Blood and their components of Blood bank in Transfusion Nursing

 

Blood Bank and Blood Component Transfusion Nursing

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LEARNING OBJECTIVES

At the end of this seminar, the learner will be able to:

1. Explain the organization and functions of a blood bank.

2. Discuss blood collection, processing, storage, and distribution.

3. Describe various blood components and blood products.

4. Explain indications, contraindications, and administration of blood components.

5. Discuss transfusion nursing responsibilities before, during, and after transfusion.

6. Identify and manage transfusion reactions.

7. Apply evidence-based transfusion practices in critical care settings.

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INTRODUCTION

Blood transfusion is one of the most commonly performed lifesaving procedures in modern healthcare. The development of blood banking and component therapy has revolutionized the management of:

• Acute hemorrhage

• Trauma

• Major surgery

• Hematological disorders

• Oncology patients

• Critical care patients

• Obstetric emergencies

Modern transfusion practice emphasizes the use of specific blood components rather than whole blood, thereby improving therapeutic effectiveness and minimizing complications.

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BLOOD BANK

Definition

A blood bank is a specialized organization or department responsible for:

• Collection of blood

• Screening of donors

• Processing of blood

• Storage of blood and components

• Compatibility testing

• Distribution of blood products

• Monitoring transfusion safety

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OBJECTIVES OF A BLOOD BANK

1. Ensure adequate blood supply.

2. Maintain blood safety.

3. Prevent transfusion-transmitted infections.

4. Provide blood components.

5. Promote voluntary blood donation.

6. Maintain quality assurance.

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FUNCTIONS OF BLOOD BANK

1. Donor Recruitment

• Voluntary blood donation camps

• Community awareness

• Donor motivation

Importance

Voluntary non-remunerated donors have the lowest risk of infectious diseases.

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2. Donor Screening

Medical History

Assess:

• Chronic illness

• Recent surgery

• Pregnancy

• Medication history

• Travel history

• High-risk behavior

Physical Examination

• Weight

• Pulse

• Blood pressure

• Temperature

• Hemoglobin

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3. Blood Collection

Standard Collection

• 350 mL blood

• 450 mL blood

Collected into sterile anticoagulant bags containing:

• CPDA-1

• CPD

• SAGM

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4. Laboratory Testing

ABO Grouping

Determines:

• Group A

• Group B

• Group AB

• Group O

Rh Typing

Determines:

• Rh positive

• Rh negative

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MANDATORY SCREENING TESTS

Every unit must be tested for:

Viral Infections

• HIV 1 & 2

• Hepatitis B

• Hepatitis C

Bacterial Infection

• Syphilis

Parasitic Infection

• Malaria

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5. Component Preparation

Whole blood is separated by centrifugation into:

• Packed RBC

• Platelets

• Plasma

• Cryoprecipitate

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6. Storage

Different blood products require different storage conditions.

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BLOOD COMPONENT THERAPY

Definition

Transfusion of a specific component rather than whole blood to correct a particular deficiency.

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ADVANTAGES OF COMPONENT THERAPY

Clinical Advantages

• Targeted therapy

• Better patient outcomes

• Reduced circulatory overload

Economic Advantages

• One donation benefits multiple patients

Safety Advantages

• Reduced adverse reactions

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BLOOD COMPONENTS

1. PACKED RED BLOOD CELLS (PRBC)

Preparation

Plasma removed from whole blood.

Volume

250–350 mL

Storage

2°C–6°C

Shelf Life

35–42 days

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Composition

Contains:

• Red blood cells

• Minimal plasma

Hematocrit:

• 60–80%

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Indications

Acute Blood Loss

Examples:

• Trauma

• GI bleeding

• Postoperative hemorrhage

Symptomatic Anemia

Examples:

• Hb <7 g/dL

• Dyspnea

• Tachycardia

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Expected Outcome

1 unit PRBC increases:

• Hb by approximately 1 g/dL

• Hematocrit by approximately 3%

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NURSING RESPONSIBILITIES FOR PRBC

Before

• Verify blood group

• Check cross-match

• Baseline vitals

During

• Observe first 15 minutes carefully

• Monitor for reaction

After

• Reassess vitals

• Evaluate clinical improvement

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2. PLATELET CONCENTRATE

Function

Primary hemostasis.

Normal count:

150,000–450,000/mm³

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Storage

20–24°C

Continuous agitation required.

Shelf life:

5–7 days

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Indications

Severe Thrombocytopenia

Platelets:
<10,000/mm³

Active Bleeding

Chemotherapy-Induced Thrombocytopenia

Dengue Hemorrhagic Fever

Aplastic Anemia

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Types

Random Donor Platelets (RDP)

Obtained from whole blood.

Single Donor Platelets (SDP)

Obtained through apheresis.

Preferred in:

• Oncology

• Bone marrow transplant

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Nursing Considerations

Assess:

• Petechiae

• Purpura

• Bleeding gums

• Hematuria

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3. FRESH FROZEN PLASMA (FFP)

Preparation

Separated and frozen within 8 hours.

