Introduction

Blood transfusion therapy is a medical intervention that involves the intravenous administration of blood or blood components to a patient. This procedure is commonly employed to restore or improve the patient’s blood volume, enhance oxygen-carrying capacity, or replace specific blood components. Here are key aspects related to blood transfusion therapy:

Principles of Blood Transfusion Therapy

• Clinical Assessment: Conduct a thorough clinical assessment to determine the patient’s need for blood transfusion. Consider factors such as hemoglobin levels, symptoms, and the underlying cause of anemia or blood loss.
• Informed Consent: Obtain informed consent from the patient or their legal representative before initiating blood transfusion therapy. Provide information about the purpose, potential risks, and benefits of the procedure.
• Blood Typing and Cross matching: Perform blood typing to determine the patient’s ABO and RhD blood group. Conduct cross matching to ensure compatibility between donor blood and recipient.
• Compatibility Testing: Ensure compatibility not only for ABO and RhD but also for other blood group antigens to prevent transfusion reactions.
• Pre-Transfusion Testing: Screen donated blood for infectious diseases, including HIV, hepatitis, and syphilis. Verify that the blood is free from bacterial contamination.
• Appropriate Blood Component Selection: Choose the specific blood component based on the patient’s clinical condition. Red blood cells are used for anemia, platelets for clotting disorders, and plasma for coagulation factor deficiencies.
• Administration Protocol: Follow a standardized protocol for the administration of blood transfusions. Use dedicated intravenous lines and infusion sets for blood products to prevent contamination.
• Continuous Monitoring: Monitor vital signs (blood pressure, heart rate, respiratory rate, and temperature) during the entire transfusion process. Watch for signs of adverse reactions, including fever, chills, rash, or respiratory distress.
• Rate of Transfusion: Control the rate of blood transfusion to prevent overload and reduce the risk of transfusion reactions. Adjust the rate based on the patient’s tolerance and clinical condition.
• Documentation: Maintain accurate and complete documentation of the blood transfusion, including patient details, blood components administered, and any adverse reactions. Record vital signs and monitoring observations at specified intervals.
• Transfusion Reactions Management: Be prepared to manage transfusion reactions promptly if they occur. Treatment may involve stopping the transfusion, providing supportive care, and addressing specific symptoms.
• Post-Transfusion Assessment: Assess the patient post-transfusion to determine the effectiveness of the intervention. Monitor for improvements in hemoglobin levels and clinical symptoms.
• Alternatives and Individualized Care: Consider alternatives to blood transfusion when appropriate, such as erythropoietin or iron supplementation. Individualize care based on the patient’s specific needs and clinical condition.
• Patient Education: Educate patients about the importance of blood transfusion, potential risks, and expected benefits. Address any concerns or questions the patient may have.

Advantages of Blood Transfusion Therapy:

