CATEGORIES OF BLOOD COMPONENTS

1. Whole Blood: This type of blood product encompasses all components of blood. It’s typically used for patients who have experienced significant and rapid blood loss or are in hypovolemic shock, a condition where there’s a dangerously low blood volume.

   • Indication: Situations involving severe and sudden blood loss, such as in cases of major trauma (like a serious car accident) or when a patient is experiencing hypovolemic shock due to severe dehydration or bleeding.

   • Purpose: Whole blood is administered to restore the overall volume of blood in the body, leading to an increase in hemoglobin levels (the protein in red blood cells responsible for carrying oxygen). This ultimately enhances the blood’s ability to transport oxygen throughout the body.

2. Packed Red Blood Cells (PRBCs): These are red blood cells that have been separated from whole blood, with approximately 80% of the plasma removed. This concentrated form of red blood cells is transfused to patients who require an increase in red blood cells without the additional fluid volume that comes with whole blood. For example, individuals with certain types of anemia, like aplastic anemia (where the bone marrow doesn’t produce enough new blood cells), may benefit from PRBCs.

   • Indication:

     • Various forms of anemia, including aplastic anemia, where the primary issue is a deficiency in red blood cells.

     • Medical situations where increasing the oxygen-carrying capacity of the blood is crucial, but adding extra fluid to the circulatory system could be harmful, such as in patients with heart conditions.

   • Purpose: The main goal of transfusing PRBCs is to boost the number of red blood cells in circulation. This directly improves the delivery of oxygen to the body’s tissues and organs, without causing fluid overload.

3. Platelet Concentrate: Platelets are tiny blood cells essential for blood clotting. Administering concentrated platelets helps patients suffering from thrombocytopenia, a condition characterized by an abnormally low platelet count. Platelets initiate the blood clotting process, working alongside other clotting factors like prothrombin, fibrinogen, and thromboplastin to stop bleeding. Imagine platelets as the “first responders” at the site of an injury, initiating the repair process to prevent excessive blood loss.

   • Indication: Thrombocytopenia, where a deficiency in platelets puts the patient at risk of excessive bleeding. This can be caused by various factors, including certain medications or medical conditions.

   • Purpose: By providing a concentrated dose of platelets, this blood product helps to restore the body’s ability to form blood clots effectively. Platelets are crucial for initiating the coagulation cascade, working in conjunction with other clotting proteins such as prothrombin, fibrinogen, and thromboplastin to seal damaged blood vessels.

4. Plasma: This is the liquid component of blood, remaining after the red blood cells are removed through centrifugation. Plasma transfusions are valuable for expanding blood volume in situations like shock, burns, and significant blood loss (hemorrhage). It can also be used as a temporary measure while waiting for blood to be cross-matched for a full transfusion. Think of plasma as the transportation medium for essential proteins and clotting factors throughout the body.

   • Indication:

     • Different types of shock, such as hypovolemic shock (due to fluid loss from trauma or burns) or septic shock (due to severe infection).

     • Patients with extensive burns who have lost significant amounts of fluid.

     • Cases of severe hemorrhage where rapid volume replacement is needed.

     • As a temporary measure when blood type compatibility for a full transfusion is still being determined.

   • Purpose: Plasma transfusion increases the overall volume of blood circulating in the body. It also supplies vital proteins, including clotting factors, which are necessary for proper blood coagulation.

Situations Requiring Blood Transfusions:

1. Severe Anemia: When the red blood cell count is critically low, leading to insufficient oxygen delivery. This can arise in various circumstances:

   • Pregnancy: The demands of pregnancy can sometimes lead to iron deficiency anemia requiring transfusion.

   • Sickle Cell Disease: This genetic condition causes red blood cells to be abnormally shaped, leading to chronic anemia and potential complications.

   • Complicated Malaria: Severe malaria can destroy red blood cells, resulting in life-threatening anemia.

2. Preoperative Needs: To correct low blood volume before surgical procedures, ensuring the patient is in optimal condition to withstand the stress of surgery.

3. Extensive Burns: To replace fluids and proteins lost due to severe burn injuries.

4. Postoperative Recovery: Following significant surgical procedures, such as:

   • Laparotomy: Surgery involving an incision into the abdominal cavity.

   • Open Reduction of Internal Fractures: Surgical repair of broken bones requiring internal fixation.

   • Total Abdominal Hysterectomy: Surgical removal of the uterus.

5. Trauma: Following accidents like road traffic accidents (RTAs) or other injuries where significant blood loss has occurred.

6. Blood Clotting Factor Deficiencies: To provide essential clotting factors that the patient’s body is lacking, which can be due to inherited conditions or other medical issues.

7. Specific Types of Anemia: When other treatments are not sufficient to manage the anemia effectively.

Important Considerations:

• Blood Type Compatibility: Matching the donor’s blood type with the recipient’s is crucial to prevent potentially dangerous transfusion reactions. The ABO blood group system (A, B, AB, O) must be compatible.

