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CARE OF PATIENTS WITH PROBLEMS OF One blood donation, can save up to three lives.
THE HEMATOLOGIC SYSTEM
ELIGIBLE/ CAN DONATE
BLOOD TRANSFUSION 1. Must be 18-65 years old
 A blood transfusion is the introduction of whole 2. Must weigh at least 110lbs (50kgs)
blood or blood components into venous circulation 3. Must not have donated in the past 56 days
4. Must have a hemoglobin level of:
PURPOSES a. Female- 12.5g/dl
1. To restore blood volume after severe hemorrhage b. Male-13.5g/dl
2. To restore the oxygen-carrying capacity of the blood 5. Must be in good health at the time of donation.
3. To provide plasma factors, such as antihemophilic
factor (AHF) or factor VIII, or platelet concentrates, INELIGIBLE/ CANNOT DONATE
which prevent or treat bleeding 1. Have tested positive for hepatitis B or hepatitis C,
lived with or had sexual contact in the past 12
BLOOD GROUPS months with anyone who has hepatitis B or
 Human blood is commonly classified into four main symptomatic hepatitis C.
groups: A, B, AB, and 0. 2. Had received a blood transfusion (except with own
 Blood antigens proteins on the surface of an blood) in the past 3 months.
individual's red blood cells that are unique for each 3. Have ever had a positive test for the AIDS virus.
person. Antigens promote agglutination or 4. Man who has had sex with another man in the
clumping of blood cells, they are also known as past 3 months.
agglutinogens. 5. Have used injectable recreational drugs unless
prescribed by a physician in the past 3 months.
RHESUS (RH) FACTOR 6. Have engaged in prostitution in the past 3 months.
 Blood that contains the Rh factor is known as Rh 7. Have traveled in the past 3 months, or lived in the
positive (Rh+); blood that does not contain the Rh past three years, in an area where malaria is
factor is known as Rh negative (Rh-). In contrast to endemic.
the ABO blood groups, Rh-blood does not 8. Have a cold, flu, sore throat, cold sore or any other
naturally contain Rh antibodies. However, after infection at the time of donation.
exposure to blood containing Rh factor, Rh 9. Have recently had a tattoo or body piercing
antibodies develop Subsequent exposure to Rh+ (cannot donate for 6 months from the date of the
blood places the client at risk for an antigen- procedure). If the body piercing was performed by
antibody reaction and hemolysis of RBCs. a registered health professional and any
inflammation has settled completely, donation of
blood after 12 hours can be done.
10. Have visited the dentist for a minor procedure you
must wait 24 hours before donating; for major work
wait a month.
11. Have engaged in "at risk" sexual activity in the
past 12 months
12. Pregnancy
13. After childbirth:
a. 6 weeks (Red Cross)
b. 9 months (WHO)
14. Breastfeeding: 3 months after infant is significantly
weaned
BLOOD TYPING AND CROSSMATCHING
 To avoid transfusing incompatible red blood cells, BLOOD PRODUCTS FOR TRANSFUSION
both blood donor and recipient are typed and their PRODUCT USE
blood crossmatched. Not commonly used except for
 Blood typing is done to determine the ABO blood extreme cases of acute hemorrhage.
group and Rh factor status. This test is also Replaces blood volume and all blood
Whole Blood
performed on pregnant women and neonates to products: RBCs, plasma, plasma
assess for incompatibility between their blood proteins, fresh platelets, and other
types (particularly Rh factor incompatibilities). clotting factors.
Used to increase the oxygen-carrying
SELECTION OF BLOOD DONORS capacity of blood in anemias,
 Screening of blood donors is rigorous. Criteria Packed Red surgery, and disorders with slow
have been established to protect the donor from Blood Cells bleeding. One unit of PRBCS has the
possible ill effects of donation and to protect the (PRBCs) same amount of oxygen-carrying
recipient from exposure to diseases transmitted RBCs as a unit of whole blood. One
through the blood. unit raises hematocrit by
 approximately 2% to 3%.
Used for blood replacement following
planned elective surgery. Client
Autologous
donates blood for autologous
RBCs
transfusion 4-5 weeks prior to
surgery.
Replaces platelets in clients with
bleeding disorders or platelet
deficiency. Fresh platelets are most
Platelets effective. Each unit should increase
the average adult client's platelet
count by about 5,000
platelets/microliter.
Provides clotting factors. Does not
Fresh Frozen
need to be typed and crossmatched
Plasma
(contains no RBCs).
