What Is a Blood Transfusion?

A blood transfusion is a safe, common procedure in which blood is given to you through an intravenous (IV) line in one of your blood vessels. Blood transfusions are done to replace blood lost during surgery or due to a serious injury. A transfusion also may be done if your body can't make blood properly because of an illness. During a blood transfusion, a small needle is used to insert an IV line into one of your blood vessels. Through this line, you receive healthy blood. The procedure usually takes 1 to 4 hours, depending on how much blood you need. Blood transfusions are very common. Each year, almost 5 million Americans need a blood transfusion. Most blood transfusions go well. Mild complications can occur. Very rarely, serious problems develop. Important Information About Blood The heart pumps blood through a network of arteries and veins throughout the body. Blood has many vital jobs. It carries oxygen and other nutrients to your body's organs and tissues. Having a healthy supply of blood is important to your overall health. Blood is made up of various parts, including red blood cells, white blood cells, platelets (PLATE-lets), and plasma. Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts. Blood Types Every person has one of the following blood types: A, B, AB, or O. Also, every person's blood is either Rh-positive or Rhnegative. So, if you have type A blood, it's either A positive or A negative. The blood used in a transfusion must work with your blood type. If it doesn't, antibodies (proteins) in your blood attack the new blood and make you sick. Type O blood is safe for almost everyone. About 40 percent of the population has type O blood. People who have this blood type are called universal donors. Type O blood is used for emergencies when there's no time to test a person's blood type. People who have type AB blood are called universal recipients. This means they can get any type of blood. If you have Rh-positive blood, you can get Rh-positive or Rh-negative blood. But if you have Rh-negative blood, you should only get Rh-negative blood. Rh-negative blood is used for emergencies when there's no time to test a person's Rh type. Blood Banks Blood banks collect, test, and store blood. They carefully screen all donated blood for possible infectious agents, such as viruses, that could make you sick. (For more information, see "What Are the Risks of a Blood Transfusion?") Blood bank staff also screen each blood donation to find out whether it's type A, B, AB, or O and whether it's Rh-positive or Rh-negative. Getting a blood type that doesn't work with your own blood type will make you very sick. That's why blood banks are very careful when they test the blood. To prepare blood for a transfusion, some blood banks remove white blood cells. This process is called white cell or leukocyte (LU-ko-site) reduction. Although rare, some people are allergic to white blood cells in donated blood. Removing these cells makes allergic reactions less likely. Not all transfusions use blood donated from a stranger. If you're going to have surgery, you may need a blood transfusion because of blood loss during the operation. If it's surgery that you're able to schedule months in advance, your doctor may ask whether you would like to use your own blood, rather than donated blood. If you choose to use your own blood, you will need to have blood drawn one or more times prior to the surgery. A blood bank will store your blood for your use. Alternatives to Blood Transfusions Researchers are trying to find ways to make blood. There's currently no man-made alternative to human blood. However, researchers have developed medicines that may help do the job of some blood parts. For example, some people who have kidney problems can now take a medicine called erythropoietin that helps their bodies make more red blood cells. This means they may need fewer blood transfusions. Surgeons try to reduce the amount of blood lost during surgery so that fewer patients need blood transfusions. Sometimes they can collect and reuse the blood for the patient. Basic Blood Transfusion Procedure Before a transfusion, the nurse will compare the patient's armband with the label on the unit of blood to make certain he or she receives the correct blood product. If the patient does not already have an intravenous (IV) line in his or her arm, the nurse will start one. A nurse will check the patient's temperature, blood pressure, and pulse before and several times during the transfusion. Patients are not necessarily confined to a bed or chair during a transfusion. They may resume their previous level of activity after the transfusion. Normally, a person receiving a transfusion will be asked to stay in a bed or chair during the transfusion to monitor for possible reactions. Every donor is screened before donating blood, and an exhaustive series of tests is conducted to determine blood purity. The chance of illness being passed through a blood transfusion is extremely small. Blood Transfusion Procedure for administering a blood transfusion: y Patient Assessment/Preparation o Previous transfusion history - previous history of adverse reactions o Previous history of heart or renal disease - may need to give transfusion slower (also with pediatric and geriatric patients) o Assess IV site - 19 gauge for adults

