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Blood Administration
Basic Immunology
Blood Type A:
A Antigen is present on the RBC surface
Anti B antibodies in the plasma
Blood Type B: B Antigen is present on the RBC surface
Anti A antibodies in the plasma
Blood Type AB: A&B Antigens are present on the RBC surface
No Anti A or B antibodies in the plasma
Blood Type O: Neither A or B Antigen is present on the RBC
surface
Anti A & B Antibodies in the plasma
Rh Positive: D Antigen (Rhesus system) is present on the RBC
surface
Basic Immunology
Do not transfuse an antigen to a recipient having antibodies
against that antigen
A B O C o m p a tib ility
D o n o r C e lls
R e c ip ie n t
W h o le B lo o d
RBCs
P la s m a
A
A
A, O
A, AB
B
B
B, O
B, AB
O
O
O
A, B, O, AB
AB
AB
A, B, O, AB
AB
R h P o s itiv e
+ / -
+ / -
+ / -
R h N e g a tiv e
-
-
+/ -
Thus the Old Adage says:
Type AB is the Universal Receiver
Type O is the Universal Donor
Transfusion Options
Homologous Blood: Blood collected from donors for
transfusion to another individual
Volunteer donors
Autologous Blood: Blood collected from the intended
recipient. Self donation. Most frequently
done for planned surgeries
Designated (Directed) Blood: Blood collected from a donor
designated by the intended recipient.
Compatibility testing is required.
Not available at MAH
Blood Bank Testing Options
Type and Screen (TS): must be within 3 days.
This option, types and screens for antibodies
Red Blood Cells (RBC):
This orders the # of units to be crossmatched.
Specimen Labeling
Safe transfusions begin with the proper identification of the intended
recipient pre transfusion specimen.
The following information is required and must be legibly copied
(handwritten) directly from the current wristband to the primary sample
tube label.
• Full name exactly as it appears on wristband including middle
initials, JR, Sr, etc
• Medical Record Number (U#)
• Date and Time Drawn
• Initials of Person Drawing Specimen
• Initials of Identification Witness
Samples not meeting these requirements will not be used under any
circumstances. Corrections are not allowed after the sample leaves the
patient’s bedside
Samples for the blood bank must be verified by a second person who
is present while the blood is being drawn and validates the patient’s
identity using 2 identifiers. Each person initials the blood tube
M o u n t A u b u r n H o s p it a l
B lo o d B a n k S p e c im e n - L a b e lin g R e q u ir e m e n t s
Surname
DOE
First Name
JOHN J.
Pat. No.
123456
DOB
Ward
Date. 11/ 12/ 07 Time. 13:05 Sig. AA/ DD
2 IN IT IA L S R E Q U IR E D
P h le b o t o m is t /W it n e s s
S p e c im e n R e q u ir e d – O n e 6 m l P in k T o p T u b e
A l l I n f o r m a t i o n m u s t b e h a n d w r i t t e n d i r e c tl y o n t h e p r im a r y t u b e l a b e l.
----------------------------I n f o r m a t i o n m u s t b e l a b e l e d a t t h e b e d s i d e a n d c o p i e d f r o m th e p a t i e n t ’ s w r i s t b a n d .
F u ll n a m e e x a c t ly a s i t a p p e a r s o n w r i s t b a n d , i n c l u d i n g m i d d l e i n i t i a l s , p r e fi x o r s u f f i x ( e x . S r . )
Whole Blood
Composition: RBCs, plasma which contains plasma proteins
(globulins and antibodies) stable clotting factors
and a preservative
Indication: to treat massive blood loss requiring O2 carrying
properties of RBCs along with volume expansion
provided by plasma
Rate: As rapidly as needed for hemodynamic stability
Considerations: never add medications, mix only with NS;
Recommend 20 gauge IV or larger. A 22
gauge may be used if the patients access
has been evaluated standard Y type infusion
set; should increase HCT by 3 points and
hemoglobin by 1 point
Packed Red Blood Cells
Composition: Concentrated RBCs in a preservative
Indication: To increase the O2 carrying capacity
in symptomatic anemic patients without the need
for volume expansion
Rate: 1 unit over 2-3 hours but not to exceed 4 hours
Considerations: recommend 20gauge or larger access;
22 gauge may be used if access evaluated
standard Y set Mix only with NS,
Leukocyte Reduced RBCs
Composition: RBCs in which the leukocyte # has been
reduced and at least 80% of the RBCs remain
Indications: To prevent recurrence of febrile, nonhemolytic
reactions caused by donor WBCs reacting with
recipient WBC
Rate: same as PRBCs
Considerations: WBC reduction may occur prior to or during
the transfusion. If not already done, you
must use a special leukocyte reduction
filter
Irradiated RBCs
Composition: Blood products which have been exposed to a
measured amount of radiation thereby rendering
the donor lymphocytes incapable of replication
Indication: To prevent graft vs host disease in patients receiving
blood products containing viable WBCs. Used for
patients at risk for GVHD: severe combined immunodeficiency; acute leukemia, multiple myeloma
Rate: same as RBCs
Considerations: Irradiation is performed by the blood collection
center and an “irradiated” label is placed on the
bag. There is no radiation risk to the
transfusionist or the recipient
Platelets
Composition:
Platelet Pheresis: Platelet rich plasma from a single donor
Pooled Platelets: Platelets pooled from 4-6 units
Indication: To control or prevent bleeding associated with
deficiencies in platelet # or function.
