Concepts about Blood Collection – Introduction to fundamental concepts of Biological Science including the organization and common characteristics of living matters, cell structures and functions, food production by photosynthesis, harvesting energy, mechanism of cells reproduction, genetics, evolutions, and Human Biology. Introduction to general chemistry including basic concepts about matter, atomic structure, chemical bonds, gases, liquid, and solids, solutions, chemical reactions, acid, bases, and salt;

organic and biochemistry including hydrocarbons and their derivatives, carbohydrates, lipids, proteins, enzymes, vitamins, and minerals, nucleic acids; principles of physics and applications to nursing including gravity and mechanics, pressure, heat and electricity; nuclear chemistry and nuclear physics, effects of radiation on human beings, and protection and disposal. The aim of the course is to acquire knowledge and skills in general biological science, general chemistry and physics.

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Concepts about Blood Transfusion

Blood transfusion is generally the process of receiving blood or blood products into one’s circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood.

Or,

Blood transfusion consists of administration of compatible donor’s whole blood or any of its components to correct / treat any clinical condition,

Purposes of Blood Transfusion:

1. To increase circulating blood volume following surgery, trauma or hemorrhage.

2. To increase the number of red blood cells and to maintain hemoglobin levels in clients with serve anemia.

3. To provide selected cellular components as replacement therapy, (e.g. clotting factors, platelets, albumin).

4. To replace circulating blood volume.

5. Restores or improves the ability to control bleeding.

6. Improves the ability to overcome infection.

7. Replace clotting factors or increases intravascular fluid volume by increasing colloidal osmotic pressure.

8. Treats blood clotting disorders such as hemophilia.

9. To correct anemia.

Indications of Blood Transfusion:

Severe blood loss or haemorrhage.
To replace circulating volume and maintain oxygen delivery.
Major operative procedures.
Following severe bums where there is excessive haemolysis and dehydration.
Postoperatively in severe debilitated & anemic patients.
During pre-operative preparation in severe anaemia.
To arrest haemorrhage or as a prophylactic measure prior to surgery, in a patient with a haemorrhage state such as thrombocytopenia, haemophilia or liver disease.

Contraindication of Blood Transfusion:

Coronary thrombosis.
Congestive cardiac failure (CCF).
Acute renal failure.
Hypertension.
Polycythaemia.

Procedure of Blood Transfusion:

A. Articles:

1. Blood transfusion set.
2. Blood or Blood components-sterile in appropriate container.
3. I/V cannula No 18/20
4. Antiseptic solution or disinfectant- spirit, Betadine etc.
5. Sterile, cotton swab.
6. Tourniquet.
7. Adhesive tape.
8. Scissors.
9. Sterile gauze or cotton.
10. Infusion stand.
11. Roller bandage and splint (optional) 12. Kidney tray or disposable bag.
13. Gloves.

B. Procedure:
1. Verify doctor’s order. Inform the client and explain the purpose of the procedure.
2. Check for cross matching and typing. To ensure compatibility
3. Obtain and record baseline vital signs
4. Practice strict asepsis
5. At least 2 licensed nurse check the label of the blood transfusion. Check the following:

Serial number
Blood component
Blood type
Rh factor
Expiration date
Screening test (VDRL, HBsAg, malarial smear) – this is to ensure that the blood is free from blood-carried diseases and therefore, safe from transfusion.

6. Warm blood at room temperature before transfusion to prevent chills.

7. Identify client properly. Two Nurses check the client’s identification.

8. Use needle gauge 18 to 19 to allow easy flow of blood.

9. Use BT set with special micron mesh filter to prevent administration of blood clots and particles.

10. Start infusion slowly at 10 gtts/min. Remain at bedside for 15 to 30 minutes. Adverse
idut reaction usually occurs during the first 15 to 20 minutes.

11. Monitor vital signs. Altered vital signs indicate adverse reaction (increase in temp, increase in respiratory rate)

12. Do not mix medications with blood transfusion to prevent adverse effects. Do not incorporate medication into the blood transfusion. Do not use blood transfusion lines for IV push of medication.

13. Administer 0.9% NaCl before; during or after BT. Never administer IV fluids with dextrose. Dextrose based IV fluids cause hemolysis.

14. Administer BT for 4 hours (whole blood, packed RBC). For plasma, platelets, cryoprecipitate, transfuse quickly (20 minutes) clotting factor can easily be destroyed.

15. Observe for potential complications. Notify physician.

Hazards/Reaction of Blood Transfusion & Management:

Reaction	Sign and symptoms	Nursing management
A. Allergic reaction	Hives. Itching. Anaphylaxis	Stop transfusion immediately and keep vein patient with normal saline. Notify physician stat. Administer antihistamine parenterally as necessary.
B: Febrile reaction fever developing during infusion	Fever and chills Headache Malaise	Stop transfusion immediately and keep vein patient with normal saline. Notify physician. Treat symptoms
C. Hemolytic transfusion reaction: Incompatibility of blood product	Immediate onset Facial flushing Fever, chills Headache Low back pain Shock	Stop transfusion immediately and keep vein patient with normal saline. Notify physician state. Obtain first voided urine. Treat shock if present. Send remaining blood in bag, tubing and filter to lab. Draw blood sample for serologic testing and
D. Circulatory overload	Dyspne Dyspnea Dry cough Pulmonary edema	Slow/stop infusion. Monitor vital sign. Notify physician. Place patient in upright position with feet dependent.
E. Bacterial reaction: Bacterial present in blood	Fever Hypertension Dry, flushed skin Abdominal pain	Stop transfusion immediately.. Obtain culture of patient’s blood and return blood bag to lab. Monitor vital signs. Notify physician. Administer antibiotics stat.

