blood admin

Main functions of blood

Transport oxygen, hormones, and nutrients; remove waste; regulate fluid, electrolytes, and acid-base balance; support clotting and infection prevention.

Indications for blood transfusions

Significant blood loss, symptomatic anemia, certain high-risk surgeries, and specific blood disorders.

Common causes of significant blood loss

Trauma, internal hemorrhage, postpartum hemorrhage, and gastrointestinal bleeding.

Surgeries with high risk of significant blood loss

Orthopedic surgeries and major obstetric procedures, including C-sections.

Indication for blood transfusion in sickle cell disease

Management of severe or symptomatic anemia and acute sickle cell complications.

Hemoglobin threshold commonly prompting consideration of blood transfusion

Below $7\,g/dL$ in many stable hospitalized adults; a threshold of $8\,g/dL$ may apply in selected populations.

Decision criteria for blood transfusion in low hemoglobin

Based on clinical symptoms, ongoing bleeding, overall patient condition, and prescribed protocol thresholds (not laboratory values alone).

Pre-transfusion therapies for specific anemias

Administration of iron, folic acid, or targeted treatment of the underlying cause.

Autologous blood transfusion

A procedure where a patient receives their own blood that was collected prior to a scheduled procedure.

Cell salvage

The intraoperative collection, filtration, processing, and reinfusion of blood lost by the patient during surgery.

Required equipment for intraoperative cell salvage

A specialized blood collection and processing unit incorporating filtration and centrifugation components.

Allogeneic blood transfusion

The administration of blood donated by one individual to a different recipient.

Mandatory confirmations prior to obtaining blood from the blood bank

Provider order, signed informed consent, required compatibility testing, baseline vital signs, prescribed premedications, and patent IV access.

Purpose of informed consent for blood administration

Ensures the patient understands the proposed therapy, benefits, and risks, and voluntarily agrees to the treatment.

Nursing action when a patient refuses blood products

Respect the patient's decision, discuss acceptable alternative treatments, and promptly notify the healthcare provider.

Purpose of type and crossmatch

Identifies blood type, screens for unexpected antibodies, and establishes recipient compatibility with specific donor red blood cells.

Baseline clinical assessment required prior to transfusion

A complete set of vital signs and a systematic assessment of the patient's baseline physical condition.

Common pre-transfusion medications

Acetaminophen or diphenhydramine when clinically indicated.

Indication for furosemide administration between blood units

Prevention or management of transfusion-associated circulatory overload in at-risk patients.

IV solution compatible with red blood cell transfusions

$0.9\%$ normal saline solution.

Components of standard Y-type blood administration tubing

Two tubing spikes, an in-line filter chamber, and line segments for blood product and compatible $0.9\%$ normal saline.

Proper method for priming Y-type blood tubing

Spike the normal saline container and flush/prime the entire line before opening or spiking the blood container.

Maximum units of blood administered through one tubing set

$2$ units (subject to specific facility policy).

Universal red blood cell donor type

O negative.

Universal red blood cell recipient type

AB positive.

Compatible RBC donor types for O negative recipients

O negative only.

Compatible RBC donor types for O positive recipients

O positive and O negative.

Compatible RBC donor types for A negative recipients

A negative and O negative.

Compatible RBC donor types for A positive recipients

A positive, A negative, O positive, and O negative.

Compatible RBC donor types for B negative recipients

B negative and O negative.

Compatible RBC donor types for B positive recipients

B positive, B negative, O positive, and O negative.

Compatible RBC donor types for AB negative recipients

AB negative, A negative, B negative, and O negative.

Compatible RBC donor types for AB positive recipients

All eight ABO/Rh red blood cell types.

Information verified during pre-transfusion two-nurse check

Patient identity, product name, blood type, compatibility status, unique unit identification number, expiration date, and product integrity.

Staff responsibility for initiating a transfusion

The Registered Nurse (RN) physically initiates the line; an LPN may serve as the second verifier if permitted by facility policy.

Timeframe to initiate transfusion after blood collection

Within $30$ minutes of release from the blood bank.

Duration of direct nursing observation at the start of a transfusion

At least the first $15$ minutes of administration.

Initial infusion rate for blood administration

Slow rate of approximately $50\text{-}75\,mL/hr$, titrated to the prescribed rate if no adverse reactions occur.

Maximum administration time for one unit of packed red blood cells (PRBCs)

$4$ hours.

Primary indication and volume of PRBCs

Restores oxygen-carrying capacity via RBC replacement; volume ranges from $250\text{-}400\,mL$.

Indication and infusion duration for platelet transfusions

Treats or prevents bleeding related to thrombocytopenia or functional platelet defects; infused over $20\text{-}60$ minutes.

Indication and infusion duration for Fresh Frozen Plasma (FFP)

Replaces multiple clotting factors in coagulopathy or active bleeding ($200\text{-}250\,mL$ volume); infused over $15\text{-}30$ minutes.

Indication for cryoprecipitate administration

Used for clinical conditions requiring replacement of fibrinogen or factor VIII/XIII/von Willebrand factor during severe bleeding.

Three common acute transfusion reactions

Febrile non-hemolytic, acute hemolytic, and allergic reactions.

Clinical manifestations of a febrile transfusion reaction

Fever, rigors/chills, headache, facial flushing, anxiety, and tachycardia.

Clinical manifestations of an allergic transfusion reaction

Pruritus, urticaria, flushing, and severe progression to wheezing, bronchospasm, or respiratory distress.

Mechanism and clinical manifestations of an acute hemolytic transfusion reaction

Caused by ABO incompatibility leading to immune destruction of donor RBCs; causes fever, chills, hypotension, back/flank pain, and hemoglobinuria.

Immediate priority nursing action for a suspected transfusion reaction

STOP the transfusion immediately.

Nursing actions immediately following the cessation of a transfusion reaction

Assess patient, maintain IV patency with fresh tubing and $0.9\%$ normal saline, and notify provider and blood bank.

First-line medication for transfusion-associated severe anaphylaxis

Intramuscular epinephrine.