BLOOD AND BLOOD COMPONENTS

BLOOD

A mixture of cells A complex TRANSPORT mechanism Transports hormones Removes waste products Regulates body temperature Protects the body Promotes hemostasis Supplies oxygen BLOOD VOLUME: 8% of total body weight = varies by age & body composition

CATEGORY

Ml/Kg

Blood Volume

Adult male Adult female Child Neonate

70 mL/kg 70ml/kg 80ml/kg 85-90ml/kg

90kg=6300 ml 60kg=4200ml 30kg=2400ml 3kg=255-270ml

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Temperature pH Specific Gravity 5 times the viscosity of water

38C (100.4F) 7.35 - 7.45 1.048 1.066

COMPOSITION OF BLOOD

1. PLASMA o Liquid part of the blood o Consists of serum and fibrinogen o Contains plasma proteins such as: Albumin = regulates & maintains Serum globulins = for transportation
Fibrinogen, prothrombin, plasminogen = to stop the bleeding

2. CELLULAR COMPONENTS formed elements a. RBC = responsible for oxygen transport b. WBC = play a major role in defense against microorganisms c. PLATELETS = responsible in clot formation BLOOD TYPES Everybody has a Blood type. The most common Blood type classification system is the ABO system discovered and defined by Karl Landsteiner in the early 1900s.. The surface of an individuals RBC contains a number of proteins known as ANTIGENS( Agglutinogens ), which promotes agglutination or clumping of blood cells. Agglutinins preformed antibodies to RBC antigens that are present in the plasma -are protectors of our bodies and are responsible for ensuring that only the Blood cells of our own particular Blood type exist in our bodies.

BLOOD TRANSFUSION * * * is the process of transferring blood or blood-based products from one person into the circulatory system of another. The person receiving the blood is the recipient. The person giving the blood is the donor

Blood Transfusion may be necessary for any of the following reasons:

Maintenance of blood volume Maintenance of coagulation properties. Maintenance of oxygen-carrying capacity of blood.

BLOOD DONATION

National Blood Services Act of 1994

Also known as the Republic Act 7719 AN ACT PROMOTING VOLUNTARY BLOOD DONATION PROVIDING FOR AN ADEQUATE SUPPLY OF SAFE BLOOD, REGULATING BLOOD BANKS, AND PROVIDING PENALTIES FOR VIOLATION THEREOF.
Eligible Donors Must: Be at least age 18-55 Weigh at least 110 lb (50 kg) Free from skin disease Have a hemoglobin level of at least 12.5 g/dl (women) or 13.5 g/dl (men) - Stable VS - (-) hx of jaundice, malaria, TB, etc. - (-) infection -previous blood transfusion - 6 mos - previous blood donation - 3 mos - No surgical procedure, ear piercing, needle punctures, or major illnesses 1yr on

Alcohol intake (-) 48 hours intake (-) medication intake for 2 days (-) pregnancy

TYPING AND CROSS MATCHING

Before any blood can be given to a patient, it must be determined that the blood of the donor is compatible with the patient. The laboratory examination to determine a persons blood group and Rh factor is called BLOOD TYPING. The process of determining compatibility between blood specimens is CROSSMATCHING. RBCs from the donor blood are mixed with serum from the recipient, a reagent from (Coombs serum) is added and the mixture is examined for visible agglutination. If no antibodies to the donated RBCs are present in the recipients serum, agglutination does not occur and the risk of transfusion reaction is small.

BLOOD COLLECTION/ DONATION METHODS * * * Homologous (Allogeneic)Directed Donor Autologous Donor (Self)

TWO METHODS IN OBTAINING BLOOD FROM THE DONOR

1. Whole Blood Donation 2. Apheresis plasmapheresis plateletpheresis leukopheresis

TRANSFUSION DEVICES

Blood Warmers Administration sets( Y type tubing) Filters - retain blood clots & other debris special filters : microaggregate leukoreduction Needles - g.18 adults, g22 for bigger children g 23/24 infants, smaller children Compatible Fluids 0.9% Saline is the only acceptable fluid Pressure Bags used to increase flow rates usually during emergencies

BLOOD PRODUCTS

1. WHOLE BLOOD

Unprocessed blood containing all cellular and plasma components of donor blood 450 ml in 63mlof anticoagulant solution Actively bleeding patient Shock Neonatal exchange transfusion Replaces blood volume and all blood products

Fresh Whole Blood -w/in 24 collection - RBC + platelets + coagulation factors

2. PACKED RED BLOOD CELL Product that remains after removal of most plasma by sedimentation or centrifugation of whole blood RBC, (-)plasma Anemia, blood loss Neonatal exchange transfusion

3. WASHED RED BLOOD CELL RBC that has been washed with a compatible solution ( NSS ) to reduce leucocytes 3x-4x RBC depleted of > 95% of leukocytes and plasma proteins ; 20 % RBC loss Patients requiring repeated BT who develop repeated transfusion reactions ( febrile, urticarial and anaphylactic reactions)

4. FRESH FROZEN PLASMA

Non cellular fluid portion of anti coagulated blood extracted from a single donor unit within 8 hrs post donation and rapidly frozen Plasma proteins & all coagulation factors Control or prevention of bleeding in multiple coagulation defects
10

5. PLATELET CONCENTRATE At least 5.5 x 10 platelets in 50ml plasma w/ or w/o bleeding w/ APC <20,000 platelet dysfunction w/ bleeding Fresh platelets most effective

6. CRYOPRECIPITATE cold insoluble portion of the plasma after FFP has been thawed Factor VIII, vWF( von Willebrand factor ), Fibrinogen 7. CRYOSUPERNATE residual plasma refrozen after removal of cryoprecipitate (-) Factor VIII Used for clients with clotting factor deficiencies