• Restoration of Blood Volume: Blood transfusion helps restore and maintain adequate blood volume, particularly in cases of hemorrhage, trauma, or surgery.
• Improved Oxygen-Carrying Capacity: Transfusing red blood cells increases the oxygen-carrying capacity of the blood, addressing conditions such as anemia or low hemoglobin levels.
• Treatment of Coagulation Disorders: Blood transfusions provide clotting factors and platelets, essential for treating coagulation disorders or conditions associated with bleeding.
• Support for Bone Marrow Disorders: Patients with bone marrow disorders, such as leukemia or aplastic anemia, may benefit from blood transfusions to support blood cell production.
• Rapid Reversal of Symptoms: Blood transfusion can rapidly alleviate symptoms associated with anemia, such as fatigue, weakness, and shortness of breath.
• Emergency Situations: In emergency situations, blood transfusion is a life-saving intervention to address acute blood loss and stabilize the patient’s condition.
• Treatment of Hypovolemic Shock: Blood transfusion is crucial in treating hypovolemic shock, a condition characterized by a severe decrease in blood volume.
• Cancer Treatment Support: Patients undergoing cancer treatments, such as chemotherapy, may require blood transfusions to manage treatment-related side effects.
• Management of Chronic Conditions: Individuals with chronic conditions causing persistent anemia or blood disorders may benefit from regular blood transfusions to improve their quality of life.
• Prevention of Organ Damage: Maintaining adequate blood volume and oxygen delivery helps prevent organ damage associated with inadequate perfusion.
• Correction of Clotting Factor Deficiencies: Blood transfusions are essential for patients with clotting factor deficiencies, such as hemophilia, to prevent or manage bleeding episodes.
• Support for Surgical Procedures: Prior to and during certain surgical procedures, blood transfusions ensure that patients have sufficient blood volume and oxygenation.
• Treatment of Neonatal Conditions: Neonates with conditions such as hemolytic disease may require blood transfusions to address severe anemia and prevent complications.
• Increased Hemoglobin Levels: Blood transfusions effectively increase hemoglobin levels in the blood, improving the oxygen-carrying capacity and overall well-being of the patient.
• Temporary Supportive Measure: In some cases, blood transfusion serves as a temporary measure while underlying conditions are addressed through other medical interventions.
• Management of Acute Blood Loss: Blood transfusion is a critical component in managing acute blood loss due to accidents, surgeries, or other traumatic events.
• Prevention of Organ Failure: Ensuring adequate blood supply through transfusions helps prevent organ failure due to inadequate oxygenation and perfusion.
• Enhanced Wound Healing: Improved oxygen delivery and clotting factors provided by blood transfusions contribute to enhanced wound healing.

The main blood components:

Red Blood Cells (RBCs):

• Function: Carry oxygen from the lungs to the rest of the body and transport carbon dioxide back to the lungs for exhalation.
• Composition: Primarily contains hemoglobin, a protein that binds to oxygen.

White Blood Cells (WBCs):

• Function: Play a crucial role in the immune system by defending the body against infections and foreign invaders.
• Types: Neutrophils, lymphocytes, monocytes, eosinophils, and basophils.

Platelets:

• Function: Essential for blood clotting and wound healing. They help prevent excessive bleeding by forming blood clots.
• Composition: Small cell fragments involved in the coagulation process.

Plasma:

• Function: Transports nutrients, hormones, and waste products throughout the body. Also plays a role in maintaining blood pressure and electrolyte balance.
• Composition: A yellowish fluid that consists of water, electrolytes, proteins (albumin, globulins, fibrinogen), hormones, and waste products.

Plasma Proteins:

• Albumin: Maintains oncotic pressure, contributing to the regulation of fluid balance between blood and tissues.
• Globulins: Involved in immune responses and transport various substances in the blood.

Fibrinogen: Essential for blood clot formation.

Cryoprecipitate:

• Function: Contains concentrated clotting factors, particularly fibrinogen, and is used to treat bleeding disorders.
• Composition: Derived from fresh frozen plasma (FFP).

Factor VIII and Factor IX Concentrates:

• Function: Essential clotting factors for individuals with hemophilia A (Factor VIII deficiency) or hemophilia B (Factor IX deficiency).

Packed Red Blood Cells (PRBCs):

• Function: Used to restore or maintain adequate oxygen-carrying capacity in individuals with anemia or significant blood loss.
• Composition: Red blood cells separated from plasma and other components.

Fresh Frozen Plasma (FFP):

• Function: Provides clotting factors, albumin, and other plasma proteins to treat conditions such as coagulopathies.
• Composition: Plasma that has been frozen and contains all clotting factors.

Whole Blood:

• Function: Used in specific situations where multiple blood components are needed simultaneously.
• Composition: A combination of red blood cells, white blood cells, platelets, and plasma.

Objectives of Blood Transfusion Therapy:

Enhance Circulating Blood Volume:

• Objective: Increase the overall volume of circulating blood, particularly in situations such as post-surgery, trauma, or hemorrhage, to improve perfusion and maintain vital organ function.

