1. BLOOD
TRANSFUSION
PRESENTED BY:
Carmina F. Gurrea, RN
Clinical Instructor

2. OVERVIEW
 Blood Transfusion
 Components of the Blood
 Blood transfusion products
 Compatibility test
 Indications for blood
transfusion
 Adverse effects of blood
transfusion
 Nursing Responsibilities
 Steps in Administering Blood
Transfusion products

3. What is Blood Transfusion?
 A Blood Transfusion is the
introduction of whole blood or
components of whole blood –
such as plasma, serum,
erythrocytes, or platelets –
into the venous circulation.

4. What are the Components of the Blood?
Human blood consists of about 22 percent solids and 78
percent water. The components of human blood are:
 Plasma, in which the blood cells are
suspended, including:
 Red blood cells (erythrocytes) - carry
oxygen from the lungs to the rest of
the body.
 White blood cells (leukocytes) - help
fight infections and aid in the
immune process. Types of white
blood cells include:
 Lymphocytes
 Monocytes
Blood Cellular Portions  Eosinophils
 Basophils
 Neutrophils (granulocytes)

5. What are the Components of the Blood?
 Platelets (thrombocytes) -
help in blood clotting.
 Fat globules
 Chemical
substances, including:
Carbohydrates
Proteins
Hormones
 Gases, including:
Oxygen
Carbon dioxide
Nitrogen

6. BLOOD TRANSFUSION
1. Whole blood – provides both
PRODUCTS O2 carrying capacity and
volume expansion.
2. Red Blood Cells – contains the
oxygen carrying capacity
(hemoglobin); for the
treatment of anemia in
normovolemic patients who
require an increase in the
oxygen capacity
3. Platelets – for the treatment
of bleeding cause by
thrombocytopenia

7. COMPATIBILITY  The most important test include ABO
blood typing, Rh typing, cross matching,
TEST the direct anti globulin test, and the anti
body screening test.
 The donor’s blood will also be screened
for Hep B, syphillis, AIDS and the
Cytomegalovirus
 Typing and cross matching establishes
the compatibility between the donor and
recipient , and minimize the risk of
hemolytic reaction.
 Rh Blood group – compose of the Rh +,
Rh -
 HLA “Human leukocyte antigens” these
are mostly detected on lymphocytes w/c
is necessary for immunity,these
determines the degree of
histocompatibility between the donor
and recipient

8. ABO & Rh Grouping
Antigen - any substance that
causes the formation of
antibodies to it.
Antibody - proteins of the
globulin class, most often
gamma globulins, produced by
lymphocytes and plasma cells
in response to antigenic
stimulation.

9. FOUR BLOOD TYPES
1. Group O- universal RBC donor
2. Group AB-universal red cell
recipient because their serum
contains no ABO antibodies.
(patient can receive packed or
washed RBC from A,B,or O
donors
3. Group A – person has an anti
– B in his serum
4. Group B – person has an anti
– A in his serum

10. Compatibility Test
 Group O “Universal donor” lacks both A & B antigen ,
which can be transfused (as packed RBC’s) in limited
amounts in emergency cases with little risk of
agglutination.
 Group AB- has neither anti A or anti B antibodies,so he can
receive A,B,O (packed RBC’s) making him a “Universal
recipient”

11. Rh blood grouping
IF the Rh (-) receives a Rh + ,Rh
(D) positive immunization will
occur resulting in RBC
hemolysis

12. Indications for a blood transfusion
1. Blood loss due to trauma
2. Heart or other major surgery
3. Organ transplants
4. Bleeding disorders (hemophilia)
5. Anemia (sickle cell)
6. Leukemia
7. Disorders that destroy blood cells
or bone marrow
8. RH incompatibility in newborn
babies

13. Adverse reactions
1. Febrile – fever & chills,which occurs
within the 30 mins of transfusion
Treatment - stop transfusion, antipyretics
Prevention – pre transfusion antipyretic
2. Allergic reaction (mild to moderate) –
urticaria,joint pain,wheezing
Treatment – Stop
transfusion, antihistamine
Prevention – pre transfusion antihistamine

14. Adverse reactions
3. Hypervolemic – dyspnea, arrhythmias,
hypertension
Treatment – cardio pulmonary support
Prevention – avoid rapid or excessive
transfusion
4. Bacterial sepsis – chills, fever, shock
Treatment – stop transfusion,
support blood pressure
Prevention - care in blood collection
& storage

15. Nursing Responsibilities
1. Confirm that there is a
physician’s order and a signed
consent from the client.
2. Have two nurses confirm that the
client name and ID number,
blood type, RH type, and product
unit numbers are correct. Check
also the expiration date.
3. Make sure the transfusion is
started within 30 minutes of
arrival at bedside.
4. Maintain asepsis. If possible
wear gloves before performing
venipuncture, transfusing blood,
and when terminating blood and
disposing of equipment.

