Blood Transfusion: Introduction Blood is one of the important constituents of our body fluid,which constitutes about 7%of body

weight(about 5.6 litres in a 70 kg man).it is composed of straw coloured transparent fluid plasma,in which different types of cells (R.B.Cs.W.B.Cs,platelets)are suspended.plasma components of blood should be in right proportion.if blood and any of its components are reduced due to any condition ,it should be replaced. Definition Blood transfusion is the intravenous administration ofcompatibles donor whole blood or a component such as plasma,packed red blood cells or platelets to a patient. Purposes 1. To replace blood volume and blood pressure during haemorrhage(hemoptysis,hemetemesis,antepartum and postpartum hemorrhage,operations etc.)truma or burns. 2. To increase the oxygen carrying capacity or haemoglobin level in cases of severe anemia which are not corrected by the administration of vitamins and iron therapy. 3. To provide antibodies and leukocytes 9immune transfusions)to in severally ill patients and persons having lowered immunity by giving blood or plasma taken from persons who has just recovered from the same disease. 4. To correct or treat defiance of plasma proteins clotting factors and haemophilic globulin,etc. 5. To combat infection in patients with leukopenia. 6. To replace the blood with haemolytic agents with fresh blood (exchange blood transfusions)as in case of erythroblastosis fetalis ,haemolytic anemia,etc. 7. To improve the leukocyte countsof blood as in agranulocytosis.

1) 2) 3) 4) 5)

Indications After surgery,truma or haemorrhage. Severe anemia. Leukopenia. Agranulocytosis . Thromboblastosis fetalis.

Blood groups Human blood classified into four main groups(A,B,AB,O)based on the type of antigens (agglutinogens)present in the erythrocytes ,as well as the type of antibodies(agglutinins)present in the plasma.two major agglutinogens found are antigen Aand antigen B.persons havingA group have A type of antigens in their red blood cells and persons with B group will have B antigens.persons with AB will have both antigens(A,B),while those with O group donot have either A or B antigens in their red cells. Similarly,two major agglutinins anti Aalpha agglutinins and which agglutinates type A blood cells and anti B beta agglutinins which agglutinates type B blood cells.the agglutinogens and agglutinins of the same type will not be found in the same person .otherwise,the persons own cells will be attacked by the antibodies found in his plasma.thus group A blood contains only beta agglutinins and group O contains both alpha and beta agglutinins. Blood groups and their respective antigens Group AB A B O Agglutinogens in the red cells A and B A B No agglutinogens Agglutinins in the plasma No agglutinins(-) Beta agglutinins(b) Alpha agglutinins (a) Both alpha and beta(ab)

THE HEMOLYTIC REACTION When similar agglutinins and agglutinogens come in contact with each other ,agglutination (clumping)and hemolysin(rupture)of the red cells occur.this produces a fatal response,called haemolytic reaction .the individual from whom the blood is taken is called the donor,and to whom the blood is given is known

as recipient .in order to avoid haemolytic reaction in blood transfusion ,the blood cells of the donor are cross-matched with the plasma of the recipient and the plasma of the donor with the cells of recipient.if no agglutination is taking place ,the blood is said to be compatible. Agglutinins in serum Donors blood cells(antigens) AB A B O Recipients plasma( antibodies) b A + + + + -

O -

ab + + + -

Donor AB can donate blood to recipients AB and A as there is no alpha agglutinins in these groups.similarly ,donor B can donate to AB and B since there are no beta agglutinins in these groups .donor O can donate blood to all four groups since it has no antigens .therefore group O is known as universal donor .group AB can receive blood from all four groups ,as it has no agglutinine in the plasma.so group AB is known as universal recipient. Rh factor There are six types of Rh antigens(C,D,E,c,d,e).each of them is called Rh factor.the type D antigen is considered more antigenic than others.therefore,any persons who has D antigen is Rh positive(Rh+ve)and who does not have,Rh negative(Rh-ve). If a person with Rh negative blood is accidentally transfused for the first time with Rh positive blood,he will not have any transfusion reactions because his blood does not have any Rh antibodies.but after this transfusion his blood cells become sensitized to the Rh antigen and develop antibodies against the D antigen .on receiving a second transfusion with Rh positive blood ,some degree of reaction due to red cell destruction will occur. A similar situation arises when an Rh negative mother is sensitized by red cells from Rh positive foetus.the maternal antibodies are capable of crossing the placenta and destroying the foetal red cells.this usually occurs during a second

