Blood transfusions are standard medical treatment in critical and non-critical situations. It is essential to understand what makes up blood and why it is necessary. Whole blood consists of RBCs, plasma, plasma proteins, and about 60 mL of anticoagulant/preservative solution in about 500 mL. Packed RBCs consist primarily of RBCs, a small amount of plasma, and about 100 mL anticoagulant/preservative solution in a total volume of about 250 to 300 mL/unit.
RBCs, WBCs, platelets, and plasma can all be transfused; each has different protocols and policies. For example, the process for WBC transfusion is the same as for RBCs. Still, the transfusion must be infused within 24 hours of the collection because WBCs have a short survival time, and therapeutic benefit is directly related to dose and viability. Facility protocol should be strictly adhered to.
Patients have different types of blood. O+ is the most common blood type, and AB- is the least common. Each can donate to and receive certain blood types. Failure to follow donation guidelines can result in adverse effects. Patients with O+ can donate to O+, A+, B+, and AB+ patients but only receive O+ or O- blood. Patients with O- blood, the "universal donors," can donate to everyone but can only receive O- blood. Patients with A+ blood can give blood to patients with A+ and AB+. However, they can receive blood from A+, A-, O+, and O- blood. Patients with A- blood can donate to A-, A+, AB+, and AB-. Patients with this type can receive blood from A- and O- patients. Patients with B+ blood can give blood to patients with B+ or AB+. However, they can receive blood from B+, B-, O+, and O-. Patients with B- can donate to patients with blood types B-, B+, AB-, and AB+. However, they can only receive blood from B- or O- patients. Patients with AB+ blood can only donate to others with this type of blood. However, they can receive blood from any blood type. Patients with this type of blood can give to others who are AB- or AB+. However, they can receive blood from AB-, O-, A-, and B-. It is important to note that A- platelets can be given to all patients; therefore, they are called "universal platelets."
There are many reasons why patients may need a blood transfusion. Surgery, trauma, pregnancy, and anemia are common indications for a blood transfusion. Patients can receive different types of transfusions; they include autologous, homologous, or directed transfusions. Autologous transfusions involve transfusing one's own blood. Homologous transfusions involve blood products from other patients. Directed transfusion is when an individual donates blood products for transfusion to a specified recipient. There are alternatives to blood transfusion that may benefit the patient, dependent upon the situation. Volume expanders, growth factors, and blood salvage are all options for patients.
Regardless of the procedure or type of transfusion, the proper equipment and steps should occur. Examples of equipment include blood, tubing, and gauges. After the essential steps are taken, such as verifying orders and patient identification, transfusion can occur; next is documentation. Documentation is as necessary as the interventions and should detail all events accordingly.
Regardless of the type of blood the patient is set to receive, compatibility between the donor and the recipient should be checked. Antigens and antibodies can cause reactions if precautions are not taken. Potential risks of blood transfusions include HIV/AIDS, CMV, and allergic, hemolytic, and febrile reactions. Acute transfusion reactions occur within the first 24 hours after a transfusion. Allergic reactions can range from mild to severe. Delayed reactions can occur days or weeks after a transfusion and can be life-threatening if not adequately addressed.
Preventative measures are in place to help prevent reactions caused by antibodies and antigens. Serologic testing occurs to assess the compatibility of a particular blood product with the recipient before releasing the blood product from the blood bank. There is also screening for infectious diseases like hepatitis, syphilis, CMV, HIV, bacteria, and parasites.