Albumin and
Plasma Blood volume expander; provides
Protein plasma proteins
Fraction
Used for clients with clotting factor
Clotting deficiencies. Each provides different
factors and factors involved in the clotting STORAGE TEMPERATURE FOR THE DIFFERENT BLOOD
cryoprecipitate pathway; cryoprecipitate also PRODUCTS
contains fibrinogen.
BLOOD AND BLOOD
TEMPERATURE
PRODUCTS
BLOOD PRODUCTS LABELLING Whole Blood and red +2°C and +6°C
 Blood Products Labelling from ISBT 128. cells
 ISBT 128 is a global standard for the identification,
Fresh Frozen plasma -20°C
labeling, and information transfer of medical
Platelets +20 °C and +24 °C with
products of human origin (MPHO) across
continuous agitation
international borders and disparate health care
Cryoprecipitate Below -30°C
systems.
ADMINISTERING BLOOD: SPECIAL PRECAUTIONS
1. When a transfusion is ordered, the nurse obtain
blood in plastic bags from the blood bank just
before starting the transfusion. One unit of whole
blood is 500 mL; a unit of packed red blood cells
(RBCs) is 200 to 250 ml.
2. Do not store the blood in the refrigerator on the
nursing unit; lack of temperature control may
damage the blood.
3. Once blood or a blood product is removed from
the blood bank refrigerator, it must be
administered a limited amount of time.
4. Traditionally, blood has usually been administered
through an #18- to #20-gauge IV needle or
catheter with the belief being that using smaller
needles may slow the infusion and damage blood
cells (hemolysis). However, studies have shown
that blood infusions through smaller gauge
catheters can be completed within 4 hours without
hemolysis.
5. Current practice guidelines established by the
AABB (American Association of Blood Banks) and
endorsed by the American Red Cross and the INS
recommend that a #14 to # 22 gauge IV catheter is
acceptable for transfusion of cellular blood
components in adults. Large-bore IV catheters are
difficult to insert in older adults and oncology
clients. Using a smaller gauge catheter is more
comfortable for the client, may reduce the number
of needlesticks, and avoid complications.
6. Blood administration sets are used to keep the g. Compatibility: The interpretation of compatibility
vein open while starting the transfusion and to testing must be recorded on the transfusion form
flush the line with normal saline before the blood and on the tag to the unit.
enters the tubing. The infusion tubing has a filter h. Appearance: There should be no discoloration,
inside the drip chamber. A transfusion should be foaming bubbles, cloudiness, clots or clumps, or
completed within 4 hours of initiation. The loss of integrity of the container.
maximum time for use of a blood filter is 4 hours.
7. With the exception of 0.9% sodium chloride, no If any of the information does not match exactly:
drug or medication should be added to blood or a. Notify the charge nurse and the blood bank.
blood components unless they have been b. Do not administer blood until discrepancies are
approved by the FDA or there is documentation corrected or clarified.
that the addition is safe and does not adversely c. Sign the appropriate form with the other nurse
affect the blood or blood component. according to agency policy.
8. If an additional unit needs to be transfused, follow d. Make sure that the blood is left at room
agency guidelines. A new blood administration set temperature for no more than 30 minutes before
is to be used with each component. starting the transfusion.
9. New IV tubing is used for administering other IV
fluids following a transfusion. MONITORING THE PATIENT
10. Normal saline must always be used when giving a For each unit of blood transfused, monitor the patient
blood transfusion. If the client has an infusion of at the following stages:
any other IV solution, stop that infusion and flush 1. Before starting the transfusion
the line with saline prior to initiating the transfusion, 2. As soon as the transfusion is started
or establish IV access through an additional site. 3. Every 15 minutes after starting the transfusion for
Solutions other than saline cause damage to the first hour
blood components. 4. Every 30 minutes during transfusion
5. On completion of the transfusion
2014 THE JOINT COMMISSION NATIONAL PATIENT
SAFETY GOALS RELATED TO BLOOD TRANSFUSION At each of these stages, record the following
SAFETY: information on the patient's chart:
Goal 1: Improve the accuracy of patient identification. 1. Patient general appearance
Goal 01.03.01: Eliminate Transfusion Errors Related to 2. Temperature
Patient Misidentification. 3. Pulse rate
Before initiating a blood or blood component 4. Blood pressure
transfusion: 5. Respiratory rate
1. Match the blood or blood component to the 6. Fluid balance of oral and IV fluid intake and urine
order. output
2. Match the patient to the blood or blood 7. Subjective complaints of patients.
component.
