/returned back to the laboratory as further testing of the components may be clinically warranted (It is a standard policy at Maricopa Medical Center that those components are submitted back to the lab as routine Microbiology cultures are performed to ensure the sterility of the blood) * Additional forms may be required to complete (i. . Transfusion Reaction Forms) * Further samples may be collected from the patient (i. e. Urine, blood samples, etc.