Tips and Reminders for Safe Transfusion

For Transfusion Reaction.

Use only 0.9% sodium chloride solution when administering blood products; other solutions (e.g., LR) will cause hemolysis and clotting in tubing.

Follow institution guidelines exactly when administering blood.

• Universal Recipients: Pts with type AB blood.
• Universal Donor: Pts with Type O, Rh-negative blood.
• Rh Factor: Pts with Rh-positive blood can receive Rh-positive or Rh-negative blood, but Pts with Rh-negative blood can receive ONLY Rh-negative blood.

Prior to Beginning Blood Transfusion

• Blood type and Rh classification of Pt MUST be known to ensure blood compatibility.
• Identify Pt and obtain informed consent (consider cultural/religious beliefs).
• Ask about prior transfusions. Pts with history of febrile or allergic reactions should be premedicated with acetaminophen or diphenhydramine to reduce likelihood of a febrile or allergic response. Notify HCP if Pt exhibits fever prior to transfusion; preexisting fever can obscure development of an acute reaction and transfusion may be withheld.
• Inspect blood bag for expiration date, damage, clots, leaks, discoloration, and bubbles.
• Confirm ABO and Rh compatibility by comparing blood bank armband number with blood bag label and blood bank administration form; notify blood bank of any inconsistencies. Any discrepancy MUST be resolved before transfusion.
• Have another nurse independently verify ABO and Rh compatibility (double-check).
• Document beginning volume of each bag (volume varies).
• Establish IV access using 18-gauge catheter; infuse NS as prescribed by HCP.
• Establish 2nd IV line to administer medications and IV fluids.
• Establish baseline set of VS and temperature, renal, circulatory, and respiratory status.
• Administer pre-transfusion medications, such as diphenhydramine, as ordered by HCP.
• Begin transfusion within 30 min of receiving blood from blood bank.

During Blood Transfusion

• Record VS, temperature before transfusion, 15 min after beginning transfusion, and every hour until 1 hr after completion.
• Begin transfusion slowly (15 drops/min) and remain with Pt for 1st 15 min to assess for transfusion reaction; if no evidence of reaction, transfuse at ordered rate.
• Monitor VS, temp, renal, circulatory, and respiratory status.
• Transfusions should not exceed 4 hr (septicemia risk); change tubing every 4 to 6 hr and after each unit of blood. Notify HCP if Pt has fever before transfusion.

Monitor Pt Closely for Evidence of Transfusion Reaction

• If there is a change in VS, particularly a temperature elevation, or if Pt begins to experience any unusual symptoms, STOP TRANSFUSION AND NOTIFY HCP STAT.
• Replace blood bag and transfusion set with new tubing and run NS.
• Obtain blood sample for plasma Hgb, culture, and retyping.
• Collect urine sample as soon as possible for Hgb determination.
• Be prepared to initiate emergency interventions until type and severity of reaction are established—refer to Transfusion Reaction below.

Blood Products

Product	Indications
Whole blood Contains all blood products Must be ABO and Rh identical	Rarely used May be given emergently to a hemorrhaging Pt
Packed red blood cells (PRBCs) No clotting factors or platelets, 80% plasma removed Must be ABO and Rh identical	Increase oxygen carrying capacity Hgb <6 g/dL or <10 g/dL if there is organ ischemia Anemia that cannot be treated with other therapies May have leukocytes removed (called “leukocyte poor”) to prevent febrile reaction
Platelets Usually given in pools of 6–10 units	Prevent bleeding related to low platelet counts or coagulopathies One unit may increase platelet count by 6,000 units Should not be given to Pts with autoimmune thrombocytopenia or thrombocytopenic purpura except in life-threatening hemorrhage May be human leukocyte antigen (HLA) matched or unmatched
Fresh frozen plasma (FFP) Plasma and clotting factors	To replace clotting factors after multiple transfusions (6 PRBCs); Coumadin intoxication; replace clotting factors Should not be given to correct coagulopathy that can be treated with vitamin K
Cryoprecipitate Clotting factors	Bleeding related to hemophilia, fibrinogen deficiency, DIC
Factor IX concentrate	Treatment of hemophilia B; carries a high risk of hepatitis because it requires pooling from many donors
Factor VIII concentrate	Treatment of hemophilia A; heat-treated product decreases risk of hepatitis and HIV transmission
With exception of normal saline, do not add medications or IV fluids to blood products.

Transfusion Times

Subtopic(s)

• Transfusion Reaction