Blood Components and Blood Transfusions

Objectives for blood transfusion administration

Increase circulating blood volume after surgery, trauma, or hemorrhage; increase RBC number of RBC and maintaining hemoglobin levels in patients with severe anemia; provide selected cellular components as replacement therapy

Blood components

Red blood cells, white blood cells, platelets, fresh frozen plasma, whole blood

Red blood cells

Contain hemoglobin, transport oxygen to tissues and remove CO2 from tissues

White blood cells

Fight infection

Platelets

Clotting factors

Fresh frozen plasma

Yellow liquid portion of blood, 92% water and 8% proteins

Whole blood

Has all blood components

Autologous transfusion

Collection and reinfusion of a patients own blood

Homologous/allogenic transfusion

Receive blood from a donor

Steps before blood transfusion

Perform thorough assessment of pt, including baseline VS, discuss fears, reservations or opposition, educate on S/S to report, require signed informed consent from pt or POA before transfusion, toilet patient prior to transfusion and make them comfortable

Information to verify with another RN

Blood components ordered are the ones given, blood delivered to pt is compatible with blood type listed in medical record, right patient receives blood (6 rights), check patient id with blood slips and blood product assuring correctness

Before obtaining blood from blood bank

Have appropriate IV catheter size in place (Adults 18-20 gauge catheter.), appropriate filter Y-Tubing, prime tubing with 0.9% NS only

Initiating blood transfusion

Stay with patient for first 15 minutes, watch for any signs of reaction, repeat VS at 15 minutes after start of infusion, take periodic VS, do not stop transfusion once it begins except for reaction, do not hang blood longer than 4hrs

Blood transfusion reactions

Febrile reaction, mild allergic reaction, severe allergic reaction, hemolytic transfusion reaction

Febrile reaction signs and symptoms

Chills, fever, headache, flushing, tachycardia, increased anxiety

Mild allergic reaction signs and symptoms

Hives, pruritus, facial flushing

Severe allergic reaction signs and symptoms

Severe SOB, bronchospasm, anxiety

Hemolytic transfusion reaction signs and symptoms

Low back pain, hypotension, tachycardia, fever and chills, chest pain, tachypnea, hemoglobinuria, may have immediate onset

Blood transfusion reaction tips

Check doctor’s orders, check patient ID, check blood with another RN/doctor, follow institution policy, check patient history for compatibility, previous transfusions, or reactions, do patient education

Transfusion reaction initiation

Immediately stop the infusion, hang new IV tubing with NEW 0.9% NS, obtain VS and notify HCP immediately, monitor patient closely, stay with patient and monitor VS q5 minutes, prepare for potential code, obtain blood and urine sample as ordered, save blood, tubing, and fluids