# Blood Transfusion --- A **blood transfusion** is when donated [[blood]] or blood product is infused into another person. There are lots of reasons why someone might need a blood transfusion, such as [[fluid volume deficit|hypovolemia]]. Client should have an active Type & Screen to determine compatibility. It's important to match the donor and recipient's [[blood type|blood types]], otherwise a transfusion reaction can occur where the recipient's body attacks the donor blood. Blood is administered as a medication... so follow the same "rights"! Checked by 2 RNs to ensure compatibility and correct order. Blood should be administered with special blood tubing that has a filter with a **larger gauge IV** (20 or bigger is best, though 22 is the smallest possible allowed) [[intravenous injection#Gauges|gauge]]. Blood should be administered through a y-type blood tubing, which is a specific type for blood transfusion. One connects to saline, the other to the blood product. Always prime with saline. Though you can technically prime it with blood products safely, if you have to waste any, you're wasting a precious commodity. **Normal saline** is the *only* approved compatible IV fluid to infuse with/after blood Ensure vital signs are taken before, during, and after infusion, or as per hospital policy -- Baseline vitals are crucial to determine if your client is having a reaction!! Closely monitor client for the first 30 minutes, which is the most likely time a reaction could occur - Transfusions MUST be initiated within 30 minutes from release - If not hung in 20 minutes, contact Blood Bank to send product back (to preserve the limited resource) - 4 hour maximum infusion time (per unit) - 4 hour maximum for tubing used in blood transfusions. ## Transfusion Reactions **Transfusion reactions** also reactions that happen shortly after the administration of blood products. Signs & Symptoms of a Transfusion Reaction: - Anxiety - Fever - Low back pain - Dyspnea - Hypotension - Bronchospasm There are different types of transfusion reactions: ![[transfusion reactions.png]] Generally speaking, the actions you take if you suspect a reaction are the same: - *stop the transfusion* - notify blood bank/MD/rapid response team - send blood *and* tubing back to blood bank - start running saline and meds - use completely new tubing - probably will have [[antihistamines]] or a [[corticosteroids]] ordered, maybe also oxygen - monitor vitals - ABCs - mental status - blood and urine samples ### Febrile Reactions **Febrile reactions** are relatively common transfusion reactions and are usually due to cytokines present in the donors blood. Reactions are usually mild and resolve on their own. ### Acute Hemolytic Reactions **Acute hemolytic reactions** are when the body's immune system attacks the blood cells received from the transfusion due to an incorrect typing. It is technically a [[type II hypersensitivity]]. Worst comes to worse it can lead to [[disseminated intravascular coagulation]]. ### Allergic Reaction Mild? Benydril Severe? EPI ### TACO 🌮 **TACO** stands for **transfusion associated circulatory overload** and can occur when transfusions are given too rapidly. Signs and symptoms of TACO are those associated with [[fluid volume excess]], such as crackles in the lungs and distended jugular veins. ### TRALI **TRALI**, or **transfusion-related acute lung injury**, which is serious and potentially life-threatening. ## Types of Blood Products - **Packed red blood cells** or **PRBCs** are what we think of "blood". - given when H&H is low - **Fresh frozen plasma** or **FFP** is rich in [[coagulation|clotting factors]] - given to patients with clotting disorders - or if they have a [[partial and activated partial thromboplastin time|PTT]] of greater than 1.5 times normal - This is not a fluid replacement. It does not stabilize blood pressure or correct dehydration - Cryoprecipitate - I don't remember, but it has a lot of clotting factors, so giving to people with some sorts of [[thrombocytopenia]] ___