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Blood Transfusion

The transfer of blood or blood components from one person (the donor) into the
bloodstream of another person (the recipient). This may be done as a lifesaving maneuver
to replace blood cells or blood products lost through bleeding. Transfusion of your own
blood (autologous) is the safest method but requires advance planning and not all patients
are eligible. Directed donor blood allows the patient to receive blood from known donors.
Volunteer donor blood is usually most readily available and, when properly tested has a
low incidence of adverse events. Blood conserving techniques are an important aspect of
limiting transfusion requirements.



A A ANTI-B 45%




WHOLE BLOOD Volume replacement and oxygen-carrying capacity;
usually used only in significant bleeding (.25% blood
volume lost)

Packed red blood cells Increases RBC mass.

(PRBCs) Symptomatic anemia: platelets in the units are not
functional; WBCs in the unit may cause reaction and are
not functional.

Platelets – random Bleeding due to severe decrease in platelets.

Prevent bleeding when platelets <5,000 – 10,000/mm
Survival decrease in the presence of fever, chills,
Repeated treatment → decreased survival due to

Platelets – single donor Used for repeated treatment: decreases alloimmunization

risk by limiting exposure to multiple donors.

Plasma (FFP) Bleeding in patients with coagulation factor deficiencies,


Granulocytes Severe neutropenia in selected patients; controversial.

Lymphocytes (WBCs) Stimulate graft-versus-disease effect.


Cryoprecipitate Von Willebrand’s disease

Hemophilia A

Antihemophilic factor Hemophilia A

Factor IX concentrate Hemophilia B (Christmas Disease)

Factor IX complex Hereditary VII, IX, X deficiency; Hemophilia A with

factor VII inhibitors.

Albumin Hypoproteinemia; burns; volume expansion by 5% to

increase blood volume; 25% → decrease hematocrit.

Intravenous gamma Hypogammaglobulinemia (in CLL, recurrent infections);

globulins (IgG) ITP; primary immunodeficiency states

Antithrombin III AT III deficiency with or at risk for thrombosis.

Concentrate (AT III)

Standard of care guidelines

When administering whole blood or blood components, unsure the following:

• Follow up on results of complete blood count and report to health care provider so
appropriate blood product can be ordered based on patient’s condition.
• Contact the blood bank with health care provider’s order and ensure timely
delivery of blood products.
• Establish a patent I.V. line with compatible I.V. fluid.
• Use appropriate administration setup, filter, warmer,, etc.
• Obtain baseline vital signs.
• Make sure proper blood product is given to the right patient.
• Transfuse at prescribed rate during prescribed time, as tolerated by patient.
• Observe for acute reactions – allergic, febrile, septic, hemolytic, air embolism,
and circulatory overload – by assessing vital signs, breath sounds, edema,
flushing, urticaria, vomiting, headache, back pain.
• Notify patient’s health care provider or available house officer if signs of reaction
or other abnormality arise.
• Be aware of delayed reactions and educate patient on risk and what to look for:
hemolytic, iron overload, graft-versus-host disease, hepatitis, and other infectious

Nursing Management before, during, and after blood transfusion:

Pretransfusion responsibilities:

Nursing actions during transfusion aim at prevention or early recognition of adverse

transfusion reactions. Preparation of the client for transfusion is imperative, and
institutional blood product administration procedures must be carefully followed. Before
administering any blood product, review the agency’s policies and procedures.

Legally, a physician’s prescription is needed to administer blood or its components. The

prescription specifies the type of component, the volume, and any special conditions the
physician judges to be important. Verify the prescription for accuracy and completeness.
In many hospitals a separate consent form must be obtained before a transfusion is

A blood specimen is obtained for crossmatching. The procedure and responsibility of

obtaining this specimen are specified by hospital policy. The laboratory requires at least
45 minutes to complete the crossmatching testing. In most hospitals a new crossmatching
specimen is required at least every 48 hours.

Blood components are viscous, requiring that a large needle (at least 20-gauge) be used,
whenever possible, for venous access, Both Y-tubing and straight tubing sets are used for
blood component infusion. A blood filter to remove sediment from the stored blood
products is included with blood administration sets and must be used to transfuse most
blood products. In massive transfusion, a microaggregate filter may be used.

Use normal saline solution as solution to administer with blood products. Ringers’
lactated and dextrose in water are not used for infusion with blood products because they
cause clotting or hemolysis of blood cells. Never add drugs to bleed products.

Before the transfusion is started, it is essential to determine that the blood component
delivered is correct and that identification of the client is correct. Check the physician’s
prescription simultaneously with another registered nurse to determine the client’s
identity and whether the hospital identification band name and number are identical to
those on the blood component tag. Checking the client’s room number is not an
applicable form of identification. Examine the blood bag label, the attached tag, and the
requisition slip to ensure that the ABO and Rh types are compatible. Check the expiration
date and inspect the product for discoloration, gas bubbles, or cloudiness, all indicators of
bacterial growth or hemolysis.


Before starting the transfusion, explain the procedure to the client. Take the vital signs,
including, temperature, immediately before starting the transfusion. Begin the infusion
slowly. Remain with the client for the first 15 to 30 minutes. Any severe reaction usually
occurs with infusion of the first 50 ml of blood. Ask the client to report unusual sensation
such as chills, shortness of breath, hives, or itching. Assess vital signs 15 minutes after
starting the transfusion to detect signs of a reaction. If there are none, the infusion rate
can be increased to transfuse 1 unit in about 2 hours(depending on the client’s cardiac
status). Take vital signs every hour throughout the transfusion or specified by agency
Blood components without large amounts or RBCs can be infused more quickly. The
identification checks are the same as for RBC transfusions. It may be necessary to infuse
blood products at a slower rate for older clients.


Before infusion:

1. Assess laboratory values. Many institutions have specific guidelines

for blood product transfusions.

2. Verify the medical prescription. Legally, a physician’s prescription is

required for transfusion. The order should
state the type of product, dose, and
transfusion time.

3. Assess the client’s vital signs, urine Determine whether the client can tolerate
output, skin color, and history of infusion. Baseline information may be
transfusion reaction. needed to help identify transfusion

4. Obtain venous access. Use a central The large-bore needle allows cells to flow
catheter or 19-gauge needle if more easily without occluding the lumen of
possible. the catheter.

5. Obtain blood products from a blood Once a blood product has been released
bank. Transfuse immediately. from the blood bank, the products should
be transfused as soon as possible.

6. With another registered nurse, Human error is the most common cause of
verify the client’s name and number ABO incompatibility reactions.
check blood compatibility, and note
expiration time.

During Transfusion:

7. Administer the blood product using Filters are needed to remove aggregates
the appropriate filtered tubing. and possible contaminants.

8. If the blood product needs to be Hemolysis occurs if any I.V. solution is

diluted, use only normal saline used.

9. Remain with the client for the first Hemolytic reactions occur more often
15 to 30 minutes of the infusion. within the first 50 mL of the infusion.

10. Infuse the blood product at the Fluid overload is potential complication of
prescribed rate. rapid infusion.

11. Monitor vital signs. Vital sign changes often indicate

transfusion reactions.

After Transfusion:

12. When the transfusion is completed, Blood borne pathogens may be spread
discontinue infusion and dispose of inadvertently through improper disposal.
the bag and tubing properly.

13. Document. The client record should indicate the type

of product infused, product number,
volume infused, time of infusion, and any
adverse reactions.