Adults Pediatric and Geriatric Patients o

19 gauge Smallest may use is 22 gauge

A 19 guage IV catheter is needed in order to minimize hemolysis and allow the transfusion to infuse within the four hour maximum time limit allowed for a unit of blood. If a smaller gauge is needed, the blood bank may be able to split the unit of blood so that it could be given over a longer period of time (by giving 1/2 a unit each time). o Baseline vital signs and assessment for skin rashes, dyspnea, wheezing, pain, chills, itching, or nausea. o Laboratory results: hemoglobin, hematocrit, electrolytes, fluid balance o Double check physician's order o Obtain informed consent as needed o Explain procedure to patient y Gather equipment, also check that transfusion report is on the patient's chart. o A filter must be used when administering blood components - standard blood sets have a 170-220 m filter. Tubing also comes in a set that has an in-line hand pump. Generally each unit of blood is administered with new tubing, although one set of tubing can be used for two units if the units are given consecutively (if the filter becomes clogged, the blood will not infuse quick enough and new tubing will have to be used). o Special leukocyte-removing filters are used when patients need leukocyte-reduced RBCs. o Only IV pumps approved from blood administration can be used with transfusions, since other pumps may cause hemolysis. o Pressure bags and warmers are used when patients require rapid transfusions and/or multiple units. Pressure bags (not blood pressure cuffs) are inflated to about 200 mmHg so the blood is infusing in a constant stream in the drip chamber. Pressures of about 300 mmHg will cause hemolysis and damage the blood bag. If a blood warmer is used, the blood must not be heated above 420 C. Only approved devices for warming blood can be used. Administering RBCs y Obtain the blood from the blood bank (blood left out of an unmonitored refrigerator for more than 30 minutes cannot be returned to the blood bank). y Inspect the blood bag for leaks, abnormal cloudiness, clots, bubbles, or an abnormal dark purple-blue color.

Verify that the correct blood is being given to the correct patient (requires 2 qualified people, usually 2 RNs, according to agency policy). Nursing students are never allowed to verify blood.

Check expiration date Compare the following information on the unit label, the Unit Record attached to the unit of blood, and the Transfusion Report in the patient's chart: y Patient's name and hospital/ID number y Blood Unit Number y Blood type (ABO/Rh) y Component label (RBCs, platelets, etc.) y Special processing if ordered - CMV negative, irradiated, or leukocyte reduced y Autologous blood or directed donation

Then recheck the information, comparing the patient's ID band with the unit of blood and the Transfusion Report. If possible have the patient state their full name. The two people verifying the information sign the Unit Record attached to the unit.

Document the time and date the transfusion was started. Keep the Unit Record attached to the unit until the transfusion is complete. Prime tubing with normal saline

Vital signs should be taken before starting the infusion, after 15 minutes, as appropriate based on the patient's condition, and at the completion of the transfusion. Transfusion should be complete within 4 hours of blood bags being removed from refrigeration (the risk of bacterial growth is too great after 4 hours). A unit of blood can usually be transfused over 1 1/2 hours. Infusion rates are based on the patient's blood volume, cardiac status, and hemodynamic condition. Patients with hypovolemia can tolerate blood being administered as fast as possible. Healthy adults with chronic anemia can receive RBCs safely at a rate of 3-4 ml/kg/hr. Patients with cardiovascular compromise may tolerate rates of no more than 1 ml/kg/hr. Nursing Responsibilities for blood transfusion the nurse is responsible for insuring that the right unit of blood is to be administered to the right patient after typing and crossmatching by the lab. this is done by checking the lot, serial numbers, blood type, and expiration date with another nurse or qualified lab personnell. then the unit of blood has to be checked off with another nurse before administration. only registered nurses are allowed by law to administer blood products. before administering the unit, the nurse has to get consent forms signed by the patient or a qualified representative of the patient, except in the cases of trauma or life saving situations if the patient is unable to make that decision. all patients have the right to refuse transfusions. after consents are signed and the blood is checked by appropriate personnell, the nurse has to take a complete set of vital signs for a baseline. after starting the transfusion, the vital signs must be checked after 15 minutes, then 30 minutes from then, then at one hour. then vital signs must be checked every hour, according to hospital protocol. the vital signs are checked this often to monitor for a reaction to the blood. if a reaction occurs, then the transfusion must be stopped immediately and normal saline infused. blood can only be transfused with normal saline. some hospitals may give premedications before transfusion to reduce the chance of a reaction. a unit of whole blood (packed red blood cells) must be infused over 3.5-4 hours, but not over 4 hours from the time of the start of the transfusion. Source(s): i am a registered nurse the nurse is responsible for insuring that the right unit of blood is to be administered to the right patient after typing and

