Unit 1. Back Ground of Blood Transfusion

UNIT 1. BACK GROUND OF BLOOD TRANSFUSION

Blood is normally transfuse to provide hemoglobin for transportation of oxygen to the tissues and vital organs .Blood or blood product are given to provide clotting factors or platelets in patients with coagulation failure

.INDICATION 1)Acute blood loss 2)Chronic blood loss and severe anemia 3)Pre-operatively in a patient with a low Hb and in whom blood loss during surgery is anticipated 4)To provide plasma ,platelets or clotting factors

TYPES OF BLOOD TRANSFUSION a)Autologous blood transfusion This is the retransfusion of a patient’s own blood during surgery. 1) It is practice among patients with ruptured ectopic pregnancy and thoracic-abdominal vascular injuries . This type of transfusion is safe where blood in the peritoneal cavity is less than 6 hours old and is not contaminated by bile or intestinal content. 2) Blood can be removed from a patient 2-7 days before elective surgery and retransfused if necessary for this to be done the patient Hb must be above 80% .After the blood collection Ferrous sulphate tablets are given b) Heterologous blood transfusion This is the most commonly practiced method of transfusion and involves giving the patient some one’s else blood .To avoid in compatibility and transfusion reaction , cross-match (or in an emergency, group specific or O negative ) blood is given.

BLOOD SCREENING Blood screening is a procedure to check the safety of the blood which is about to be transfused .This is done to minimize certain risk like infection SCREENING PARAMETERS The following are some of the parameters ; -checking for blood grouping antigens (blood grouping) -checking for Hepatitis A B C $ D infection -checking for syphilis -checking for HIV -checking for malaria -checking for compatibility between the donor and the recipient Compatibility is a testing procedure of investigating the indifferences of blood ,antigens and antibodies from a donor and the recipient. A donor is any healthy person of adult age who can give blood

CONDITION TO DONATE -must have Hb >70% -most be of age >18 years most not have any history of allergy -must have be donated blood <60 days -must not be jaundice

1 .Recipient is a patient to whom blood donated is given.He or she may receive blood from a donor with the same blood group or different blood group . But compatibility testing most be done .

BLOOD COLLECTION Blood collection is a process of inserting a needle from a blood bag into any suitable vein on the fore arm of the donor .Before this is done the fore arm is swab with spirit and an elastic tourniquet tied on the proximal portion of the fore arm to facilitate pressure.

BLOOD BAG Blood flowing from the vein is collected into a plastic bag containing specific volume of anticoagulant. A 250 blood bag has 25ml of anticoagulant .A 500ml bag has 50ml anti coagulant .The type of anticoagulant in the bag determines the storage shelf life of the blood . The acid citrate dextrose anticoagulant keep blood cells for 21days . The acid citrate phosphate adenine anticoagulant keeps blood for 35 days .

ABO BLOOD TYPES AND TRANSFUSION - Blood Group O persons can give blood to Blood Group O , A, B and AB persons - Blood Group O persons can only receive Blood from Group O persons - Blood Group A Persons can give only to A and only receives from A - Blood Group B persons can give only to B and only receives from B - Blood Group AB persons can give to A or B persons but receives only from AB. - RHESUS D BLOOD TYPES AND TRANSFUSION - Persons with Rhesus D positive blood can only give and receives from Rhesus D Positive - Persons with Rhesus D negative Blood can give to Rhesus D positive but receives only from Rhesus D negative

UNIVERSAL DONORS These applies to persons who have Blood Group O Rhesus D negative( No antigenic expression on the Red Blood Cells )

UNIVERSAL RECIPIENTS These applies to individuals who are Blood Group AB Rhesus D negative

DANGEROUS GROUP O DONORS This applies to individuals who are either Blood Group O Rhesus D positive or negative but have haemolysin A and B antibodies.

BLOOD BANK A blood bank is a specialized refrigerator with in –build temperature alarm system , having different shelves in which different blood group types are stored. Blood can be stored in a domestic refrigerator only for a short period of time , over night storage would damage the blood cells. The storage temperature is 4oC

2 BLOOD PRODUCTS These are product derived from blood after fractionization a)Plasma : This provide colloid , protein or clotting factor b)platelets : They are transfused to patients with platelets deficiency c) cryoprecipitate :This contain concentrated clotting factor including factor 8 d)Albumin solution : These are colloidal solution ,using transfused at concentration of 4% ,10% and 20% BLOOD SUBSTITUTION These are synthetic compounds called perflourocarbon that are being develop and that will transport oxygen to the tissues. BLOOD VOLUME EXPANDERS These constitute the different types of electrolytes that might be given intravenously to replace loss fluid during dehydration or surgery ,e.g. Nacl, Hartman , glucose5or 10% etc

NURSING GUIDELINES IN SETTING UP BLOOD FOR TRANSFUSION -Before Transfusion -check that the blood is the correct group , name and number on both the label and the form match the patient -check that the IV line of the patient and whether is sufficiently calibrated (1g gauge or wide) During Transfusion -check that the blood is running in at the correct speed -observe for signs of transfusion reaction by recording temperature and pulse every 15minutes during transfusion

TRANSFUSION REACTION This is a series or specific type of reaction that the recipient manifest as a result of blood incompatibility . Cross-matching reduces the risk of transfusion reaction . A transfusion reaction is characterized by the following signs in increasing order of severity -pyrexia(.38oC)and rigor -Tachycardia -itchiness and pefechial rash -loin pain -tachypnoea -hemoglobinuria -confusion, hypo tension and anaphylactic shock

NURSING ACTION AGAINST TRANSFUSION REACTION -1) Stop the blood transfusion 2) Give 20mg of hydrocortisone IV 3 )Check the number on the blood tag and the form to make sure the correct unit is being transfused . 4) Send the blood back to the blood bank together with a further sample of the patient blood. 5)Test the patient ‘s urine for hemoglobin . 6)Send patient and donor’s blood for culture.