Used prophylactically PLT < 10,000 - 20,000
If evidence of bleeding with PLT < 50,000
Rate: determined by volume tolerance but must be infused
within 4 hours
Consideration: If need Leukocyte reduced, there is a different
filter. WBC reduction may occur prior to
transfusion; if not a filter is required to reduce
Fresh Frozen Plasma
Composition: 91% water, 7% proteins (albumin, globulins,
antibodies, and clotting factors)
Indications: To increase the level of clotting factors in patients
with a demonstrated deficiency
Rate: 10ml/min or more slowly if overload is a potential problem
Considerations: Contains no RBCs so cross-matching is not
required but ABO compatibility is required
Albumin
Composition: 96% albumin 4% globulin's and other proteins
from plasma.
5% which is oncotically the same as plasma.
25% which pulls fluid intravascularly (both from Pharmacy)
Indication: To provide volume expansion where crystalloids are
not adequate.
Rate: 1-10ml/min or faster
if in shock
Considerations: With 25%, can cause increased blood volume
and increased blood pressure due to its ability to draw
fluid from the intravascular space
There are no ABO blood antibodies present
Administration set may be supplied with the albumin
Keys to the Transfusion
Process
1. Ensure order is written clearly
2. Ensure Consent Form is signed
3. Assess IV access
4. Obtain pre transfusion vital signs
After you have checked these things and are sure you are ready
to administer the blood………
Enter a Transport Request to pick up blood
Blood
Consent
MD Responsibility
May sure the
I authorize is
checked before
transfusing!!!!
Verifying Blood Products
•With a SECOND person, compare the following:
 name on blood tag with order page of medical record
 unit number on blood tag with medical record (computer if not
in record)
 blood type in patient chart, blood tag and blood bag
 blood number on blood tag and that on bag
 patient name and unit number on blood tag with ID bracelet
AT THE PATIENT’S BEDSIDE
 check expiration date on bag and tag
 Compare the following information on the tag with the
transfusion report
* Name
* Blood Product #
* Medical Record #
* Expiration date
* Blood type
NOW YOU CAN SIGN THE TRANSFUSION REPORT
Blood Tag
Blood
Product
number
Type of product and
blood type
Patient’s name
&
medical record #
Expiration
date and time
Compare to medical record and patient ID bracelet
Keys to the Transfusion
Process
• Explain to patient symptoms to report to RN
• Obtain baseline vital signs, at 15min, 1 hour, and at completion
• Spike bag with Y set and NS on the second spike
More than I unit to hang? change tubing with each bag Q4hrs
• Infuse at 1ml/min x 15min, stay with patient x 10minutes
• If no reaction,  rate to 5-10ml/min; if at risk for overload
 to 2-4ml/min
• Complete transfusion report
Transfusion Report
Compare with
blood tag
Documents
vital signs
and times
per policy
What now, my patient needs
to go to……..