Management of Mismatch Blood Transfusion:

1. Stop transfusion immediately.
2. Check patient’s identity against donor unit.
3. Inj. Hydrocortisone 2 vial IV stat.
4. Inj. Ca-gluconate 10 ml 10% IV slowly stat.
5. Maintain intravenous access with 0.9% NaCl solution after discarding giving set.
6. Monitor urine output closely with urinary catheter.
7. Give IV fluid to maintain urine output < 1.5 ml/kg/hr.
8. If the urine output is 1.5 ml/kg/hr insert CVP line and give fluid challenge accordingly.
9. If CVP is adequate and still the urine output is < 1.5 ml/kg/hr, then give injection frusemide.
10. If bacterial contamination is suspected, treat with broad spectrum IV antibiotics.
11. Contact senor medical staff for advice.
12. Contact blood ban sample required for further investigation.

Liver Function Tests

Liver function tests:
Liver function tests (LFTs or LFs) are groups of laboratory assays designed to give information about the state of a patient’s liver.

The liver function tests are
➤ Tests for excretory function:

In blood:
✓ Serum bilirubin concentration [0.3-1 mg/dl or 3-17 µmol/L]
Conjugated & unconjugated bilirubin
✓ In urine – Urinary bilirubin, urobilinogen

➤ Enzyme concentration:

Evidence of hepatocellular damage (as in hepatitis):
✓ Serum ALT/SGPT [10-40 U/L]
✓ Serum AST/SGOT [ 10-35 U/L]
Evidence of cholestasis (as in obstructive jaundice):
✓ Alkaline phosphatase (ALP) [40-125 U/L]
✓ Gamma-glutamyl transferase [Male: 10-55 U/L, Female: 5-35 U/L]

➤ Test for synthetic function:

Serum albumin [35-50 gm/L]
Albumin/globulin ratio [Normal- 1.7: 1; Range (1.3-4.1): 1]
Prothrombin time [Normal: 12-16 sec]. It assesses the liver function test for production of factor-II.
Serum total protein concentration [Normal: 60-80 gm/L]
Serum albumin & globulin level

➤ Test for detoxification function:

NH3 concentration in blood.

➤ Other biochemical tests:

Serum electrolytes (Hyponatraemia may occur in severe liver disease)
Blood urea level
Serum ferritin level (Haemochromatosis)
Serum & urinary copper (Wilson’s disease)
Serum ceruloplasmin (Wilson’s disease)

➤ Tumour marker (for hepatocellular carcinoma):

a-fetoprotein (AFP)

➤ Viral markers: Different viral markers for different types of viral hepatitis,
➤ Immunological tests (for autoimmune liver disease):

Anti-mitochondrial antibody
Anti-smooth muscle antibody
Antinuclear antibody (ANA)

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Clinically important liver function tests with their importance:

Important liver function	Importance
Serum bilirubin	Increased in different types of jaundice
ALT/SGPT	Rises in hepatitis
AST/SGOT	High levels are seen in hepatic necrosis, myocardial infarction, muscle injury and congestive cardiac failure.
Plasma albumin	A valuable guide to the severity of chronic liver disease.
Prothrombin time	Because of its short half-life, it is a sensitive indicator of both acute and chronic liver disease.
Alkaline phosphatase (ALP)	Serum ALP is raised in cholestasis (obstruction to bile flow) from any cause, whether intrahepatic or extrahepatic disease.

Functions of gall bladder:

In the gallbladder, the bile is concentrated by absorption of water.
Acidification of the bile.
It helps in the intermittent flow of bile.
It excretes cholesterol to some extent.
It secretes mucus, which is the main source of mucin of bile.
It equalizes the pressure in the biliary system by its contracting power.

(Ref-Ganong/25th/513+ Chakrabarti, Ghosh & Sahana/2nd/422)

Factors that favor gall bladder emptying:

Presence of fatty food in duodenum.
Cholecystokinin: By far the most potent stimulus for causing the gallbladder contractions is the hormone cholecystokinin.
Acetylcholine: Gallbladder is stimulated less strongly by acetylcholine-secreting nerve fibers from both the vagi and the intestinal enteric nervous system.

Substances having Cyclopentanoperhydrophenanthrene nucleus:

1. Bile acid.
2. Vitamin D.
3. Cholesterol.
4. Steroid hormones etc.

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Concepts about Blood Transfusion | CHAPTER 18 | Basic Science