Blood Transfusion Case Study
Blood Transfusion Case Study
Blood Transfusion Case Study
Tammy Hale
IV Therapy
The patient is a 60 year old female that has a hemoglobin value of 7 g/dl which is
below the normal level of 11.7-15.5 g/dL (Van Leeuwen & Peolhuis-Leth, 2009). The
doctor ordered packed red blood cells for her to increase her hemoglobin. A unit of
packed red blood cells will raise her hemoglobin level 1 g/dL. Hemoglobin of 7 g/dL will
cause a decrease in the oxygen delivery to the tissue. A transfusion of packed red blood
cells will increase the oxygen delivery to the tissues because oxygen is delivered by red
This patient also has a perforated gastric ulcer. When an ulcer is perforated it
causes internal bleeding which will in turn cause a decrease in red blood cells. The
packed red blood cells will be administered to replace the red blood cells that are lost
Granulocytes are a blood product that was not ordered by the doctor because the
patient does not have an infection. Platelets have a normal range of 150,000-
c
±50,000/mm3 (Van Leeuwen & Peolhuis-Leth, 2009), there was no decrease in this
value therefore platelets were not administered. Another blood product is plasma which
increases coagulation that is usually monitored by the PT/PTT levels. There was no
Before a blood transfusion can be given to a patient they need to sign a consent
form. This form is to be signed after the nurse or doctor explains why she is receiving
the red blood cells. Indications for her receiving this blood product are, blood loss from
the perforated ulcer, anemia of 7 g/dL, and decreased oxygen delivery. Explaining the
risks for receiving packed red blood cells are also needed, such as, fever, rash, and
pain at the IV site. Rare risks include bacterial contamination, anaphylaxis, and
symptoms that may occur are decreased treatment options, risk for bleeding, and
hypoxia (Red Cross, 2010). Discuss other alternatives to transfusions with the patient
such as vitamin K, Iron, and hematopoietic growth factors. After the patient has been
educated on the procedure, talk with them to see if there are any questions and
concerns. The consent form can then be signed by the patient and a witness (Red
Cross, 2010).
At the bedside two nurses need to perform identification checks and blood
verification to decrease risk for any mistakes. First, identify the patient by asking the
patient to state their full name and date of birth. Next, verify this by comparing their
name band and identification number with the physician¶s orders. The name and ID
number should be identical on the paperwork. Check the blood product for verification
and compare all identification numbers with all paperwork. Compare the blood type to
c
make sure it is the one ordered and that it is compatible. Note if any special processing
was needed and number of units. Verify date and time of infusion and flow rate and do
not forget to check expiration date of blood product. One last time before preparing to
administer make sure patient ID, physician orders, lab paperwork, and blood type are all
correct. Document all the steps as well as the person who checked the blood product
The patient is complaining of dyspnea, has a runny nose, and a rash. This would
indicate that she is having a hemolytic reaction. Immediately, I would stop the
transfusion and take down all tubing sets involved in administration, grab new tubing
and a new bag of 0.9% sodium chloride to be infused rapidly. I would notify the
physician and the blood bank of the patient¶s reaction and check the blood bag again for
compatibility tag, label, and patient identifier for any errors (Alexander, 2010). These
are the first few things to complete after a possible blood reaction. A few more things
that may be needed are sending anticoagulated and clotted blood samples, a reaction
form, and the blood bag to the blood bank. Some tests to be ordered may include a
urine sample, BUN, creatinine, and coagulation studies (Alexander, 2010). As you can
hypocalcemia. This is of worry due to albumin mostly. Almost half of the body¶s
these calcium particles will become free floating. Citrates rise in the plasma during
c
large volume transfusions and they will bind with the free floating calcium and may
transfusion. The immune system differentiates between its own blood cells and the
blood cells of another person. A hemolytic transfusion reaction occurs when a person¶s
immune system who is receiving a blood transfusion makes antibodies that attack and
destroy the blood cells being infused. This most often occurs when the blood being
transfused does not match the blood type of the client receiving the blood. It may also
occur when a person who has Rh negative blood receives Rh positive blood (Dugdale,
2009).
The person who does receive an incompatible blood type will experience a
hemolytic transfusion reaction. The most common observable signs and symptoms of a
reaction include, ³bloody urine, dyspnea, chills, dizziness, fever, back pain, and rash´
(Dugdale, 2009, p. 1). Most of the time these signs and symptoms will occur
immediately after or during the transfusion, however a delayed reaction is possible with
signs and symptoms not occurring until several days after the blood has been
If a hemolytic reaction is suspected from the signs and symptoms that the patient
exhibits then the transfusion should be stopped immediately and the following steps
should be implemented:
c
1. The IV should be left in place but the blood bag with the transfusion set should
be disconnected.
2. A new bag of 0.9% normal saline with new tubing should be started and keep
the IV open.
3. Notify the blood bank of reaction so that they can document specific details for
5. Confirm that there was not a clerical error by checking the compatibility tag and
6. Confirm that patient¶s identification is correct and that no clerical errors were
made.
a. The blood bag with attached transfusion set should be removed from the
pump.
b. At the patient¶s bedside all labels, forms and patient ID should be verified.
c. Blood bag with attached transfusion set should be returned to lab, keeping
it as aseptic as possible.
8. Collect all packaging from the disposable items used in the transfusion and
9. Collect the first post-transfusion urine passed by the patient and notify the lab so
10. If the physician orders blood work that should be drawn and most likely would
11. Complete transfusion reaction work-up form including patient information, patient
symptoms and when they presented, lot numbers of all disposables, all blood
Throughout this process the patient¶s vital signs must be monitored, intravascular
volume must be maintained and respiratory status monitored and supported (Phillips,
2001).
c
References
Dugdale, D. (2009). Transfusion reaction ± hemolytic. Retrieved from the Medline Plus
website: http://www.nlm.gov/medlineplus/ency/article/001303.htm.