crossmatching by the lab. this is done by checking the lot, serial numbers, blood type, and expiration date with another nurse or qualified lab personnell. then the unit of blood has to be checked off with another nurse before administration. only registered nurses are allowed by law to administer blood products. before administering the unit, the nurse has to get consent forms signed by the patient or a qualified representative of the patient, except in the cases of trauma or life saving situations if the patient is unable to make that decision. all patients have the right to refuse transfusions. after consents are signed and the blood is checked by appropriate personnell, the nurse has to take a complete set of vital signs for a baseline. after starting the transfusion, the vital signs must be checked after 15 minutes, then 30 minutes from then, then at one hour. then vital signs must be checked every hour, according to hospital protocol. the vital signs are checked this often to monitor for a reaction to the blood. if a reaction occurs, then the transfusion must be stopped immediately and normal saline infused. blood can only be transfused with normal saline. some hospitals may give premedications before transfusion to reduce the chance of a reaction. a unit of whole blood (packed red blood cells) must be infused over 3.5-4 hours, but not over 4 hours from the time of the start of the transfusion. Source(s): i am a registered nurse What Is Anemia? Anemia is a condition that develops when your blood lacks enough healthy red blood cells. These cells are the main transporters of oxygen to organs. If red blood cells are also deficient in hemoglobin, then your body isn't getting enough oxygen. Symptoms of anemia -- like fatigue -- occur because organs aren't getting what they need to function properly. Anemia is the most common blood condition in the U.S. It affects about 3.5 million Americans. Women and people with chronic diseases are at increased risk of anemia. Important factors to remember are: y Certain forms of anemia are hereditary and infants may be affected from the time of birth. y Women in the childbearing years are particularly susceptible to a form of anemia called iron-deficiency anemia because of the blood loss from menstruation and the increased blood supply demands during pregnancy. y Seniors also may have a greater risk of developing anemia because of poor diet and other medical conditions. There are many types of anemia. All are very different in their causes and treatments. Iron-deficiency anemia, the most common type, is very treatable with diet changes and iron supplements. Some forms of anemia -- like the anemia that develops during pregnancy -- are even considered normal. However, some types of anemia may present lifelong health problems. What Causes Anemia? There are more than 400 types of anemia, which are divided into three groups: y Anemia caused by blood loss y Anemia caused by decreased or faulty red blood cell production y Anemia caused by destruction of red blood cells Anemia Caused by Blood Loss Red blood cells can be lost through bleeding, which can occur slowly over a long period of time, and can often go undetected. This kind of chronic bleeding commonly results from the following: y Gastrointestinal conditions such as ulcers, hemorrhoids, gastritis (inflammation of the stomach), and cancer y Use of nonsteroidal anti-inflammatory drugs (NSAIDS) such as aspirin or Motrin y Menstruation and childbirth in women, especially if menstrual bleeding is excessive and if there are multiple pregnancies Anemia Caused by Decreased or Faulty Red Blood Cell Production The body may produce too few blood cells or the blood cells may not function correctly. In either case, anemia can result. Red blood cells may be faulty or decreased due to abnormal red blood cells or the a lack of minerals and vitamins needed for red blood cells to work properly. Conditions associated with these causes of anemia include the following: y Sickle cell anemia y Iron deficiency anemia y Vitamin deficiency y Bone marrow and stem cell problems y Other health conditions Sickle cell anemia is an inherited disorder that affects African-Americans. Red blood cells become crescent-shaped because of a genetic defect. They break down rapidly, so oxygen does not get to the body's organs, causing anemia. The crescent-shaped red blood cells also get stuck in tiny blood vessels, causing pain. Understanding Anemia -- the Basics What Causes Anemia? continued... Iron-deficiency anemia occurs because of a lack of the mineral iron in the body. Bone marrow in the center of the bone needs iron to make hemoglobin, the part of the red blood cell that transports oxygen to the body's organs. Without adequate iron, the body cannot produce enough hemoglobin for red blood cells. The result is iron-deficiency anemia. This type of anemia can be caused by: y An iron-poor diet, especially in infants, children, teens, vegans, and vegetarians y The metabolic demands of pregnancy and breastfeeding that deplete a woman's iron stores y Menstruation y Frequent blood donation

