Module 10 - Blood Administration

Blood Transfusion

Refers to ‘whole blood’, but blood includes:

• Whole blood

• Pakced red blood cells (PRBC)

• Platelets

• Plasma (FFP)

• Albumin

• Different components used for various reasons

Blood Compatibilities

PRBC and Platelets

• O - universal donor

• AB - universal recipient

• A - only recieve A or O

• B - only receive B or O

Fresh-frozen Plasma

• O - universal recipient

• AB - universal donor

• A - only receive A or AB

• B - only receive B or AB

Rh Factor

An antigenic substance in the erythrocytes

Rh-positive patient has the factor, can receive Rh-positive or Rh-negative blood

Rh-negative patient does not have the factor, can only recieve Rh-negative blood

Before Transfusion

• Informed consent required unless life saving - obtained by MRP

• Assess cultural beliefs

• Baseline VS and lab values

Verification

Two nurses must check and sign transfusion request and blood bag at bedside

Inspect blood for clumping, clots, discolourations, particulate or foreign matter

Gently invert the unit of blood to mix cells

During Transfusion

Begin infusion within 30 minutes of obtaining blood

Monitor

• VS per protocol

• Patient response: chills, fever, dizziness, dyspnea

Observe for signs of infection

After Transfusion

Complete infusion within 4 hours

Dispose of bags and tubing in biohazard waste

Acute Hemolytic Reaction

Incompatibility between donor and recipient’s blood

Life-threatening emergency

• Fever - > 1°C from baseline, or > 38°C within 6 hours, or > 39°C at any time

• Hypotension

• Tachycardia

• Chills

• Dyspnea

• Hematuria

• Renal failure

• Difffuse hemorrhagic (DIC)

• Shock

Febrile Nonhemolytic Reaction

Antibodies against donor WBC

• Sudden shaking (rigors)

• Fever

• Headache

• Flushing

• Anxiety

• Muscle aches

Mild Allergic

Antibodies against donor plasma proteins

• Flushing

• Itching

• Urticaria (hives)

Anaphylactic

Antibodies to donor plasma, especially anti IgA

• Anxiety

• Urticaria (hives)

• Dyspnea

• Wheezing progressing to cyanosis

• Severe hypotension

• Circulatory shock

• Cardiac arrest

Circulatory Overload or TRALI

Blood administered faster than circulation can accomodate

• Dyspnea

• Cough

• Crackles or rales

• Rapid onset

• Hypoxemia

• Distended neck veins

Sepsis

Bacterial contamination of transfused blood components

• Rapid onset of chills

• High fever

• Severe hypotension

• Circulatory shock