Administration of blood
Blood transfusion refers to the introduction of whole blood or blood components (packed red cells, plasma,
platelets) directly into a client’s circulatory system.
Indications
to improve the oxygen-carrying capacity of the blood
to restore coagulation factor deficiencies
increase the number of circulating platelets
increase white blood cells to decrease the chance of infection
Types of Blood Components
1. Packed red blood cells (PRBCs)
Description:
-PBRCs are a blood product used to replace erythrocytes in conditions like anaemia, ; infusion time for 1 unit
between 2 and 4 hours.
-Each unit increases the hemoglobin level by 1 g/ dL (10 mmol/L) and hematocrit by 3% (0.03);
-The change in laboratory values takes 4 to 6 hours after completion of the blood transfusion.
-Evaluation of an effective response is based on the resolution of the symptoms of anemia and an increase in
the erythrocyte, hemoglobin, and hematocrit count.
2. Platelet transfusion
Description
-Platelets are used to treat thrombocytopenia and platelet dysfunctions.
- Crossmatching is not required but usually is done (platelet concentrates contain few red blood cells).
-Platelets are administered immediately upon receipt from the blood bank and are given rapidly, usually over
15 to 30 minutes.
-Evaluation of an effective response is based on improvement in the platelet count, and platelet counts
normally are evaluated 1 hour and 18 to 24 hours after the transfusion; for each unit of platelets administered,
an increase of 5000 to 10,000mm3 is expected.
3. Fresh-frozen plasma (FFP)
Description
-Fresh-frozen plasma may be used to provide clotting factors or volume expansion; it contains no platelets.
-Fresh-frozen plasma is infused within 2 hours of thawing, while clotting factors are still viable, and is infused
over a period of 15 to 30 minutes.
-Rh compatibility and ABO compatibility are required for the transfusion of plasma products.
-Evaluation of an effective response is assessed by monitoring coagulation studies, particularly the
prothrombin time and the partial thromboplastin time, and resolution of hypovolemia.
4. Cryoprecipitates
Description
-Cryoprecipitate is a plasma protein rich in fibrinogen and blood clotting factor VIII
-Prepared from fresh-frozen plasma, cryoprecipitates can be stored for 1 year. Once thawed, the product must
be used; 1 unit is administered over 15 to 30 minutes.
-Used to replace clotting factors, especially factor VIII and fibrinogen
-Evaluation of an effective response is assessed by monitoring coagulation studies and fibrinogen 158 levels.
5. Granulocytes
-May be used to treat a client with sepsis or a neutropenic client with an infection that is unresponsive to
antibiotics
-Evaluation of an effective response is assessed by monitoring the WBC and differential counts.
Types of Blood Donations
A. Autologous
1. A donation of the client’s own blood before a scheduled procedure is an autologous donation; it reduces the
risk of disease transmission and potential transfusion complications.
2. Autologous donation is not an option for a client with leukemia or bacteremia.
3. A donation can be made every 3 days as long as the hemoglobin remains within a safe range.
4. Donations should begin within 5 weeks of the transfusion date and end at least 3 days before the date of
transfusion.
B. Blood salvage
1. Blood salvage is an autologous donation that involves suctioning blood from body cavities, joint spaces, or
other closed body sites.
2. Blood may need to be “washed,” a special process that removes tissue debris before reinfusion.
C. Designated donor
1. Designated donation occurs when recipients select their own compatible donors.
2. Donation does not reduce the risk of contracting infections transmitted by the blood; however, recipients
feel more comfortable identifying their donors.
Summary of blood compatibility
Blood typing refers to identifying the client’s blood group. Cross matching is the process of ensuring that the
client’s blood group is compatible with the donor blood.
Characteristics Type A Type B Type AB Type O
RBC antigen A B AB none
Antibody Anti B Anti A None Anti A, Anti B
RBCs that can A, O B, O AB, O O
be received.
RBCs to donate A, AB B, AB AB O, A, B, AB
to
Nursing Responsibilities before, during and after blood transfusion
Explain the procedure to the client and determine whether the client has ever received a blood
transfusion or experienced any previous reactions to blood transfusions.
Check the client’s identity before administering a blood product.
Check the health care provider’s prescription,
Ensure client has an appropriate venous access site,
Ensure that cross-matching procedures have been completed
Check that informed consent has been obtained,
Ensure the correct client is receiving the correct type of blood.
No solution other than normal saline should be added to blood components.
The blood administration set should be changed with each unit of blood
Check the blood bag for the date of expiration
Inspect the blood bag for leaks, abnormal color, clots, and bubbles.
Blood must be administered as soon as possible (within 20 to 30 minutes) after being received from
the blood bank
Assess for any cultural or religious beliefs regarding blood transfusions.
Check the client’s vital signs; assess renal, circulatory, and respiratory status and the client’s ability to
tolerate intravenously administered fluids.
The name and identification number of the intended recipient must be provided to the blood bank, and
a documented permanent record of this information must be maintained.
Complications of blood transfusion
Febrile reactions e.g fever, chills, headache, malaise
Allergic reactions e.g flushing, wheezing, rash, itching, urticarial
Haemolytic reactions e.g- clumping, coagulation,
Circulatory overload e.g distended neck veins, increased venous pressure, coughing, dyspnea abnormal breath
sounds
Septic reactions- fever, chills, vomiting, diarrhea, hypotension
Nursing responsibilities during reactions
Stop blood transfusion
Treat according to symptom such as giving of antipyretics, antihistamine,
Check vital Signs
Administer Normal Saline fast
Administration of blood transfusion – procedure manual.