Boost Red Blood Cell (RBC) Count and Sustain Hemoglobin Levels:

• Objective: Elevate the number of red blood cells (RBCs) and sustain adequate hemoglobin levels, especially in individuals with severe anemia, to optimize oxygen-carrying capacity and address symptoms associated with low hemoglobin.

Provide Targeted Cellular Component Replacement:

• Objective: Offer specific cellular components, such as clotting factors, platelets, and albumin, as replacement therapy. This targeted approach aims to address deficiencies or imbalances in these components, ensuring effective hemostasis, clot formation, and maintenance of plasma oncotic pressure.

Nursing Interventions for Blood Transfusion:

Verify Doctor’s Order:

• Objective: Confirm the physician’s prescription. Inform the client and provide a clear explanation of the purpose and process of the blood transfusion.

Check for Cross-Matching and Typing:

• Objective: Ensure compatibility by verifying cross-matching and blood typing results to prevent transfusion reactions.

Obtain and Record Baseline Vital Signs:

• Objective: Establish baseline vital signs to monitor the client’s response during the transfusion.

Practice Strict Asepsis:

• Objective: Adhere to rigorous aseptic techniques to minimize the risk of infection during the blood transfusion procedure.

Two-Nurse Verification:

• Objective: Prior to administration, two licensed nurses must independently verify the blood product label, checking for serial number, blood component, blood type, Rh factor, expiration date, and screening test results for blood-borne diseases.

Warm Blood at Room Temperature:

• Objective: Prevent chills in the client by warming the blood to room temperature before transfusion.

Proper Client Identification:

• Objective: Ensure accurate patient identification. Two nurses should independently confirm the client’s identity before initiating the transfusion.

Use Needle Gauge 18 to 19:

• Objective: Facilitate easy blood flow by using a needle gauge between 18 and 19.

Micron Mesh Filter Blood Transfusion Set:

• Objective: Utilize a blood transfusion set with a special micron mesh filter to prevent the administration of blood clots and particles.

Start Infusion Slowly and Remain at Bedside:

• Objective: Initiate the infusion at a rate of 10 drops per minute. Stay at the bedside for the first 15 to 30 minutes as adverse reactions typically occur during this time.

Monitor Vital Signs:

• Objective: Continuously monitor vital signs. Any alterations, such as an increase in temperature or respiratory rate, may indicate an adverse reaction.

Avoid Mixing Medications with Transfusion:

• Objective: Prevent adverse effects by refraining from mixing medications with the blood transfusion. Do not introduce medications into the blood transfusion, and avoid using blood transfusion lines for IV push of medications.

Administer 0.9% NaCl Before, During, or After Transfusion:

• Objective: Use normal saline for pre-transfusion, during, or post-transfusion to avoid hemolysis. Never administer IV fluids with dextrose, as it can cause hemolysis.

Follow Transfusion Duration Guidelines:

• Objective: Administer whole blood or packed red blood cells over 4 hours. For plasma, platelets, and cryoprecipitate, transfuse quickly within 20 minutes, as clotting factors may be easily destroyed.

Observe for Complications and Notify Physician:

• Objective: Monitor for potential complications and promptly notify the physician if any issues or adverse reactions arise during the blood transfusion.

Complications of Blood Transfusion

Allergic Reaction:

• Cause: Sensitivity to donor plasma proteins.

Assessment: Flushing, Rash, hives, Pruritus, Laryngeal edema and difficulty breathing.

Febrile Non-Hemolytic Reaction:

Cause: Hypersensitivity to donor white cells, platelets, or plasma proteins.

Assessment: Sudden chills and fever, Flushing, Headache and Anxiety.

Septic Reaction:

Cause: Transfusion of blood or components contaminated with bacteria.

Assessment: Rapid onset of chills, Vomiting, Marked hypotension and High fever

Circulatory Overload:

Cause: Administration of blood volume at a rate exceeding circulatory capacity.