CHANGES TO BLOOD DUE TO STORAGE 1) Oxygen-caring capacity is reduced due to deteriorating red cells function during storage, fresh blood has the best oxygen caring capacity 3 2) Platelets function declines rapidly, so that after 48-72hours of storage the platelet will not assist in coagulation 3) Deterioration of coagulation factors 4) Citrate toxicity ; the anticoagulation losses it potency. 5) Hypothermia ;

4 UNIT 2 : RECOMMENDED LABORATORY SCREENING TESTS AND PROCEDURES

NATURE OF BLOOD GROUPING ANTISERA

TYPE OF ANTISERUM COLOR PRESENTATION PRESERVATIVE Anti- A Blue Sodium azide Anti- B Yellow Sodium azide Anti - AB Straw Sodium azide Anti - D Colorless Sodium azide Anti-Human Globulin Green Sodium azide

1. ABO & Rh.D Grouping Principle This test is based on the detection of Red Blood Cell Antigens found on the RBC surface. The Concentration of the Antigens varies from one Red Blood Cell type to another.

NATURE OF REACTION The nature of reaction is based on Antigen - Antibody agglutination. The end results of the agglutination reaction is scored as follows.

Observation Designation Complete agglutination of Red cells into a single Clump ++++ Several large clumps of red cells +++ Few large red cells visible clumps ++ Small evenly distributed red cells clumps + Many un agglutinated but microscopic clumps of 5- 10 reds cells ± Mainly un agglutinated but microscopic clumps of 3-5 red cells w No red cell agglutination observed Neg

FACTORS AFFECTING ANTIGEN/ANTIBODY REACTIONS

- Concentration - Hydrogen ion Concentration - Temperature - Ionic Strength of Solution

Methods There are two methods the Tile and Tube Methods. Materials used White crucible tile, Pasture pipette , ABO antiserum, Lancet Prickers , Control Cells

a) Tile Technique 1. Direct Grouping

5  Label the White Tile with patient identification and the respective A, AB, B and D antiserum.  Place four separate drop of the patient’s blood on the white clean tile.  Apply the corresponding antiserum in equally volume to the drop of blood  Mix with applicator stick and rock the tile for about five minutes  Observe and record strength of the agglutinations.  Interpret the resulting ABO & Rh.D Blood Grouping .

Patient RBCs 1 2 3 4 Anti A ++ - ++ - Anti B - - ++ ++ Anti AB ++ - ++ ++ Anti D ++ ++ - ++

Interpret A. RhD+ O.RhD+ AB.RhD- B.RhD+

2. Indirect Grouping  Label the White Tile with patient identification and the respective A, AB, B and D antiserum.  Place four separate drop of the patient’s blood on the white clean tile.  Apply the corresponding antiserum in equally volume to the drop of blood  Mix with applicator stick and rock the tile for about five minutes  Observe and record strength of the agglutinations.  Interpret the resulting ABO & Rh.D Blood Grouping .

Serum Group 1 2 3 4 A Cells - - + + B Cells + - - + O Cells - - - -

Interpret A AB B O b) Standard Tube Technique

 Place 2 drops of patient serum into each of four precipitin tubes. Add 1 drop of 3% suspension of known group A1 rbc to the first tubes, group A2 rbcs to the second, group B rbcs to the third and O rbcs to the Fourth. Mix cells and serum gently.  Repeat the above Procedure using 2 drops of anti-A, anti-B, anti- AB ,anti –A1 antisera and 1 drop of 3% test red cell suspension.  Incubate for 30minutes  Centrifuge tubes at 200 x g for 1 minute  Examine tubes for haemolysis or agglutination over light box. Control tubes should be read first. If the control results are erroneous , all tests must be discarded and repeated. Negative tests should be confirmed by light microscopy.  Record the scores for each test and interpret.

6 1 2 3 4 5 6 7 8 Cell Group Anti-A C C ++MF - C +++ - - Anti-B - - - - C C C - Anti-AB C C +++ +++ C C C - Anti-A1 C - - - C - - -

Serum Group A1 Cells - +/- +/- +/- - +/- C C A2 Cells ------C C B Cells C C C C - - - C O Cells ------

Interpretation A1 A2 A2 AX A1B A2B B O

FALSE POSITIVE RESULTS FALSE NEGATIVE RESULTS

 Rouleaux Formation or Pseudo-  The Use of anti-sera which have agglutination lost their potency due to Solution : use few drops of Normal incorrect storage or repeated Saline .Rouleaux formation disappears in freeze -thaw cycles N/S, While true agglutination Persist.  Infected Red Cells ( Thomsen  Failure to allow method protocol Phenomenon). RBC infected by bacteria expose the T antigen site on e.g too short an incubation time, the RBC which is capable of forgetting to add antiserum. agglutinating with T antibody present on most animal and human serum.  Failure to recognize that that Solution : Use fresh RBC in Grouping haemolysis must be reported as  Cold Agglutinins such and not recorded as Cold antibodies reacting at lower temp negative because no agglutination instead of normal room temp due to certain cab be seen. infections .  Solution : RBCs should be rewashed in warm  Saline and retested.