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Responsibilities of Nurses in Blood Transfusion

Blood transfusion involves the transfer of blood components to patients for various medical reasons such as anemia or severe blood loss. Nurses play a critical role in ensuring the safety and efficacy of blood transfusions by properly identifying indications, managing complications, and handling different types of blood components. They also oversee the process of blood sampling, labelling, and ordering blood products for transfusion in accordance with established protocols and guidelines.

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Responsibilities of Nurses in Blood Transfusion

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  1. Title: RESPONSIBILITY OF NURSES IN BLOOD TRANSFUSION PREPARED BY: WAN RABIATUL ADAWIAH BINTI WAN ROSDI PEGAWAI JURURAWAT HSAAS Name:

  2. DEFINATION • Blood transfusion is the transfusion of the whole blood or its compenent such as blood cells or plasma from one person to another person

  3. FUNCTION OF BLOOD BLOOD CARRIES THE FOLLOWING TO THE BODY TISSUE: • Nourishment • Electrolytes • Hormones • Vitamins • Antibodies • Heat • Oxygen BLOOD CARRIES THE FOLLOWING AWAY FROM THE BODY TISSUES: • Waste Matter • Carbon Dioxide

  4. PURPOSE • Restore blood volume • Replace clotting factor • Improve oxygen carrying capacity • Restore blood elements that are depleted • Prevent complication • To raise haemoglobin level • To provide antibodies

  5. INDICATION •Anemia •Severe blood loss due to surgery •Blood loss due to trauma, injury, or other medical conditions. •Patients of hereditary disorders like Haemophilia and Thalassaemia.

  6. COMPLICATION Types •allergic and anaphylactic transfusion reactions. •febrile nonhemolytic transfusion reactions (FNHTR) •acute hemolytic transfusion reactions (AHTR) •hypotensive transfusion reactions. •transfusion-associated sepsis.

  7. TYPE OF BLOOD

  8. TYPE OF BLOOD

  9. Packed cells • Composition: ⚬ A component obtained by removing most of the plasma from whole blood. • Purpose: ⚬ Increase RBC mass and oxygen-carrying capacity ⚬ Assists the body to rid carbon dioxide and other waste products • Indication: ⚬ Symptomatic and chronic anemia ⚬ Blood loss due to injury or surgery

  10. Fresh frozen plasma (FFP) • Composition: ⚬ All coagulation factors • Purpose: ⚬ Increase blood plasma ⚬ Replenish clotting factors • Indication: ⚬ Bleeding in patients with coagulation factor deficiencies; ⚬ Plasmapheresis ⚬ Burn ⚬ Liver Failure ⚬ Severe Infection

  11. Cryoprecipitate • Composition: ⚬Concentrated source of certain plasma protein prepared from FFP which contain cryoglobulin fraction such as concentrated Factor VIII, Factor XIII, von Willebrand factor, fibrinogen and fibronectin. • Indications: ⚬Generally indicated if plasma fibrinogen < 1 g/L. ⚬In massive bleeding and DIC with bleeding. ⚬Factor XIII deficiency. ⚬Uraemic patients with bleeding.

  12. FRESH FROZEN PLASMA (FFP) AND CRYOPRECIPITATE • FFP and cryoprecipitate need to be transfused IMMEDIATELY after thawing. ￭ Thawing process will take about 30 minutes ￭ Once thawed must be refrozen ￭ Thawed FFP may be stored at 2 - 6 deg C for 24 hours . ￭ Thawed CRYO may be stored at ambient temperature within 4 hours. • Both blood components should only be collected just before use.

  13. Platelets • •Component: Derived from whole blood containing >5.5 x 10^10 platelets in 60 – 70 mL of plasma. • •Indications: • •To provide platelet replacement for quantitative or qualitative deficiency of platelet • •Platelet count should be maintained at or above 50 x 10^9/L in trauma patients. • •In patients who are undergoing surgery or invasive procedures who have platelet counts <50 x 10^9/L. • •In patients with platelet count <100 x 10^9/L who have intracerebral, pulmonary, or ophthalmic haemorrhages. • •Prophylactic transfusion for patients who have platelet count <10 x 10^9/L with active bleeding.

  14. PLATELET CONCENTRATES • TMU,HSAAS does not keep stock for platelet concentrates because of their short shelf life and to avoid wastage . • The National Blood Centre will usually supply with a shelf life of 3 days. • The request should reach TMU no less than 24 hours before the surgery/procedure to ease the ordering from the National Blood Centre.

  15. Whole blood • Composition: ⚬ Red blood cells ⚬ White blood cells ⚬ Plasma ⚬ Platelets ⚬ Hematocrit ⚬ Clotting factors • Purpose: ⚬ Volume replacement ⚬ Increase oxygen-carrying capacity • Indication: ⚬ Exchange transfusion in neonates ⚬ Significant blood loss (>25%)

  16. Blood sampling • Collect 4ml of fresh blood sample in 1 EDTA tube for pre-transfusion sample. • For paediatric cases: • infants up to 4 months old: the volume to be taken shall be 1.0-2.0 ml in EDTA tube • 4 ml sample in EDTA tube from the mother • Send both sample from the infant and mother under a single request form -fill up using infant’s data

  17. Blood labelling • Labelling of the sample should be done by the same person who takes the blood sample at the bedside ONE PATIENT AT A TIME. • The information on the label should include : ⚬ Patient’s full name ⚬ MRN or IC ⚬ Sampling date ⚬ Initials of the phlebotomist • DO NOT label more than 1 patient at any one time.