• Rh Factor Compatibility: The Rh factor (positive or negative) is another vital blood group marker that needs to be considered for compatibility. Rh-negative individuals can receive Rh-negative blood, but Rh-positive individuals can receive either Rh-positive or Rh-negative blood.

• Crossmatching: This is a laboratory procedure conducted to further ensure compatibility between the donor’s and recipient’s blood before a transfusion. It involves mixing small samples of the blood to check for any adverse reactions.

• Potential Risks: While life-saving, blood transfusions carry potential risks, including allergic reactions (ranging from mild itching to severe anaphylaxis), infections (despite rigorous screening processes), and transfusion-related acute lung injury (TRALI), a rare but serious complication.

• Alternatives to Blood Transfusion: In certain situations, alternative treatments may be available, such as erythropoietin (a medication to stimulate red blood cell production for anemia) or medications to increase platelet production.

REQUIREMENTS FOR BLOOD TRANSFUSION

Similar to setting up a standard intravenous infusion, with the addition of specific items:

• Top Shelf:

  • A dedicated blood giving set equipped with a filter to remove any potential clots or debris.

  • A larger gauge needle or cannula to accommodate the thicker consistency of blood products.

• Bottom Shelf:

  • The prescribed unit of blood, obtained from the blood bank.

  • Normal saline solution, which is often used to flush the IV line before and after the transfusion.

  • An observation chart and a fluid balance chart to meticulously document the patient’s vital signs and fluid intake/output.

  • The patient’s medical chart containing specific details regarding the transfusion order.

  • Any other medications prescribed in conjunction with the transfusion.

PROCEDURE FOR BLOOD TRANSFUSION

The technique for administering a blood transfusion shares similarities with a standard intravenous infusion.

1. Post-Transfusion Handling: Once the transfusion is complete, the empty blood bag should not be rinsed. It should be retained on the ward for 24 hours in case further testing is required due to a suspected reaction.

2. Documentation: Thorough record-keeping is essential:

   • The exact date and time the transfusion was initiated and completed.

   • The unique identification number of the blood bag.

   • The total volume of blood transfused.

   • The names of the nurses or doctor who verified the blood product and initiated the transfusion.

   • The patient’s initial reaction and response to the transfusion.

   • The patient’s urine output, which can indicate kidney function and fluid balance.

3. Saline Administration: It is standard practice to administer normal saline solution intravenously both before and after the blood transfusion.

POSSIBLE COMPLICATIONS OF BLOOD TRANSFUSION

Several adverse reactions can occur during or after a blood transfusion:

1. Allergic Reactions:

   • Cause: The patient’s immune system reacts to certain components within the transfused blood product.

   • Signs & Symptoms: These can range from mild itching and skin flushing to hives (urticaria), difficulty breathing, and potentially life-threatening anaphylactic shock.

   • Management:

     • Immediately stop the transfusion.

     • Contact the physician without delay.

     • Administer antihistamines as prescribed by the doctor.

2. Febrile Reaction:

   • Cause: Antibodies present in the recipient’s blood react to the donor’s white blood cells.

   • Signs & Symptoms: The patient may experience fever, chills, and a headache during the transfusion.

   • Management:

     • Stop the transfusion promptly.

     • Notify the physician.

     • Provide comfort measures such as extra blankets or administer prescribed antipyretics (fever-reducing medications).

     • Reassure the patient.

3. Incompatibility Reaction:

   • Cause: This is a severe and potentially fatal reaction caused by transfusing incompatible blood types (e.g., giving type A blood to a patient with type B blood).

   • Signs & Symptoms: Symptoms typically appear rapidly and include shivering, chills, headache, lower back pain, nausea, vomiting, hemoglobinuria (hemoglobin in the urine, making it appear reddish or brown), and acute kidney failure.

   • Management:

     • Stop the transfusion immediately.

     • Notify the physician urgently.

     • Keep the intravenous line open with normal saline solution.

     • Treat the patient for shock if present.

     • Return the remaining blood unit to the blood bank for thorough re-evaluation.

     • Collect blood samples from the recipient and a urine specimen to check for hemoglobinuria.

     • Administer diuretics as prescribed to help the kidneys flush out the breakdown products.

4. Circulatory Overload:

   • Cause: Administering blood too quickly or in excessive amounts, exceeding the capacity of the circulatory system.

   • Signs & Symptoms: Signs include distended neck veins, shortness of breath (dyspnea), a dry cough, and pulmonary edema (fluid buildup in the lungs).

   • Management:

     • Stop the transfusion immediately.

     • Inform the physician, who may decide to discontinue the transfusion entirely or reduce the infusion rate significantly.

     • Administer medications as prescribed, such as diuretics to help remove excess fluid.

     • Monitor and record vital signs frequently.

5. Pyogenic Reaction:

   • Cause: Bacterial contamination of the blood product itself or the transfusion equipment.

   • Signs & Symptoms: The patient may develop a high fever, chills, nausea, and vomiting.

   • Management:

     • Stop the transfusion without delay.

     • Provide tepid sponge baths to help lower the fever.

