BLOOD TRANSFUSION, TYPES OF BLOOD TRANSFUSSION AND SUBSTANCES IN BLOOD

 

BLOOD TRANSFUSSION

BLOOD TRANSFUSION

This the transfusion of whole blood, packed cell and plasma from a healthy person into a patients vein it can also be defined as a medical procedure that involves the transfer of blood or blood components from one person (donor) to another person (recipient). It is often used to replace blood lost due to injury, surgery, or disease, or to treat various medical conditions that cause certain blood components to be deficient.

 

Types of Blood Transfusion

1. Autologous : Blood taken from a patient or an individual and transfused to the same person

 

2. Heterologous: Blood donated by other persons for transfusion to other persons.

 

Types of blood

Blood is grouped into four types namely; A, B, AB, O.

Blood group A

It has antigen A in the red blood cells and anti B antibodies in the plasma. Blood group A can donate to A and AB and can receive from A and O

Blood group B

It has antigens B in the red blood cells and anti A antibody in the plasma. Blood group B can donate to B and AB and can receive from B and O

Blood group AB

It has A and B antigens in the red blood cells but no antibodies in the plasma. Blood group AB can only donate to AB and can receive from A, AB, B and O. Persons in this group are called universal recipients.

Blood group 0

It has no antigens in the red blood cells but has both anti A and B antibodies in the plasma. Blood group O can donate to A, B, AB, and O and can only receive from 0. Persons in this group are called universal donors.

SUBSTANCES PRESENT IN BLOOD

1. ANTIGENS:

 They are found in a red blood cell. Antigens are substances that causes an immune response in the body by identifying substances in or markers on cells. (In other words, antigen are enemies) Most of the time the antigen is a molecule that imitates a production of an antibody and causes an immune response. Antigen can include toxin, chemical, bacteria, viruses or pollen grains. Substance actually triggers the production of antibodies.

2. Antibody:

Found in the plasma. They are also called immunoglobulin. Antibody/immunoglobulin is a protective protein produced by the immune system in response to the antigens (So it is like white cell which fight against bacteria and other toxins in a body). Antibody are in a form of Y- shape which has a binding in site. Antibodies are soldiers that fight the enemy (antigen) and renders less active to cause any diseases.

3. Agglutinogens.

Protein exists on the surface of every red blood cell in a body. The kind of agglutin present in a red blood cell help determine the blood type of an individual

4. Agglutin:

Substances in a red blood cells that causes particles to coagulate and aggregate (coming to getter): to change from fluid like state to a thicken – mass state. Agglutins can be antibody that cause antigen to aggregate by binding to the sites of antibodies. An Agglutins can also be any substance other than antibodies protein lectins. 

RHESUS (Rh) FACTOR

Red blood cells contain rhesus antigen (an antigen discovered from rhesus monkey) or not. People whose red cell contain rhesus antigen are said to be rhesus +(Rh+) and those who do not carry the antigen are termed as rhesus Rh- this is normally indicated on the blood group of the individual e.g., A+ or A-, B+ or B -, O- or 0+

About 85% of the populations are Rh+. An Rh+ person should never be given Rh+ blood because this could cause severe reactions. Collection of blood from the donor should be done under strict asepsis into a plastic bag containing 60mls of citrate-phosphate-dextrose (CPD) as anticoagulant and preservative. CPD keeps the red cell viable for 21 days in vitro. The use of CPDA-1, adenine-enriched CPD, extends the shelf life to 35 days. The labeled plastic bag is stored as early as possible in a special blood bank fridge at 2-6 degrees.

Erythroblastosis Fetalis

A mother with Rh- and father with Rh+ when there is pregnancy, the foetus will be Rh+. Small blood leaks from the foetus through the placenta in the blood stream of the mother. The mother begin to produce Rh+ antibody. In second pregnancy with Rh+ foetus there could be haemolysis in the foetal blood when Rh+ antibodies cross the placenta. Such a baby may die or born jaundiced

Purpose of Transfusion

1.Severe anaemia and to increase oxygen carrying capacity

2.Severe haemorrhage when the blood pressure and blood volume has reduced

3.To correct deficiencies of plasma proteins, clotting factors and haemophilia

4.During major operation

5.Severe burns

6.Bleeding disorders such as haemophilia and leukaemia (decrease number of leukocytes in the body)

7.To prevent infection in patient with leukaemia

Forms of Blood Transfusion

Platelets

Whole blood

Albumin

Plasma either dry or frozen

Concrete suspension or red blood cells

Dextran 10% (substitute of plasma)

Points to be Noted in the Nurses Notes and on the Transfusion bag during blood transfusion

1.State the time and date blood transfusion was started, and date and time of completion

2.Amount of blood administered

3.Blood group and Rhesus should be noted

4.The type of blood transfused e.g. whole blood, platelet, etc.