or third pregnancy with Rh positive foetus.severe foetal haemolytic anaemia and intrauterine death may occur.this problem has been largely prevented by prophylactic administration of anti-Rh serum to the susceptible Rh negative mother within 72 hours of delivering an Rh positive baby or following an abortion. Selection of donor: 1. Should not be suffering from disease of heart ,kidneys,liver,lungs,cancer,jaundice,tuberculosis,hepatitis,AIDS,allergies etc. 2. Should not have donated blood within the previous 90 days. 3. Should be healthy and in the age group of 18-65 years. 4. Should not be pregnant. 5. Should have HB level above 12gm%. 6. Should have normal vital signs (TPR,BP). 7. should not be empty stomach.

General instruction : 1. Blood should be fresh. 2. Donors should not have any history of jaundice ,cancer,malaria,hepatitis,tuberculosis,syphilis,AIDS or any other transmissible diseases. 3. Donor must be tested for AIDS .his grouping and cross matching should be done and it should be compatible with the recepients blood .any error in the labelling of blood can lead to serious consequences. 4. Blood must be stored at a temp1-6 degree Celsius. 5. Donors must have a normal temps pulse and blood pressure. 6. Use an appropriate,sterile,pyrogens free transfusion set containing a fitter for administration of blood one filters will remove clots and lagers aggregrates of leukocytes and platelets. 7. Use 18 gauge needles for infusion .it will prevent damage to the red cells and will provide adequate rate of flow. 8. Maintain TPRchart prior to blood transfusion to find on any complication. 9. Donot add any medications to the blood or administer through the same intravenous needle,because they may cause damage to the red cells.

10.Adjust the rate flow to 5-10 ml per minute during first half an hour of transfusion to detect any complication as early as possible.because signs usually appear during the first half an hour of transfusion.the subsequent flow rate depends upon the condition of the patient and the need for rapid transfusion. 11.The blood should be given at a slower rate if the patient is elderly suffering from heart and lung diseases,amemia,etc. 12.Whole blood and packed cells are administered cold.avoid shaking the container ,if needed the blood may be allowed to stand in the room temp for 30-45 mins,before administering to the patient. Preparation Collection of blood from the donor is done in the laboratory by the laboratory technicians. All the articles used for the collection of blood should be sterile. The donor blood immediately after it is withdrawn should be placed in the refrigerator. Stored blood shall be inspected daily. The transportation of the blood in the hospital should be done within 30 mins. Freezing ,heating of the blood will destroy the blood cells. Where sending the recipients blood sample for grouping and cross matching it must be carefully labelled at the bedside of the recipient with identifications. Care is to be taken to prevent introduction of air into the apparatus. It is recommended to use 18 gauzeneedles for infusion to prevent damage to the red cells of to provide an adequate rate of flow. No medications,antibiotics,vitamins,calcium should be administered. Rinse the infusion set with the normal saline before starting the solution. Before the administration of blood the vital signs should be recorded correctly. Adjust the rate of flow to 5-10ml per min during the first 30 mins of transfusion . Whole blood and packed cells are administered cold,blood may be allow to stand in the room temp for 30-45mins before it is administered. Once the blood is exposed to the atmosphere it should be discarded.

 Watch the patient carefully for the onset of any complications any reactions developed ,it should be reported to the charge nurse and the physician immediately. Keep the patient warm and comfortable with blankets(if necessary). Offer bed pan before the procedure. Record in the nurses record book with date and time (amount of blood administered,group,rate of flow,any reaction seen ,any medications). Articles Articles A tray containing : A blood transfusion set A mackintosh and a towel A tourniquet. Cotton swabs with antiseptic(iodine,spirit) Adhesive tape and scissors Gloves A kidney tray or paper bag. i/v stand normal saline Rationale to transfuse blood. To protect the bed To constrict the blood vessel. To clean the site of infusion

blood or any of its components with cover received from the blood bank with the name of the recipient .

To secure the tubings and needle. To prevent infection To discard the waste. To hold the blood bottle. To start the blood transfusion line. To make sure that the blood sent from the blood bank is meant only for this particular patient .avoid mistake in identification.

Procedure Steps of procedure Wash hands,wear gloves Rationale Reduces risk of infection Scientific principles Microbiology Nursing principles Safety

Identify the accessible veins .select a large vein wich allows the patients mobility. Check the blood to be transfused for group ,Rh type,expiry date etc.inspect for abnormal color,cloudiness,clot and excess air.

