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Blood Transfusion & its Reaction

By: ANAND.B.NAIR NURSE EDUCATOR BSH

Blood transfusion is a lot like marriage. It should not be entered upon lightly, unadvisedly or more often than is absolutely necessary - Beal

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Although blood transfusions are life-saving procedure, they are have risk also. The most serious risks are transfusion reactions and infections.

WHAT IS BLOOD TRANSFUSION? A blood transfusion is the infusion of whole blood or a blood component such as plasma, red blood cells, or platelets into the patients venous circulation.

PURPOSE OF BTT
* REPLACEMENT * THERAPUTIC 1.To restore intravascular volume with whole blood or albumin. 2. To restore the oxygen capacity of blood by replacing red blood cells. 3. to replace clotting factor and correction of anemia

WHAT IS CROSS MATCHING ? Cross matching is the process of determining compatibility between blood specimens

WHAT IS BLOOD GROUP ? Blood group is an inherited trait, that determines the type of antigens and antibodies present in the blood

BLOOD TYPES A - B - AB - O

BLOOD GROUP A B AB O A B A+B

ANTIGEN antigen antigen antigens -

Negative

RH
Positive

WHAT IS ANTIGENS ? An antigens is a substance that causing the formation of antibodies


WHAT IS ANTIBODIES ? Antibodies is a protein substance develop in the body in response to the presence of an antigen that has entered the body

DONOR

The person giving the blood

RECIPENT

The person receiving the blood

Blood product transfusions sometimes cause transfusion reactions. There are is any unfavorable transfusion-related event occurring in a patient during or after transfusion of blood components .

what is blood transfusion reaction ? It is abnormal signs and symptoms that will occur during or after transfusion and effects the patients health

Acute Reaction

Causes Sensitivity to plasma protein or donor antibody, which reacts with recipient antigen

Clinical Manifestations Flushing itching ,rash urticaria, hives asthmatic wheezing laryngeal edema anaphylaxis

Management STOP TRANSFUSION IMMEDIATELY KEEP VEIN OPEN WITH NS Notify doctor , infection control, blood bank

Allergic

Give antihistamine as directed.


Send blood samples and blood bags to blood bank. Collect urine samples for testing.

Prevention
ASSESSMENT (assess the history) before transfusion ask the patient about past reaction. If patient has history of reaction, alert health care provider , emergency drugs should be ready.

Acute Reaction

Causes hypersensitivity to donor white blood cells , platelets, or plasma protein

Clinical
Manifestations

Management STOP TRANSFUSION IMMEDIATELY KEEP VEIN OPEN with NS Notify doctor , infection control, blood bank give antipyretics as directed. check temperature every 1/2hrs.or as indicated send blood samples and blood bags to blood bank. Collect urine samples for testing.

Febrile non hemolytic

Flushing sudden chills and fever headache anxiety

Prevention
ASSESSMENT

Give antipyretic before transfusion as directed Leukocyte LESS blood products may be recommended for future transfusion

Acute Reaction

Causes

Clinical
Manifestations

Management STOP TRANSFUSION IMMEDIATEL KEEP VEIN OPEN with NS Notify doctor , infection control, blood bank give antipyretics as directed. check temperature every 1/2hrs.or as indicated obtain cultures of patients blood return blood bags & blood set to blood bank. treat septicemia as directed ( IV fluids. Antibiotics...

Septic reactions

Transfusion of blood or blood components contaminated with bacteria

rapid onset of chills High fever Vomiting , diarrhea Marked hypotension

Prevention
don't keep the blood outside for Longer time because warm temperatures promote bacterial growth. inspect blood for gas bubbles, clotting or abnormal colour.

Acute Reaction

Causes

Clinical
Manifestations

Management

Circulatory overload

If Fluid administrated is greater than the circulatory system accommodation. Increased blood in pulmonary vessels and decreased lung compliance.

raise in venous pressure distended neck veins. Dyspnea Cough Crackles at base of lunges

STOP TRANSFUSION IMMEDIATELY. KEEP VEIN OPEN with NS Notify doctor , infection control, blood bank place patient upright with feet in dependent position. administer prescribed diuretic and oxygen

Prevention
Preferably concentrated blood products should be given. central venous pressure should be monitored for heart disease patient.

Acute Hemolytic Transfusion Reaction


Pathophysiology

Ab (in

recipient serum) + Ag (on RBC donor)


-Neuroendocrine

responses

-Complement Activation
-Coagulation Activation - Cytokines Effects
Acute hemolytic transfusion reaction

Acute Reaction

Causes Infusion of incompatible blood product. Antibodies in RECIPIENTS plasma


DONERS RBCs

Clinical Mainifestations
chills, fever lower back pain feeling of head fullness, flushing oppressive feeling Tachycardia,tachypnea hypotension,vascular collapes hemoglobinurea,hemog lobinemia bleeding acute renal failure

Hemolytic reaction

Incompatible PLASMA
OR

Antibodies in DONOR plasma


RECIPENTS RBCs

Incompatible RBCs

PREVENTION STOP TRANSFUSION IMMEDIATELY Verify patient KEEP VEIN OPEN with 0.9% identification from saline. sample collection to Notify doctor , infection control, product infusion. blood bank Begin infusion slowly treat shock if present and observe closely draw testing samples, collect urine samples. for 30 min. maintain blood pressure with IV consequences are in colloid solutions. proportion to the administer prescribed diuretic, amount of to maintain blood flow, glomerular incompatible blood filtration, and renal blood flow. transfused monitor hourly urine output.

