BLOOD TRANSFUSION

Blood transfusion is the process of receiving blood products into one's circulation intravenously. 

·         Transfusions uses whole blood, although modern medical practice commonly uses only components of the blood, such as red blood cells, white blood cells, plasma, clotting factors, and platelets.

Step 3: Indication of Blood Transfusion(10 minutes)

·         Transfusion of whole blood from one individual to another is indicated for two main reasons:

• when the volume of blood within the circulation system of the patient is less than that required to sustain life and,
• When the red blood cells are deficient either in quantity or quality.

·         Blood loss through accident, surgery, or haemorrhage at childbirth, or from such a condition as the bleeding of a stomach ulcer, may reduce the amount of circulating fluid in the bodies below safe limits.

·         In general, Indication of blood transfusion can be summed up as

• Anaemia
• Major Surgical Operation
• Accidents resulting in considerable blood loss
• Cancer patients requiring therapy
• Women in childbirth and newborn babies in certain cases
• Patients of hereditary disorders like Haemophilia and Thalassaemia
• Severe burn victims.

Step 4: Nursing Care and management of Patient with Blood Transfusion(20 minutes)

Compatibility testing

·          Before a recipient receives a transfusion, compatibility testing between donor and recipient blood must be done.

• Blood sample should be taken from the patient for cross-match and groupings

• Typing of recipient's blood  to determines the ABO and Rh status is important in order to avoid agglutination
•  In urgent cases where crossmatching cannot be completed, and the risk of dropping hemoglobin outweighs the risk transfusing uncrossmatched blood, O-negative blood is used, followed by crossmatch as soon as possible

Preparation of patient

·         Inform the patient about the procedure

·         Record history of previous transfusion as well as reaction to these.

·         Ask the patient if he/she would like to empty the bladder

·         Ensure that the right patient receive the right blood (2 nurses needed in this case)

·         Obtain and record the patients vital sign to provide baseline in case reaction occurs

Preparation of equipment and the procedure of blood transfusion

The tray should contain the following important items

·         Sterile giving set with a filter

·         A large needle or cannula

·         Right blood from the blood bank  or refridgerator

·         Identify the blood by name and number of the donor, Blood group and Rhesus factors

·         Check the date of donation and expiry date

·         Check blood for abnormalities and if abnormal return to the blood bank

·         Check for the temperature of the blood before transfusing (should be nearly equal to that of body temperature)

After transfusion

·         Stay at the bedside for the first 15 minutes to observe the patient closely.

·         While the transfion in progress, monitor the vital sign at least half hourly.

·         Record the following on the patient’s chart.

• Date and time of starting transfusion, number of the bottle, amount of blood, name of the nurse or doctor who checked the blood and set the transfusion, urinary output

·         Administer normal saline as prescribed at the end of the transfusion

Step 5:  Complication of blood transfusion(10 minutes)

Transfusions of blood products are associated with several complications, many of which can be grouped as immunological or infectious

·         Immunologic complications

•  Haemolytic reactions occur with transfusion of red blood cells and are due to destruction of donor erythrocytes by preformed recipient antibodies. Most often this occurs due to clerical errors or improper typing and crossmatching. Symptoms include fever, chills, chest pain, back pain, hemorrhage, increased heart rate, shortness of breath, and rapid drop in blood pressure.
• Febrile nonhemolytic reactions are due to recipient antibodies to donor white blood cells. This may occur after exposure from previous transfusions.
• Allergic reactions may occur when the recipient has preformed antibodies to certain chemicals in the donor blood, and does not require prior exposure to transfusions. Symptoms include urticaria, pruritus, and may proceed to anaphylactic shock. Treatment is the same as for any other type 1 hypersensitivity reactions.
• Posttransfusion purpura is a rare complication that occurs after transfusion containing platelets that express a surface protein.

·         Infectious complications

• Also known as transfusion transmitted bacterial infection.
• Due to contaminated blood
• Sources of contaminants include the donor's blood, donor's skin, phlebotomist's skin, and from containers.
• Contaminating organisms varies greatly, and includes skin flora, gut flora, or environmental organisms. Others may be Hepatitic C and HIV.