5.State the rate of flow

6.Note any antihistamine given such as hydrocortisone

7.Note batch number

Requirement for giving blood transfusion

Blood giving set

Paint of blood

Blood transfusion chart

Premedication like Phenergan hydrocortisone

All requirements needed for intra venous therapy

 

Nurse’s Responsibility during blood transfusion

1.Blood should be checked at the blood bank for expiring date, abnormal color of blood, gas bubbles before taking it to the ward

2.Blood should be checked by two professionals, either a registered nurse or doctor for name of patient, blood group, serial number, rhesus factor compatibility and the expiring date.

3.Also check, age, ward at the bedside before setting up the blood. 

 

Steps in blood Transfusion

1.Explain the procedure to the patient and make sure he has signed an informed consent form before transfusion therapy.

2. Record the patient’s baseline vitals sign

3. Collect blood from the laboratory half an hour before administration

4. Check vital signs and record in the 1st 15 minutes, 30 minutes, 1 hour, 2 hours.

5. Recheck the following on patient’s folder and label on the unit of blood

a. Full name.    c. Blood unit member

b. Rhesus factor   d. Blood group

e. Ward f. Expiring date of blood.

6. Put on gloves, a gown and a face shield due to spilling of the blood.

7. Insert the giving set into the paint of blood and expel air

8. Perform a vein-puncture, using a large diameter cannula. Avoid using an existing line if the needle is small. Central venous access device also may be used for transfusion therapy.

9. If administering whole blood, gently invert the bag several times to mix the cells.

10. Connect blood to the cannula and apply strip and splint to keep the cannula in position

11. Regulate number of drops or flow rate based on your calculation

12 Remain with the patient, and watch for signs of transfusion reaction. If such sign develops, stop the transfusion and record vitals sign. Infuse saline solution at a moderate rate and inform the doctor

13 Document time, amount of blood, number of paints, blood group, batch number on the nurse’s notes and fluid chart.

14 After completing the transfusion, put on gloves and remove and discard the used infusion equipment. Check vital signs document time of completion and note any reaction after the transfusion.

 

Observation / Monitoring during blood transfusion

Observe the rate of flow

Persistently observe the blood level in the bag.

Observe the needle site for signs of dislodgment or swelling

Observe the urine output during and after transfusion

Observe for the potency of the transfusion set

Observe for signs of circulatory overload

Keep the patient warm and comfortable throughout the procedure.

Check and record pulse, respiration blood pressure half hourly and temperature four hourly

Observe the patient closely throughout the transfusion for any sign of incompatibility or adverse reaction such as headache, dyspnea, vomiting, cough, hyperpyrexia and oliguria

If there is any adverse reaction stop or discontinue the transfusion immediately and inform the charge nurse or medical officer

Blood transfusion should take about four hours to complete

BLOOD TRANSFUSION REACTION

Transfusion reaction results from anti-gen antibody reaction and can occur as a result of a single or massive transfusion of blood or blood product. A transfusion reaction requires immediate recognition and prompt nursing action to prevent further complication and possibly death – particularly if the patient is unconscious or so heavily sedated that he can’t report the common systems

Equipments for blood transfusion

Normal saline

Giving set

Sterile urine container

Needle syringe and tubes for blood sample

Transfusion reaction form

Oxygen, Ephedrine, Hypothermia blanket

Implementation of blood transfusion reaction

1. As soon as you suspect an adverse reaction, stop the transfusion and start saline infusion at a keep – vein- open rate to maintain venous access. Don’t discard the blood bag or administration set

2. Notify the doctor

3. Monitor vital signs every 15 minutes or as indicated by severity and type of reaction

4. Compare the label on all blood container with corresponding patient identification forms to verify that the transfusion was the correct blood product

5. Notify the blood bank of a possible transfusion reaction and collect blood samples as ordered. Immediately send the sample. All transfusion containers and the administration set to the blood bank

6. Collect the first post transfusion urine specimen, mark the collection slip “possible transfusion reaction” and send it to the laboratory immediately. (The lab test this urine specimen for the presence of hemoglobin (HB), which indicates a hemolytic reaction)

7. If prescribed, administer oxygen epinephrine, or other drugs and a hypothermia blanket to reduce fever

8. Make the patient comfortable as possible and provide reassurance as necessary.

9. Document the time and date of the transfusion reaction, type and amount of infused blood or blood products, clinical signs of the transfusion reaction in order of occurrence, patient vital signs, specimen sent to the laboratory for analysis, treatment given, and patient’s response to treatment. If required by the facility policy, complete transfusion reaction form.

Complications of blood transfusion

Allergic reaction (sign of allergy include urtcaria rash)

Circulatory overload

Shock

Haemolytic reaction (signs and symptoms are chills, pyrexia, Iow BP low back pain, nausea / vomiting headache tightness of the chest, severe cases vascular collapse)

Thrombophlebitis

Haematoma at the site

Air or pulmonary embolism

Infection