3. Use a two-person verification process or a The following should also be record in patient's
one-person verification process accompanied medical chart and in BT Sheet Form:
by automated identification technology, such 1. Time the transfusion is started
as bar coding. 2. Time the transfusion is completed
3. Volume and type of all products transfused
WITH ANOTHER NURSE (MOST AGENCIES REQUIRE 4. Unique donation numbers of all products
AN RN), VERIFY THE FOLLOWING BEFORE INITIATING transfused
THE TRANSFUSION: 5. Any adverse effects.
a. Order: Check the blood or component against the
primary care provider's written order. TRANSFUSION REACTIONS
b. Transfusion consent form: Ensure the form is  Transfusion of ABO- or Rh- incompatible blood
completed per facility policy. can result in a hemolytic transfusion reaction,
c. Client identification: The name and identification which causes destruction of the transfused RBCs
number on the client's identification band must be and subsequent risk of kidney damage or failure.
identical to the name and number attached to the
unit of blood. If signs of transfusion reaction develop, the nurse
d. Unit identification: The unit identification number should:
on the blood container, the transfusion form, and 1. Stop the transfusion immediately.
the tag attached to the unit must agree. 2. Keep the line open with normal saline.
e. Blood type: The ABO group and Rh type on the 3. Do not use the saline attached to the Y-set tubing
primary label of the donor unit must agree with because the filter contains blood and you do not
those recorded on the transfusion form. want to give the client who is experiencing an
f. Expiration: The expiration date and time of the acute transfusion reaction another drop of blood
donor unit should be verified as acceptable. Instead, use new IV tubing.
4. Disconnect the infusion tubing from the hub of the
IV catheter and replace with the new IV tubing.
5. Do not piggyback the new tubing into the access sensitivity to or without immediately.
port of the transfusion tubing, because it is infused plasm itching Keep vein
possible that some of the blood product could be proteins open with
administered to the client. normal saline.
6. Hydrate the client with normal saline and notify the 2. Notify the
primary care provider. primary care
7. Continue to monitor vital signs. provider.
3. Administer
REACTION CLINICAL NURSING medication
CAUSE SIGNS INTERVENTIONS (antihistamines
Hemolytic Fever or hills, 1. Discontinue , steroids) as
reaction! flank pain, and the transfusion ordered.
incompatibility reddish or immediately. Allergic Dyspnea, 1. Stop the
between brown urine, Note: When reaction stridor, transfusion
client's blood tachycardia, the transfusion (severe): decreased immediately.
and donor's hypotension is antibody- oxygen 2. Keep the vein
blood discontinued, antigen saturation, open with a
the blood reaction chest pain, normal saline
tubing must be flushing solution.
removed as 3. Notify the
well. Use new primary care
tubing for the provider
normal saline immediately.
infusion. 4. Monitor vital
2. Mainlain signs.
vascular Administer
access with cardiopulmona
normal saline, ry resuscitation
or according to if needed.
agency 5. Administer
protocol. medications
3. Notify the and/or oxygen
primary care as ordered.
provider Circulatory Dyspnea, 1. Stop the
immediately. overload: blood hypotension, transfusion,
4. Monitor vital administered orthopnea, immediately.
signs, faster than the crackles 2. Place the client
5. Monitor fluid circulation can (rales), upright.
intake and accommodate distended 3. Notify the
output. neck veins, primary care
6. Send the tachycardia, provider.
remaining hypertension 4. Administer
blood, bag, diuretics and
filler, tubing, a oxygen as
sample of the ordered
client's blood, Sepsis: High fever, 1. Stop the
and a urine contaminated chills, transfusion.
sample to the blood vomiting, 2. Keep the vein
laboratory administered diarrhea, open with a
Febrile Fever; chills; 1. Discontinue hypotension, normal saline
reaction: warm, flushed the transfusion oliguria infusion.
sensitivity the skin; immediately, 3. Notify the
client's blood to headache; 2. Keep the vein primary care
white blood anxiety; open with a provider.
cells, platelets, nausea normal saline 4. Administer IV
or plasma infusion. fluids,
proteins; does 3. Notify the antibiotics.
not cause primary care 5. Obtain a blood
hemolysis provider. specimen from
4. Give the client for
antipyretics as culture.
ordered. 6. Send the
Allergic Flushing, 1. Stop the remaining
reaction (mild): urticaria, with transfusion blood and
 tubing to the
laboratory.

Healthcare facilities must have a protocol relating to