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Contains

All coagulation factors:

• I

• II

• V

• VII

• VIII

• IX

• X

• XI

• XIII

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Storage

−18°C or lower

Shelf life:

1 year

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Indications

Disseminated Intravascular Coagulation (DIC)

Liver Disease

Massive Transfusion

Coagulation Factor Deficiency

Warfarin Reversal

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Contraindication

Not for:

❌ Volume expansion

❌ Nutritional supplementation

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Nursing Responsibilities

Monitor:

• PT

• INR

• aPTT

Assess bleeding status.

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4. CRYOPRECIPITATE

Definition

Cold-insoluble portion of plasma rich in clotting proteins.

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Contains

• Fibrinogen

• Factor VIII

• Factor XIII

• von Willebrand factor

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Indications

Hypofibrinogenemia

DIC

Massive Obstetric Hemorrhage

Cardiac Surgery

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Nursing Considerations

Monitor:

• Fibrinogen levels

• Bleeding status

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SPECIAL BLOOD PRODUCTS

Leukocyte-Reduced Blood

Purpose

Reduces:

• Febrile reactions

• CMV transmission

Used for

• Cancer patients

• Transplant recipients

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Irradiated Blood

Purpose

Prevents:

Transfusion Associated Graft Versus Host Disease (TA-GVHD)

Used for:

• Stem cell transplant

• Immunocompromised patients

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Washed Red Cells

Purpose

Removes plasma proteins.

Used in:

• Severe allergic reactions

• IgA deficiency

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MASSIVE TRANSFUSION

Definition

≥10 units PRBC within 24 hours

OR

Replacement of one blood volume in 24 hours

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Common Causes

• Polytrauma

• Ruptured ectopic pregnancy

• Postpartum hemorrhage

• GI hemorrhage

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Massive Transfusion Protocol

Ratio:

1 : 1 : 1

• PRBC

• Plasma

• Platelets

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COMPLICATIONS OF MASSIVE TRANSFUSION

Dilutional Coagulopathy

Hypothermia

Hyperkalemia

Citrate Toxicity

Hypocalcemia

Metabolic Acidosis

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TRANSFUSION NURSING

Pre-Transfusion Responsibilities

Verify Physician Order

Check:

• Product type

• Volume

• Rate

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Obtain Informed Consent

Legal requirement.

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Patient Identification

Use two identifiers.

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Blood Verification

Two qualified staff must verify:

• Name

• Registration number

• Blood group

• Expiry date

• Compatibility report

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DURING TRANSFUSION

First 15 Minutes Critical

Most severe reactions occur early.

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Vital Signs Monitoring

• Before

• 15 minutes

• 30 minutes

• Hourly

• Completion

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Observe for

Acute Hemolytic Reaction

Signs:

• Fever

• Chills

• Back pain

• Hemoglobinuria

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Allergic Reaction

• Rash

• Urticaria

• Itching

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Anaphylaxis

• Dyspnea

• Hypotension

• Shock

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TRALI

(Transfusion Related Acute Lung Injury)

Features:

• Acute hypoxemia

• Bilateral infiltrates

• Respiratory distress

Usually within 6 hours.

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TACO

(Transfusion Associated Circulatory Overload)

Features:

• Hypertension

• Pulmonary edema

• Raised JVP

Common in:

• Elderly

• CHF

• Renal failure

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MANAGEMENT OF TRANSFUSION REACTION

Immediate Actions

STOP TRANSFUSION

Most important nursing action.

Maintain IV Line

Use normal saline.

Inform Physician

Immediately.

Recheck Blood Bag

Verify patient identity.

Send Samples

• Blood bag

• Patient blood sample

• Urine sample

For investigation.

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DOCUMENTATION

Record:

• Component transfused

• Unit number

• Start and end time

• Vital signs

• Adverse events

• Nursing interventions

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ROLE OF CRITICAL CARE NURSE

The ICU nurse must:

• Interpret laboratory values

• Recognize early shock

• Manage massive transfusion protocols

• Monitor hemodynamics

• Prevent transfusion complications

• Participate in haemovigilance reporting

• Ensure patient safety through evidence-based transfusion practices

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KEY VIVA QUESTIONS

1. Why is component therapy preferred over whole blood?

2. What is the storage temperature of PRBC?

3. Indications of FFP?

4. Difference between TRALI and TACO?

5. What is cryoprecipitate?

6. Why are platelets stored at room temperature?

7. Define massive transfusion.

8. What is citrate toxicity?

9. What are the first nursing actions during a transfusion reaction?

10. Why is irradiated blood used?

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REFERENCES

1. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th Edition.

2. Lewis's Medical-Surgical Nursing, 12th Edition.

3. AABB Technical Manual, 21st Edition.

4. Mollison's Blood Transfusion in Clinical Medicine, 12th Edition.

5. Harmening DM. Modern Blood Banking and Transfusion Practices, 7th Edition.

6. Directorate General of Health Services (DGHS), India – Standards for Blood Banks and Blood Transfusion Services.

7. WHO Guidelines on Blood Transfusion Safety.