Open the sterile packing of the blood transfusion set especially.insert the infusion set into the bag of blood to be transfused. If the patient has an Large gauze I/V infusion ,check needles permit whether the needle infusion of whole and solution are blood.normal appropriate to saline prevents administer blood .the hemolysis. needle should be 18 or 19 gauze and the solution must be normal saline. Place tourniquet 10Makes the vein 12cm above the more prominent insertion site ,by for insertion asking the patient to clench its fist.

Prolonged reactions of arm movement is uncomfortable and inconvenient for the patient. Help in identifying the correct blood to be transfused in the patient ,where blood was sent formatting with the donors blood. Maintain the sterility of blood

Body mechanics

Comfort.

chemistry

Safety

Microbiology

Safety

physiology

Therapeutic effectiveness.

Anatomy and physiology

Therapeutic effectiveness.

Clean the insertion site with iodine and spirit. Insert the needle and start infusion with normal saline

Begin transfusion after identifying the blood product and the patient thoroughly Adjust rate 2ml/minfor the first 15 min and remain with the patient.if any reaction is suspected,notify the blood bank and the physician. Monitor vital signs every five mins for the first 15minsand every hour thereafter.observe the flushing ,itching,dyspnoea or rash.stop transfusion immediately,if any reaction is suspected. Remove and dispose of gloves,hand washing shouldbe done. Record administration of

Iodine is antiinfective and spirit is antiseptic Normal saline infusion helps to check the patency and it prevents hemolysis Reduces risk of error

microbiology

Safety

Biochemistry

Safety

Biochemistry

Safety

Allows detection of reaction while infusing the smallest possible volume of the blood product.

Biochemistry and physiology

Safety

Any change in vital signs indicates an early sign of reaction

Physiology

Safety

Reduces transmission of microorganism Documents administration of

Microbiology

Safety

Safety ,good workmanship

blood,date,time,blood the blood group,any adverse components is reaction and the necessary for the amount of blood accuracy in infused. treatment and also for legal purposes.

After care of the patient: 1. After the infusions have been started ,the nuse should see that it is secured carefully by using the arm board,bandages,adhesive plaster etc. 2. The movement of the patient in the bed should not dislodge the IV cannula. 3. The cut down site is inspected frequently to detect infilitration of fluid the dislodgement of cannula etc. 4. The incision site should be cleaned and dressed daily to help in the healing of the wound. 5. After a week ,the sutures are removed.

Complications 1. Haemolytic transfusion reaction :occurs due to incompatibility of blood,improper storage of blood,uncontrolled refrigeration resulting in freezing ,storage beyond 21 days limit,warming of blood above 40 degree Celsius or by exposure of red cells to dextrose solution .it is characterized by the onset of the fever ,chills,headache dyspnoea,cyanosis and chest pain ,nausea ,vomiting,increased pulse in renal failure. 2. Pyrogenic reactions:it results from substances in the transfusion tubings but its incidence is reduced nowadays due to the use of disposable sets.contamination may occur from improper preparation of donor site and not following aseptic technique .pyrogenic reactions are characterized by feverwithchills,nausea,vomiting,diarrhoea,headache,backache,delirium,shoc k and renal failure. 3. Allergic reactions:there are due to the sensitivity of individual to plasma proteins in the transfused blood ,characterized by rashes,itching,laryngeal oedema and bronchial spasms.

4. Circulatory overload:it occurs in people suffering from severe anemia when they receive whole blood as they need only RBC replacement and not other components.patients who have heart failure are more vulnerable for circulatory overload. 5. Transmission of infectious diseases:the common diseases ,which may be transmitted through transmission ,are serum hepatitis,malaria,filarial syphilis,AIDSetc. 6. Anaphylactic reaction:this can be rare but life threatening .it characterized by a severe respiratory and cardiac vascular collapse ,severe GI disturbances etc.

Bibliography: Clement, basic concepts of nursing procedures,1st edition,2007,jaypee publishers,page no.262-264. Annamma Jacob, clinical nursing procedures:the art of nursing practice1 st edition,2007,jaypee publishers,page no .253-255. TNAI, fundamentals of nursing a procedure manual,2nd edition ,2007,published by secretary general on behalf of trained nurses association of india,page no.391-395. Ratna prakash , Manipal manual of nursing procedures,1 st edition,2007,CBS publishers and distributors,page no.145-152.

Lily pritam Telu Ram , Manual of nursing arts procedures,3rd edition ,1993,vikas publishing house ,page no.184-189.