Blood Transfusions Overview

Introduction

• Blood transfusion is a process where a patient low on red blood cells receives new red blood cells via venous access.
• Commonly used to replenish red blood cells from blood donations when a patient is low due to:
  • Blood loss from surgery or trauma.
  • Severe anemia due to conditions like renal failure or cancer.

Importance of Red Blood Cells

• Red blood cells, with hemoglobin, carry oxygen from the lungs throughout the body and remove carbon dioxide.
• Symptoms of low red blood cells include:
  • Pallor (paleness).
  • Fatigue.
  • Shortness of breath.
  • Tachycardia (increased heart rate).

When to Transfuse

• Depends on the patient’s condition and tolerance of low blood levels.
• The American Association of Blood Banks recommends transfusions when hemoglobin levels fall to 7-8 grams per deciliter.
• Normal hemoglobin levels:
  • Males: 14-18 grams per deciliter.
  • Females: 12-16 grams per deciliter.

Nurse's Role in Blood Transfusion

• Preparation: Critical to prevent transfusion reactions.
  • Follow hospital protocols meticulously.
  • Type and cross-match the patient’s blood.
  • Ensure correct patient identification and documentation.
• Informed Consent:
  • Explain procedure, assess understanding, and inquire about past transfusions and reactions.
  • Pre-medication may be required for patients with a history of reactions.
• Check Patient Compatibility:
  • Know patient’s blood type and Rh factors.
  • Universal donor: O
  • Universal recipient: AB

Transfusion Process

• IV Access:
  • Requires an 18-gauge or larger IV.
• Supplies Needed:
  • Y tubing with an inline filter.
  • 0.9% Normal saline (the only solution compatible with blood transfusions).
• Timing:
  • Transfuse one unit at a time within 4 hours to prevent bacterial growth.
• Blood Warmers:
  • Use only if necessary for rapid transfusions to prevent hypothermia.
• Verification with Another Nurse:
  • Check order, patient ID, blood type, expiration date, and the condition of blood.
• Baseline and Continuous Monitoring:
  • Get baseline vitals, especially temperature.
  • Monitor signs of adverse reactions.

Transfusion Reactions

• Types of Reactions:
  • Hemolytic Reaction: Immune system attacks donor red blood cells.
  • Allergic Reaction: Reaction to proteins in donor blood.
  • Febrile Reaction: Non-hemolytic, often due to prior transfusions.
  • GVHD: Graft-versus-host disease.
  • Circulatory Overload and Septicemia.

Common Signs of a Reaction (mnemonic: REACTION)

• R: Rash
• E: Elevated temperature
• A: Ache (backache, chest pain)
• C: Chills
• T: Tachycardia
• I: Increased respirations
• O: Oliguria
• N: Nausea

Response to a Transfusion Reaction

• Immediate Actions:
  • Stop the transfusion.
  • Maintain IV access with saline.
  • Notify physician and blood bank.
• Monitor Patient:
  • Stay at bedside, monitor vitals every 5 minutes.
  • Document the event thoroughly.

Conclusion

• Ensure thorough preparation and monitoring during blood transfusions to ensure patient safety and minimize risks of reactions.
• Continual vigilance and adherence to protocols are vital for successful blood transfusion management.