MANAGEMENT

Patient may require dialysis if renal failure occurs

DELAYED REACTION

Causes

Clinical

Management

Mainifestations
The destruction of transfused flood cells by antibody not detect fever Mild jaundice Decreased hematocrit generaly no acute treatment is required, but hemolysis may be enough to cause shock and renal falure

Delayed hemolytic reaction

DELAYED REACTION

Causes

Clinical

Management

Mainifestations
Deposition of iron in the heart, endocrine organs,liver,spleen,ski n and other major organs as a result of multiple, long tearm transfusion . Diabetes Decreased thyroid function Heart failure and other symptoms related to major organ failure Treat symptomatically deferoximine which removes accumulated iron through the kidneys. I.V-I.M-S.C

Iron overload

DELAYED REACTION

CLINICAL CAUSES

MAINIFESTATIONS
Elevated liver enzymes Anorexia, malaise Nausea and vomiting Fever Dark urin Jaundice

MANAGEMENT

Hepatitis B

Treat symptomatically as instructed by doctors

Hepatitis C

INFECTED BLOOD PRODUCTS

Elevated liver enzymes Chronic liver disease and cirrhosis may develop Night sweats Unexplained weight loos Diarrhea Etc

Treat symptomatically as instructed by doctors

AIDS

As instructed by doctors

DELAYED REACTION

CLINICAL CAUSES

MAINIFESTATIONS Generalized rash Regional lymphadenopathy Presence of chancre


fever

MANAGEMENT

Syphilis

INFECTED BLOOD PRODUCTS INFECTED BLOOD PRODUCTS

Penicillin therapy

Malaria

Fatigue Hepatomegaly Spleenomegaly

Rest and suportive management

PREVENSION OF DELAYED REACTION

Proper blood screening In case of malaria doner should be asked if he has cold,flu or foreign travel

Nurses roles and points to remember during Blood Transfusion

PATIENT
Previous allergic reaction Consent Name and phone number of a contact person in case of emergency

Check physicians order for Blood component, volume, and rate of transfusion

NURSE
Only trained and qualified nurses are allowed to perform the blood transfusion steps

NURSE
While sending blood sample for cross matching, check CLEAR and CORRECT Patient name, file number, room number, age, sex, department, bed number, date,time,nurse name and signature

NURSE
BEFORE receiving blood Doctor order Consent Patient assessment Pre medicate the PT.30min. before transfusion.

PREPARE THE EQUIPMENT Having equipment available saves time and facilitates the task.

Blood filter designed to trap fibrin clots ,broken blood cells and other debris that accumulate during blood storage

Multi-lead tubing

NORMAL SALINE
ICE BAG, WARM COMPRESSES

ASEPTIC TECHNIQUES

Before receiving blood or blood product IV cannula to be inserted & maintained at a KVO rate.

while receiving the blood nurse should verify client identity, blood group, RH compatibility.

Flow chart

Healthy donors Blood screening for infectious diseases. Blood compatibility RH Proper storage Antibody screening

DONORS
LABPRATORY STAFF

BEFORE receiving blood


Doctor order Consent Patient assessment Preparation-IV cannula Equipment - Multi-lead tubing Premedicate the PT.30min-TAB. before transfusion - IV

AFTER receiving blood


Check blood Patient identity Patient assessment bed side

DURING
Instruct the client Remain with the patient-15min V/S every hour until 1hr after transfusion Blood components are infused within standard time limits ( 4 hours)

AFTER
Close observation to the pt. Proper dispose of IV tubing/bag Documentation

Identification of blood & blood products should be performed at the patients bedside by two LICENSED PROFESIONALS,QUALIFIED NURSES according to the facilitys policy.

Blood should be transported and transfused to only one patient at the time

Hand hygiene to prevents the spread of microorganisms . Gloves protect against accidental exposure to the patients blood.

If youre administering whole blood, gently invert the bag several times to mix the cells.

Start the administration slowly (not more than 25 to 50 ml for the first 15 minutes of transfusion

Medication are NEVER added to blood or blood products.

If no signs of a reaction appear within 15 minutes, youll need to adjust the flow clamp to the ordered infusion rate.

Then remember to reconnect the original I.V. fluid, if necessary, or disconnect the I.V. infusion.

Practice Pointers
Although some microaggregate filters can be used for up to 10 units of blood, always replace the filter & tubing if more than 1 hour elapses between transfusions.

In case of emergency, When administering multiple units of blood, use blood warmer to avoid hypothermia.

Blood has not been used within 30minutes must be RETURNED , if blood Transfusion exceeds more than 4hrs it should be DISCONTINUED to prevent the risk of BACTERIAL CONTAMINATION.

Life Saving &

Life Threatening Process


Thank you