16. Nursing Responsibilities
5. Use appropriate
blood administration
set
6. Mix the blood cells
with plasma gently
to maintain their
integrity
7. Assess the client
closely for
transfusion
reactions.

17. Nursing Responsibilities
8. If any reaction occurs
a. Stop infusion immediately
b. Notify the physician
c. Maintain patency of the IV
with normal saline
d. Send the blood to the
laboratory
e. Monitor vital signs frequently
f. Send a urine specimen to the
laboratory if hemolytic
reaction is suspected

18. Steps/Checklist
1. Verify the doctor’s order and make
a treatment card according to
hospital policy.
2. Observe the 10 rights when
preparing and administering any
blood or blood components
3. Explain the procedure/rationale for
giving blood transfusion to patient
and significant others and secure
consent. Get patient’s history
regarding previous transfusion
4. Explain the importance of the policy
on Voluntary Blood Donation (RA
7719 – National Blood Service Act
of 1994)

19. Steps/Checklist
5. Request prescribed blood/ blood
components from blood bank to to
include blood typing and cross-
matching and blood result of
transmissible disease
6. Using a clean lined tray, get
compatible blood from hospital blood
bank.
7. Wrap blood bag with clean towel and
keep it at room temperature.
8. Have a doctor and a nurse assess
patient’s condition. Counter check
the available blood to be transfused
against the cross-matching sheet.
The ABO grouping and Rh serial no.
of each blood unit and expiry date
with the blood bag label and other
laboratory blood exams as required
before transfusion (Hgb and Hct)

20. Steps/Checklist
9. Get the baseline vital signs (BP,
RR, & temperature) before
transfusion. Refer to MD
accordingly.
10. Give pre med 30 min before
transfusion as prescribed.
11. Do hand hygiene before and after
procedure
12. Prepare equipment needed for BT
(IV Injection tray compatible BT
set, IV catheter/ needle G19,
plaster, tourniquet, blood/ blood
components to transfused, plain
NSS 500cc, IV set, needle gauge 18
(only if needed), IV hook, gloves,
sterile 2x2 gauze or transparent
dressing, etc.

21. Steps/Checklist
13. If main IVF is with dextrose
5%, initiate and IV line with
appropriate IV catheter with plain
NSS on another site, anchor
catheter properly and regulate IV
drops.
14. Open compatible blood set
aseptically and close roller clamp.
Spike blood bag carefully, fill the
drip chamber at least half
full, prime tubing and remove air
bubbles (if any), use needle G18
or G19 for side drip (for adults) or
G22 for pedia (if blood is given
through the Y injection port, the
gauge of the needle is
disregarded)

22. Steps/Checklist
15. Disinfect the Y-injection port of IV
tubing (Plain NSS and insert the
needle from the BT administration
set and secure with adhesive tape.
16. Close roller clamp of IV fluid of
plain NSS and regulate to KVO
while transfusion is going on.
17. Transfuse the blood via the
injection port and regulate at 10-
15gtts/min. initially for 15mins and
then at the prescribed rate (usually
based on the patient’s condition.)
18. Monitor the patient within the first
5 – 10 mins of transfusion and refer
immediately to the MD for any
adverse reactions.

23. Steps/Checklist
19. Observe/ assess patient on an on-going
basis for any untoward signs &
symptoms such as flushed skin, chills,
elevated temperature, itchiness,
urticaria, dyspnea. If any of these
symptoms occur, stop transfusion, open
the IV line with plain NSS and regulate
accordingly and report to the doctor
immediately.
20. Swirl the bag gently from time to time
to mix the solid with the plasma N.B.
one BT set should be used for 1-2 units
of blood.
21. When blood is consumed, close the
roller clamp of BT and disconnect from
IV lines then regulate the IVF of plain
NSS as prescribed.
22. Continue to observe and monitor
patient post transfusion for delayed
reaction could still occur.

24. Steps/Checklist
23. Re – check Hgb and Hct, bleeding
time, serial platelet count within
specified hourse as prescribed and/
or per institution policy.
24. Discard blood bag and BT set and
sharps according to Health Care
Waste Management (DOH/ DENR)
25. Fill out adverse reaction sheet as
per institutional policy.
26. Remind the doctor about the
administration of calcium gluconate
if patient has several units of blood
transfusion (3-5 more units of
blood)

25. Thank You!