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Blood Transfusion

Intravenous administration of blood to help replenish excessive blood loss due to haemorrhage or otherwise is known as blood transfusion.

Haemorrhage either acute  or chronic if the Hb levels are below 40%
Shock : to increase the blood volume
Blood Diseases, severe anaemia, aplastic anemia, hemophilia, thrombocytopenic purpura
Carbon-monoxide poisoning in which abnormal compounds are formed

Compatibility and Incompatibility
When the  blood of one species of animal is mixed with that of another, the corpuscles are agglutinated and then haemolysed.
Among the human beings the same phenomenon of haemagglutination occurs when one group of blood is mixed with another group. So before blood transfusion, compatibility of the donor blood with that of the recipient should be tested

Compatibility Test or Matching of Blood (Cross Matching)
Blood  from the recipient is centrifuged to  separate plasma or serum. The serum is mixed with the blood of the donor and after 10 mt the mixture is examined for  clumping of RBCs. If clumping of the RBCs is seen, it is incompatible blood.
It should not be transfused.
If there is no clumping, the  blood is compatible. 
It can be transfused

Effects of transfusing incompatible blood
When mismatched blood is injected IV to a recipient, severe symptoms and even death occurs.
1.    Red cells are agglutinated which later on undergo haemolysis.
2.    Haemolysis leads to jaundice
3.    Haemoglobinuria
4.    Renal failure

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What is the first instruction or priority action to be taken when a patient is admitted for blood transfusion ?
Instruct the patient ro report any itching, headache or dyspnea. This will help the nurse to take immediate action in case a reaction happens during a transfusion.

Apart from checking the details in the blood bag what should be checked in the patient prior to starting the blood transfusion ?
The nurse must assess the vital signs before and 15 mt after the procedure so that any changes during the transfusion may indicate a transfusion reaction.

What blood product should be given in case of deep puncture wound which has bled a lot as an emergency measure ?
The nurse should provide clotting factors and volume expansion. Fresh-frozen plasma may be used to provide clotting factors or volume expansion. It is rich in clotting factors and can be thawed quickly and transfused right away.
In this situation increasing the hemoglobin, hemotocrit and neutrophil levels is not needed and transfusing  whole blood will not specifically increase the Hb, hematocrit and neutrophil levels significantly.
Note that FFP does not contain any platelet

What is the most essential piece of equipment should the nurse get before multiple transfusions are started and why ?
The nurse should get a blood warmer before starting multiple blood transfusions.  Rapid Multiple transfusions of blood may cause hypothermia in the patient and cardiac dysrrhthmias will occur.
Cardiac monitor and ECG machine has to be present during all transfusions.

How long should a nurse monitor a patient receiving blood transfusion for transfusion reaction ?
The nurse should monitor the patient closely for 15 mt. Usually a transfusion reaction occurs within 15 mt. of a transfusion

What type of IV set or blood transfusion set should a nurse choose to transfuse packed cells / packed RBCs / whole blood ?
The nurse should choose a tubing with an in-line filter. The in-line filter ensures that any particles larger than the size of the filter are caught in the filter and are not infused.

Whar are the other types of IV sets available?
Micro infusion set. (but blood transfusion is a macro drup)
Polyvol Pro Burette Set (used to administer IV medication infusion)
Photofusion set (used to administer drugs which should be light protected)

How to verify the age of blood cells in a blood bag?
Look at the blood expiration date. The safe storage of blood usually takes 35 days. Examining the expiration date befor the blood transfusion is started  is an important responsibility of a nurse

What IV fluid should be started right after completing packed cell or blood transfusion ?
Normal saline (0.9% sodium chloride) should be started after completion of blood transfusion. It is the standard solution used to follow infusion of blood products. Solutions containing dextrose in water will hemolyze red cells

What symptoms indicate that a patient is experiencing transfusion reaction?
Patient will have sudden difficulty in breathing; skin becomes flushed and patient has chills.

What nursing intervention should the nurse do in case of suspicion of a transfusion reaction ?
The nurse should first stop the transfusion.
Next start a normal saline drip and run at a keep-vein-open rate; Keep vein patent (KVO/KVP) for further remedial medication.
Inform the physician.
The nurse should not  remove IV line because then there will be no IV access route.
IV solutions containing dextrose will hemolyze the red cells.

How will the nurse know that the patient is benefited by a platelet transfusion ?
The patient will have less episodes of bleeding.

How will the nurse know that the patient is benefited by a transfusion of agranulocytes ?
There will be a decline in the febrile episodes.

How will the nurse know that the patient is benefited from transfusion of red blood cells/packed cells ?
The hemoglobin level and the hemotocrit will be increased.

There is nausea, vomiting, drop in BP, high fever, chills, diarrhoea and shock in a patient during a blood transfusion. What is suspected ?
Septicemia. Septicemia happens with transfusion of blood that is contaminated with microorganisms.

What are the symptoms of circulatory overload ?
Hypertension, cough, dyspnea, chest pain, tachycardia and wheezing.

What are the features of a delayed reaction after blood transfusion ?
Delayed reaction occurs days to years after a transfusion. It causes fever, rashes, mild jaundice and oliguria/anuria.

How do you recognize hypocalcemia in a patient who has received multiple transfusions rapidly ?
Hypocalcemia causes paresthesias, tetany, muscle cramps, hyperactive reflexes, positive Trousseau's sign and positive Chvostek's sign.

Can a nurse procede  with packed cells transfusion in the presence of fever  in the patient ?
If the patient has a temperature higher than 100°F the nurse should not procede with the transfusion. The physician should be notified and follow further orders. The decision to administer the blood is not within the scope of nursing practice. The administration of any medicine will need the physician's prescription

How to lessen the risk of possible transfusion reaction in elective surgery ?
By giving an autologous blood donation the risk of transfusion can be prevented.

How to assess the effectiveness of cryoprecipitate therapy ?
By doing coagulation studies and fibrinogen levels the effect of cryoprecipitate therapy can be assessed.