  18. ORDERING BLOOD AND BLOOD COMPONENTS FOR RANSFUSION Consent for transfusion Written informed consent from patient If patient is unable to give consent: family/ two fully registered medical practitioners

  19. TYPE OF REQUEST GSH Blood samples for GSH will be retained for only 48 hours from the time of reaching the TMU if in the situation that cross match blood is required within 48 hours (refer to convert GSH to GXM). if there is no request for transfusion, the GSH request expires automatically after 48 hours from the time of reaching the TMU. The ward/clinic needs to send a new blood sample if further request of GSH or GXM has exceeded 48 hours. If the antibody screening test (part of GSH test) is positive and suspect to have alloantibody, the TMU will inform the doctor-in charge of the patient. Additional blood samples are needed and will be sent to the National Blood Centre for antibody identification and to find the crossmatch-compatible blood before the surgery/procedure.

  20. TYPE OF REQUEST GSH CONVERT GXM This procedure is valid within the 48 hours duration after sending the GSH request. ● Call MO on duty for the code number and to specify indication for transfusion and ● amount of blood required. Fill GSH to GXM Conversion Slip. ● Sent the form to the Transfusion Medicine Unit. Copy of the slip will be given to ward. ● Only ONE (1) conversion of GSH to GXM is allowed within 48 hours after sending the ● GSH request. ● New GXM request and sample need to be sent if more than one conversion is ● needed.

  21. Blood request form • Patient's name in CAPITAL LETTERS • Fill in patient's IC number, MRN, Location, Diagnosis, Hb • Stick patient's sticker with initials, on each 3 ply of the forms

  22. REJECTION OF REQUEST • The request form must be completed by the medical officer with date and time of collection and doctor’s signature • Among the reasons for rejection of GSH/GXM request: ￭ Improper or inadequately filled request form ￭ inadequately/wrongly labelled blood sample ￭ Discrepancy in the request form and the labelling of the blood sample, the request will be rejected ￭ Sample sent in the wrong container ￭ Illegible handwriting on the request form or tube label ￭ Different patient’s detail on the carbon copy of the request form ￭ Double label on the sample tube ￭ Sample tube not labelled ￭ No patient’s blood sample sent ￭ Blood sample lysed or clot • Rejected samples will be informed

  23. COLLECTION AND TRANSPORTATION OF BLOOD PRODUCT • Fill up the Collection of Blood and Blood Component form.

  24. COLLECTION AND TRANSPORTATION OF BLOOD PRODUCT • Bring the form with an ice box to the Transfusion Medicine Unit for collection of blood. • For collection of whole blood, packed cells, FFP and Cryoprecipitate: bring an ice box with ice packs covered on top with cardboard to avoid direct contact of blood with ice. • For Platelet: ice box or container for transportation must not contain any ice packs.

  25. COLLECTION AND TRANSPORTATION OF BLOOD PRODUCT • Blood and blood products will only be issued to hospital personnel. ￭ For ward, only staff nurses/medical officers are allowed to collect blood. ￭ For OT orICU,> PPK are allowed to collect blood from the Transfusion Medicine Unit. • bring a collection form that has been signed and stamped by a medical officer or specialist who ordered the blood/blood product. • The person who collected the blood product needs to check the details on the blood bag and match them to the collection form before signing the collection form. One copy will be given to the ward for the record.

  26. RETURN OF EMPTY AND USED BLOOD BAG • After each transfusion, the ward needs to correctly and completely fill up the reverse sideof the compatibility card for each blood bag. • The ward should return all the empty blood bags and the filled-compatibility cardto the TMU within 24 hours. • Any remnants of blood shall be clearly labeled as USED BLOOD and returned it with the filled compatibility card to TMU immediately.

  27. RETURN OF EMPTY AND USED BLOOD BAG

  28. RETURN OF UNTRANSFUSED BLOOD BLOOD BAG • Alluntransfused blood should be immediately returned to TMU. • The attending doctor in the ward/OT/ICU need to fill in the form “Record of the Returned Unused Blood Product” before returning the untransfused blood product to TMU. • Return the untransfused blood product to TMU according to the guidelines in collection and transportation of blood product.

  29. Expired blood?

  30. QUESTIONS????? WHAT IS THE RESPONSIBILITY OF NURSES IN BLOOD TRANSFUSION???? ● PRE ● INTRA ● POST

  31. • References 1.Basavanthappa, B., (2015). Medical-Surgical Nursing. New Delhi: Jaypee Brothers Medical Publishers. 2.Billings, D. and Hensel, D., 2019. Lippincott Q & A Review For NCLEX-RN. 13th ed. St. Louis, MO., USA.: Wolters Kluwer Medical. 3.Hinkle, J.L. & Cheever, K.H. (2018). Brunner & Suddarth’s Textbook of Medical- Surgical Nursing (14th ed.). Philadelphia: Wolters Kluwer. 4.Morton, P., & Fontaine, D. (2018). Critical Care Nursing. Wolters Kluwer. 5.Potter, P.A., Perry, A.G., Stockert, P.A., & Hall, A.M. (2019). Essentials for Nursing Practice (9th ed.). St. Louis: Elsevier. 6.Hpupm transfusion user manual : version 1 7.Handbook on clinical use of blood Transfusion practice guidelines for clinical and laboratory personal

  32. Terima Kasih

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