     • Inform both the physician and the blood bank about the suspected contamination.

     • Monitor vital signs closely.

     • Return the blood unit to the blood bank for investigation.

     • Administer prescribed antibiotics to combat the bacterial infection and antipyretics for fever.

6. Transmission of Infectious Diseases:

   • Cause: Although rare due to stringent screening, blood products can potentially transmit infectious agents like malaria, syphilis, viral hepatitis (e.g., hepatitis B and C), and HIV/AIDS.

   • Prevention: Rigorous screening of all donated blood is paramount to minimize this risk. Donors are carefully selected, and blood is tested for various infectious diseases.

THE NURSE’S ROLE: BEFORE, DURING, AND AFTER BLOOD TRANSFUSION

Before Blood Transfusion (Nurse’s Responsibilities):

1. Prescription Verification: Ensure a valid blood transfusion order has been documented by the physician in the patient’s medical record.

2. Patient Identification: Accurately identify the patient who will receive the transfusion using at least two patient identifiers (e.g., name and medical record number).

3. Procedure Explanation: Clearly explain the blood transfusion procedure to the patient to reduce anxiety and promote understanding.

4. Counseling and Education: Provide emotional support, address the patient’s concerns, and educate both the patient and their family about the benefits and potential risks of the transfusion.

5. IV Line Establishment: Insert an intravenous cannula into a suitable vein to establish a secure IV access. Maintain the patency of the IV line and draw a blood sample for laboratory testing to determine the patient’s blood group and cross-match it with potential donor blood for compatibility.

6. Blood Pack Collection: Retrieve the compatible blood pack from the laboratory, ensuring proper handling and transport.

7. Blood Pack Inspection: Carefully examine the blood pack:

   • Confirm the blood group is the correct match for the patient.

   • Verify the patient’s name on the label matches the patient.

   • Check the expiration date to ensure the blood is still viable.

   • Confirm the Rh factor is compatible.

   • Verify the reference number on the blood pack.

8. Leak and Clot Check: Inspect the blood pack for any signs of leakage or damage. If leaks are present, the pack should not be used. Also, check the color and consistency of the blood for the presence of clots, and replace the pack if any are found.

9. Infusion Set Integrity: Ensure the blood administration set is sterile and intact.

10. Baseline Vital Signs: Record the patient’s baseline vital signs, including blood pressure (BP), temperature, pulse rate (TPR), and maintain a temperature chart for ongoing monitoring.

11. Patient Positioning: Position the patient’s arm comfortably to facilitate the IV infusion.

12. Blood Warming (If Necessary): Warm the blood to room temperature to help prevent chills during the transfusion. Special blood warmers are often used for this purpose.

13. Blood Pack Connection: Securely connect the blood pack to the blood administration set on the IV pole.

14. Air Chamber Priming: Partially fill the drip chamber of the administration set with blood and carefully expel all air from the tubing by allowing blood to flow through it, preventing air embolism.

15. Pre-medication Administration: Administer any pre-medications prescribed by the physician, such as antihistamines or antipyretics, as indicated.

During Transfusion (Nurse’s Responsibilities):

1. Start Time Documentation: Record the precise time the blood transfusion is initiated.

2. Flow Rate Monitoring: Carefully regulate the blood flow rate according to the physician’s orders and established protocols.

3. Reaction Monitoring: Closely observe the patient for any signs or symptoms of an adverse reaction. If a reaction is suspected, stop the transfusion immediately.

4. Continuous Vital Sign Monitoring: Continuously monitor the patient’s vital signs to ensure they remain stable throughout the transfusion. Report any significant changes promptly.

5. Infusion Site Assessment: Regularly inspect the IV infusion site for signs of swelling, leakage, pain, or redness. Also, check the administration set for any signs of blood clotting within the tubing.

6. Disconnection: Once the transfusion is successfully completed, disconnect the blood administration set from the patient’s IV line.

7. End Time Documentation: Record the precise time the blood transfusion is completed.

8. Patient Acknowledgement: Thank the patient for their cooperation during the procedure.

After Transfusion (Nurse’s Responsibilities):

1. Post-Transfusion Reaction Monitoring: Continue to monitor the patient closely for any delayed post-transfusion reactions.

2. Ongoing Vital Sign Monitoring: Maintain a close watch on the patient’s vital signs and continue to update the temperature chart.

3. Blood Pack Retention: Retain the empty blood bag at the patient’s bedside for a specified period (typically 8-12 hours) as per hospital policy. This is crucial if a delayed reaction occurs and further investigation is needed.

Important Notes:

• Saline Flush: Administer normal saline solution intravenously both before starting and after completing the blood transfusion. This helps to ensure the IV line remains patent and prevents mixing of incompatible solutions.

• Administration Time Guidelines:

  • Whole blood and packed red blood cells are generally administered over a period of approximately 4 hours per unit.

  • Plasma, platelets, and cryoprecipitate (another blood component) are typically administered more rapidly, usually over about 20 minutes per unit. These timelines can be adjusted based on the patient’s clinical condition and physician’s orders