y y y

Endurance training Digestive conditions such as Crohn's disease or surgical removal of part of the stomach or small intestine Certain drugs, foods, and caffeinated drinks

Vitamin-deficiency anemia may occur when vitamin B-12 and folate are deficient. These two vitamins are needed to make red blood cells. Conditions leading to anemia caused by vitamin deficiency include: y Megaloblastic anemia: Vitamin B-12 or folate or both are deficient y Pernicious anemia: Poor vitamin B-12 absorption caused by conditions such as Crohn's disease, an intestinal parasite infection, surgical removal of part of the stomach or intestine, or infection with HIV y Dietary deficiency: Eating little or no meat may cause a lack vitamin B-12, while overcooking or eating too few vegetables may cause a folate dificiency y Other causes of vitamin deficiency: pregnancy, certain medications, alcohol abuse, intestinal diseases such as tropical sprue and celiac disease During early pregnancy, sufficient folic acid can prevent the fetus from developing neural tube defects such as spina bifida. Bone marrow and stem cell problems may prevent the body from producing enough red blood cells. Some of the stem cells found in bone marrow develop into red blood cells. If stem cells are too few, defective, or replaced by other cells such as metastatic cancer cells, anemia may result. Anemia resulting from bone marrow or stem cell problems include: y Aplastic anemia occurs when there's a marked reduction in the number of stem cells or absence of these cells. Aplastic anemia can be inherited, can occur without apparent cause, or can occur when the bone marrow is injured by medications, radiation, chemotherapy, or infection. y Thalassemia occurs when the red cells can't mature and grow properly. Thalassemia is an inherited condition that typically affects people of Mediterranean, African, Middle Eastern, and Southeast Asian descent. This condition can range in severity from mild to life-threatening; the most severe form is called Cooley's anemia. y Lead exposure is toxic to the bone marrow, leading to fewer red blood cells. Lead poisoning occurs in adults from work-related exposure and in children who eat paint chips, for example. Improperly glazed pottery can also taint food and liquids with lead. Anemia associated with other conditions usually occur when there are too few hormones necessary for red blood cell production. Conditions causing this type of anemia include the following: y Advanced kidney disease y Hypothyroidism y Other chronic diseases -- examples include cancer, infection, and autoimmune disorders such as lupus or rheumatoid arthritis

Anemia Caused by Destruction of Red Blood Cells When red blood cells are fragile and cannot withstand the routine stress of the circulatory system, they may rupture prematurely, causing hemolytic anemia. Hemolytic anemia can be present at birth or develop later. Sometimes there is no known cause (spontaneous). Known causes of hemolytic anemia may include: y y y y y y Inherited conditions, such as sickle cell anemia and thalassemia Stressors such as infections, drugs, snake or spider venom, or certain foods Toxins from advanced liver or kidney disease Inappropriate attack by the immune system (called hemolytic disease of the newborn when it occurs in the fetus of a pregnant woman) Vascular grafts, prosthetic heart valves, tumors, severe burns, chemical exposure, severe hypertension, and clotting disorders In rare cases, an enlarged spleen can trap red blood cells and destroy them before their circulating time is up

Kathleen D. Obatay Rick Wilson Bunao RN MAN PCI: Junah Nahial CUSN-4 Self

BSN-3

07-09-2011 Group #3 ThFS 7 am 3pm

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