Transfusion is the process of giving whole blood or one of its components to a patient who is ill or injured. According to the National Heart, Lung and Blood Institute, almost five million Americans need blood transfusions each year to treat various illnesses, as well as to replace blood lost through surgery or traumatic injury.
Most blood transfusions use blood donated by a healthy volunteer, but in certain cases the patient may bank his own blood in advance of a planned surgery to eliminate the possibility of receiving contaminated blood.
Indications
Transfusions are given to increase the blood's ability to carry oxygen, restore the body's blood volume, improve immunity or correct clotting problems. According to the American Cancer Society, accident victims, patients undergoing surgery and those suffering from a variety of diseases may need a transfusion.
Risks
Giving and receiving blood is very safe in the United States, reports the National Blood Lung and Heart Institute. Some infectious agents, such as HIV and hepatitis, can infect the person receiving the blood transfusion. To keep blood safe, blood banks carefully screen donated blood. In fact, the risk of contracting HIV from a blood transfusion is lower than the risk of being killed by lightning. Only about one in 2 million donations might transmit HIV if given to a patient.
Other risks include lung injury, fever, allergic reactions, and serious reactions in which the patient's blood attacks the donated blood.
Blood Types
According to the National Health Blood and Lung Institute, the blood used in a transfusion must work with the patient's blood type---A, B, AB and O---and Rh factor---negative or positive. If the blood is incompatible, the patient's antibodies will attack the donated blood and the patient will become sick.
Preparation
According to the University of Michigan, blood transfusion requires an intravenous line, a blood administration tubing set with an in-line filter and a bag of normal saline--salt--solution. An infusion pump or a blood warmer may be used, if needed.
Except in an emergency, a nurse or physician must explain the process, risks and alternatives, and the patient must consent in writing before the transfusion begins.
How It Works
Transfusions are administered in a hospital or clinic. Safety checks are required before beginning the transfusion, according to the University of Michigan. The nurse must record the patient's vital signs---temperature, pulse, respiratory rate and blood pressure---and cross-check the blood labels and medical records with a second nurse.
The nurse gently mixes the unit of blood and attaches it to the administration set. The initial flow rate must be slow--no more than 1 milliliter per minute for the first 15 minutes. If no reaction occurs, the rate may be increased to 4 milliliters per minute.
Close observation is important, particularly during the first 15 minutes. Vital signs must be recorded after the first 15 and 30 minutes, and then every hour thereafter.
Time Frame
The maximum infusion time is four hours. Normally, a transfusion of red blood cells will take about two hours. A transfusion of platelets, plasma or cryoprecipitates--clotting factors--will take about 30 minutes.
Termination
If the transfusion is completed successfully, the saline solution is discontinued. The blood bag and tubing are discarded in a bio-hazard---red---waste container.
If the patient experiences a reaction during the transfusion, the nurse must stop the transfusion and save the blood unit and tubing.
References
- National Heart Lung and Blood Institute: What Is a Blood Transfusion?
- Merck: The Merck Manuals: Blood Transfusion: Introduction
- American Cancer Society: Blood Component Transfusion
- American Cancer Society: Why Cancer Patients Might Need Blood Transfusions
- National Heart Lung and Blood Institute: What Are the Risks of a Blood Transfusion?