RECOMMENDED INFUSION TIME

WHOLE BLOOD PRBC/WRBC PLASMA

4 hours 4 hours 2-3 hours Fast drip/ 10-15 mins

450-500 ml 250-350ml 200-250 ml 50-70ml 300-400ml 15 ml 200 ml

PLATELETS Platelet Pheresis Cryoprecipitate Cryosupernate

PREPARATION TIME
Whole Blood 15-45 minutes Washed RBC 3 hours PRBC/ FP/ PRP 2 hours Platelet concentrate 4 hours FFP at least 24 hours Cryoprecipitate &Cryosupernate at least 24 hours Platelet Pheresis 4-5 hours

Blood product Fresh Frozen Plasma

Storage Temperature - 18 C

Expiration date 6 hrs after thawing ; can be stored for one year if not used

Platelet Concentrate Room temperature Packed Red blood Cell 1-6 C Whole Blood Cryoprecipitate -18 C 1-6 C 35 days 35 days 6 hrs after thawing ; can be stored for one year if not used 5 days

Nurses Responsibilities in Blood Transfusion

Before Transfusion
Obtain Informed consent Explain the procedure to the patient/relatives including the benefits & risks Review the doctors order, including any special processing requested Assess the patient Obtain important medical history information Review pertinent laboratory values Vital signs Assessment for skin rashes, shortness of breath, wheezing, pain, chills or nausea In patient with cardiopulmonary disease, listen to lungs to establish a baseline for the presence of any rales( crackles) Give pre BT medication as ordered Ex. Antihistamine Benadryl Avoid obtaining either whole blood or packed RBCs until youre ready to begin the transfusion. Prepare the equipment when youre ready to start the infusion. When you received the delivery from the blood bank, you should receive both the product and the transfusion record that corresponds to it. Inspect the blood for the following: Labels

Integrity of Unit Appearance Dont transfuse the blood product if you discover a discrepancy in the blood number, blood slip type, or patient identification number
Two nurses must identify the patient and. blood productbefore administering a transfusion (to prevent errors & potentially fatal reaction.

DURING TRANSFUSION

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Administer the blood or component at the recommended rate. Stay with the patient for the first few minutes of the transfusion Review signs and symptoms of what the patient should report to you. Dont add medications to the blood. Blood extraction during transfusion is not allowed. Monitor the patient regularly including the blood being transfused. Discontinue transfusion immediately once the patient manifest symptoms of transfusion reaction, assess the patient and notify the doctor.

Blood transfusion regulation

Gtts/min= vol. of blood in cc x

No. of hours to be infused

drop factor 60

AFTER TRANSFUSION

Continue to monitor patient for any signs and symptoms of reaction for at least one hour after the transfusion. Obtain any ordered post-transfusion laboratory studies. Document the transfusion in the patients chart. After completing the transfusion, youll need to put on gloves anddiscard the used transfusion equipment.

DOCUMENTING BLOOD TRANSFUSION

Date and time the transfusion was started and completed Name of the health care professional who verified the information of the patient and the blood Catheter type and gauge

Total amount of the transfusion Type of blood component w/serial number Patients vital signs before and after the transfusion Infusion device used Flow rate and if blood warming was used Vital signs obtain prior to, during, and after the transfusion Transfusion reactions & nursing action Document interventions done and to whom you notified. Patients outcome.

SAFETY PRECAUTIONS

Make sure that YOU are protected too by proper Personal Protective Equipment (PPE) Always perform disinfection technique. If possible, use a needleless system. If using sharps, do not recap the needle. Always observe proper waste disposal according to your institutions policy. If there are spills, never touch the blood with bare hands. Make sure that blood bag is secured. Always double or triple check. Always perform HAND HYGIENE

BLOOD TRANSFUSION REACTIONS AND MANAGEMENT

1.

FEBRILE Pyrexia Rigors Anxiety Restlessness

Treatment / Management 1. Stop transfusion /slow rate of flow 2. Give antipyretics as ordered 3. If no improvement in 30 mins, discontinue transfusion.

2. CIRCULATORY Distention of cervical veins Pulmonary edema Dyspnea

 Headache Heaviness in limbs, may be pyrexia and rigors Treatment / Management 1. Discontinue transfusion 2. Give diuretics. 3. ALLERGIC Pyrexia and rigors Urticaria Facial edema Dyspnea

Treatment / Management 1. Discontinue transfusion 2. Give antihistamines 3. Watch for laryngeal edema

4. HEMOLYTIC Pyrexia , rigors, lumbar pain Pain along vein Jaundice Hemoglobinuria Oliguria later uremia

Treatment / Management 1. Discontinue transfusion 2. Refer to the physician 3. Save all urine, used bottles, packs and blood samples

5. INFECTED BLOOD Hyperpyrexia Pain in limbs and chest Headache, pallor

 Burning pain along injected vein Low blood pressure, rapid pulse Profound collapse and shock 1. 2. 3. 4. Treatment / Management Discontinue transfusion Refer to the physician Save all urine, used bottles, packs , blood samples with labels.
Anti-shock treatment, antibiotics in large amounts

Associated Acute lung Injury ( TRALI )

-syndrome of acute respiratory distress Symptoms: non cardiogenic pulmonary edema, hypotension & often assocaited with fever. Treatment/Management: -Oxygen administration - May require intubation and mechanical ventilation

Iron Toxicity

Consequence of chronic RBC transfusion

Citrate Toxicity

Hypocalcemia may occur Transfusion Associated Graft Vs Host Disease - the recipients (HOST) tissues are attacked by the donated white blood cells ( GRAFT). Symptoms : fever, rash, low BP, low blood counts, tissue destruction & shock

Mary Jane P. Ediza, RN IV Nurse Preceptor