Assessment: Rise in venous pressure, Dyspnea Crackles or rales, Distended neck veins ,Cough and Elevated blood pressure

Hemolytic Reaction:

Cause: Infusion of incompatible blood products.

Assessment: Low back pain (initial sign due to kidney inflammatory response), Chills, Feeling of fullness, Tachycardia, Flushing, Tachypnea, Hypotension, Bleeding, Vascular collapse and Acute renal failure

Assessment Findings of Transfusion Complications:

Hemolytic Transfusion Reaction:

• Clinical Manifestations: Fever, Chills, Low back pain, Flank pain, Headache, Nausea, Flushing, Tachycardia, Tachypnea, Hypotension and Hemoglobinuria (cola-colored urine)

Delayed Hemolytic Reaction:

• Clinical Signs and Laboratory Findings: Fever, Mild jaundice, Gradual fall of hemoglobin and Positive Coombs’ test.

Febrile Non-Hemolytic Reaction:

• Clinical Manifestations: Temperature rise during or shortly after transfusion, Chills, Headache, Flushing and  Anxiety,

Septic Reaction:

• Clinical Manifestations: Rapid onset of high fever and chills, Vomiting, Diarrhea and Marked hypotension

Allergic Reactions:

• Clinical Manifestations: Hives, Generalized pruritus and Wheezing or anaphylaxis (rarely)

Circulatory Overload:

• Clinical Manifestations: Dyspnea, Cough, Rales, Jugular vein distention
• Infectious Disease Transmission: Manifestations may develop rapidly or insidiously, depending on the disease. Graft-Versus-Host Disease (GVH):
• Characteristics: Skin changes (e.g., erythema, ulcerations, scaling), Edema, Hair loss and Hemolytic anemia

10 Nursing Diagnoses:

Hyperthermia

Hypothermia

High Risk for Infection

High Risk for Injury

Pain

Ineffective Breathing Pattern

Decreased Cardiac Output

Fluid Volume Deficit

Fluid Volume Excess

Impaired Gas Exchange

Prevention of Transfusion Reaction:

Meticulously verify patient identification, blood product, and labeling. Inspect the blood product for abnormalities before administration. Begin transfusion slowly (1 to 2 mL/min) and observe closely, especially during the first 15 minutes.

Transfuse blood within 4 hours and change blood tubing every 4 hours. Prevent infectious disease transmission through careful donor screening. Ensure irradiation of blood products containing viable WBCs to prevent GVH disease. Prevent hypothermia by warming the blood unit to 37°C before transfusion.

Remove leukocytes and platelet aggregates with a micro aggregate filter in the blood line. Detection and Intervention for Transfusion Reaction: Stop the transfusion immediately and notify the physician. Disconnect the transfusion set, keeping the IV line open with 0.9% saline.

Send blood bag and tubing to the blood bank for repeat typing and culture. Draw another blood sample for plasma hemoglobin, culture, and retyping. Collect a urine sample for hemoglobin determination. Intervene appropriately based on the specific reaction observed.

Nursing Interventions If Reaction Occurs:

• Stop the transfusion.
• Start an IV line with 0.9% NaCl.
• Place the client in Fowler’s position if experiencing shortness of breath and administer O2 therapy.
• Remain with the client, observing signs and symptoms, and monitoring vital signs every 5 minutes.
• Notify the physician immediately.
• Prepare to administer emergency drugs per physician’s order or protocol.
• Obtain a urine specimen for hemoglobin determination.
• Save blood container, tubing, label, and transfusion record for laboratory analysis.

Nursing Evaluation:

• The patient maintains a normal breathing pattern.
• The patient demonstrates adequate cardiac output.
• The patient reports minimal or no discomfort.
• The patient maintains good fluid balance.
• The patient remains norm thermic.
• The patient remains free of infection.
• The patient maintains good skin integrity, with no lesions or pruritus.
• The patient maintains or returns to normal electrolyte and blood chemistry values.

Read more: Tips & Techniques on IV Insertion