X_RAY
CT SCAN
If a patient needs to go
off the unit
during a transfusion……
They must be accompanied by
an RN /MD
GI UNIT
Symptoms of a Transfusion
Apprehension
convulsions
Reaction
Feelings of Impending doom
Tachy / Bradycardia
Hypo/hypertension
Cyanosis
Flushing
Edema
Bleeding
Tachypnea
Apnea
Dyspnea
Cough
Hypoxia
Wheezing
Rales
Nausea
Vomiting
Abd pain
Diarrhea
Renal:
Oliguria
Renal failure
Colored urine
Skin:
Rash
Itch
Diaphoresis
Fever
Chills
Muscle aches
Back pain
Chest pain
Headache
Heat at IV site
Transfusion Reactions
A Transfusion Reaction is any unfavorable event occurring
during or following transfusion of blood, blood components,
or blood derivatives which can be related to that transfusion.
Every transfusion carries the risk of alloimmunization as
well as transmission of disease
It is essential that when a transfusion reaction is suspected,
1. Stop the transfusion immediately
2. Re-Verify that the correct unit is being transfused
to the intended recipient.
3. Call the MD for orders
4. Notify the Blood Bank
Acute Hemolytic Reaction
Cause: Infusion of ABO incompatible blood; Antibodies in the
recipient’s plasma attach to antigens on the transfused
blood causing RBC destruction
SX: chills, fever, low back pain, flushing, tachycardia, tachypnea,
hypotension, vascular collapse, hemoglobinuria, bleeding,
ARF, shock, cardiac arrest, death
Mgmt: Stop the infusion, reverify identity,& call MD
Treat shock; draw pink top tube for blood bank with proper
identification, send urine to lab, maintain BP with
crystalloids, insert catheter and monitor UOP, Do not
restart transfusion, Send blood bag and set with reaction
form to blood bank
Prevent: Meticulous verification of blood products and patient
identification
Febrile, Non Hemolytic
Cause: Sensitization between antibodies in recipient and and
antigens on WBC and platelets
SX: Sudden chill, fever (1C or 1.5 F), headache, flushing,
anxiety, muscle pain
Mgmt: STOP the transfusion, reverify identity & call
MD
Give antipyretic
Do not restart transfusion
Send blood bag &set to the blood back with reaction form
Prevention: Consider leukocyte-reduced blood products
Mild Allergic
Cause: sensitivity to foreign plasma proteins
SX: flushing, itching, hives
Mgmt: STOP the transfusion
Reverify identity, & Call MD
Give antihistamine as directed
May restart only if sx are mild
Send the blood bad and infusion
set to the Blood Bank with the Blood reaction form
if deemed to be a suspected reaction
Prevention: Prophylactic antihistamines
Anaphylactic Reaction
Cause: Infusion of IgA proteins to IgA deficient recipient who
has developed IgA antibody
Sx: anxiety, urticaria, wheezing, cyanosis, shock, and possible
cardiac arrest
Mgmt: STOP the transfusion
Epinephrine 0.4ml of 1:1,000 SC
CPR if indicated
Do not restart transfusion
Prevention: Transfuse washed RBC products and IgA
deficient plasma products
Circulatory Overload
Cause: Fluid administered faster than the circulation can
accommodate
Sx: cough, dyspnea, rales, headache, HTN, tachycardia,
distended neck veins
Mgmt: STOP the transfusion re-verify identity, call MD
Place in high fowlers
Administer diuretics, O2, morphine
Send blood bag and set to Blood Bank with reaction form
Prevention: Adjust volume and rate based on clinical status
Have unit split (NOT DONE AT MAH)
Sepsis
Cause: Transfusion of contaminated blood components
Sx: rapid chills, high fever, vomiting, diarrhea,
marked hypotension, and shock
Mgmt: STOP the transfusion, re-verify identity & Call MD
Obtain culture of patient and send bag for further study
Antibiotics, IV fluids, vasopressors, steroids
Send blood bag and set to blood bank with reaction form
Prevention: Sterile technique
Do not interrupt transfusion
Infuse within 4 hours of starting time and prior to
component expiration
TRALI
Transfusion-related acute lung injury
Cause: WBC antibodies in the blood component cause massive
leakage of fluids and proteins into the lungs
SX: Severe respiratory distress, pulmonary edema, hypoxia,
SOB
(can occur within 6 hours of transfusion)
Mgmt: STOP the transfusion, re-verify
identity & call MD
Aggressive respiratory support
Send blood bag and set to blood
bank with reaction form
Delayed Reactions
(Notify the Blood Bank)
Delayed Hemolytic
Hepatitis B or C
Post Transfusion Purpura (PTP)
Iron Overload
Graft vs Host disease
HIV