A. History of Blood Transfusion: The 1600 - 1700s
A. History of Blood Transfusion: The 1600 - 1700s
A. History of Blood Transfusion: The 1600 - 1700s
BLOOD TRANSFUSION
1628
British physician William Harvey discovers the circulation of blood. The first known
blood transfusion is attempted soon afterward.
1658
Microscopist Jan Swammerdam observes and describes red blood cells.
1665
The first recorded successful blood transfusion occurs in England: Physician Richard
Lower keeps dog alive by transfusing blood from other dogs.
1667
Jean-Baptiste Denis in France and Richard Lower and Edmund King in England
separately report successful transfusions from sheep to humans.
The 1800s
1818
British obstetrician James Blundell performs the first successful transfusion of human
blood to a patient for the treatment of postpartum hemorrhage.
1873-1880
U.S. physicians attempt transfusing milk from cows, goats and humans.
1884
Saline infusion replaces milk as a “blood substitute” due to the increased frequency
of adverse reactions to milk.
The 1900s
1901
Karl Landsteiner, an Austrian physician, discovers the first three human blood
groups.
1907
1
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
1914
Long-term anticoagulants, among them sodium citrate, are developed, allowing
longer preservation of blood.
1939-1940
The Rh blood group system is discovered by Karl Landsteiner, Alexander Wiener,
Philip Levine and R.E. Stetson.
1940
1941
1944
Dried plasma becomes a vital element in the treatment of wounded soldiers during
World War II.
1945
The Red Cross ends its World War II blood program for the military after
collecting more than 13 million pints.
2
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
Robin Coombs, Arthur Mourant and Rob Race describe the use of anti-human
globulin to identify incomplete antibodies. The process became known as the
Coombs test, also known as the antiglobulin test.
1947
ABO blood-typing and syphilis testing is performed on each unit of blood.
1948
The Red Cross begins the first nationwide blood program for civilians by opening its
first collection center in Rochester, N.Y.
1949
The U.S. blood system is comprised of 1,500 hospital blood banks, 46 community
blood centers, and 31 American Red Cross regional blood centers.
1950
Audrey Smith reports the use of glycerol cryoprotectant for red blood cells.
The U.S. enters Korean War. Red Cross becomes blood collection agency for
military during Korean War.
1956
Establishment of national blood clearinghouse.
1957
The American Association of Blood Banks forms its committee on Inspection and
Accreditation to monitor the implementation of standards for blood banking.
1961
Platelet concentrates are recognized for reducing the mortality from hemorrhage in
cancer patients.
1964
Plasmapheresis is introduced as a means of collecting plasma for fractionation.
1967
American National Red Cross Board of Governors receives report that national
headquarters will host a national Rare Blood Donor Registry for blood types
occurring less than once in 200 people.
1969
S. Murphy and F. Gardner demonstrate the feasibility of storing platelets at room
temperature, revolutionizing platelet transfusion therapy.
3
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
1970
U.S. blood banks move toward an all-volunteer blood donor system.
1971
Hepatitis B surface antigen (HbsAg) testing of donated blood begins.
1972
The Red Cross calls for national blood policy, which the federal government
sets up in 1974, supporting standardized practices and an end to paid
donations.
Apheresis is used to extract one cellular component, returning the rest of the
blood to the donor.
Food & Drug Administration (FDA) begins to regulate all 7,000 U.S. blood and
plasma centers.
1978
FDA requires blood bags to be labeled “paid” or “volunteer.”
1983
1985
Immediately after the Food and Drug Administration (FDA) licenses the first test to
detect the antibody to HIV on March 3, Red Cross Blood Services regions begin
testing all newly donated blood.
1987
The Red Cross opens its Holland Laboratory dedicated to biomedical research.
1992
Testing of donor blood for HIV-1 and HIV-2 antibodies (anti-HIV-1 and anti-
HIV-2) is implemented.
First National Testing Laboratory, applying standardized tests to ensure safety
of Red Cross blood products, opens in Dedham, Mass.
2000 to Present
2002
Nucleic acid amplification test (NAT) for HIV and hepatitis C virus (HCV) licensed by
the Food and Drug Administration.
Blood transfusions are a potentially life-saving procedure that replaces blood lost
during surgery or injury. A blood transfusion can also serve as a treatment for
patients with illnesses that stifle their ability to naturally produce enough blood cells
for their bodies.
Blood transfusions are a routine medical procedure that delivers blood into a
patient’s body through a narrow tube that’s connected to a vein in their arm or hand.
For people in critical condition, blood transfusions can be lifesaving. Four types of
blood products may be given through blood transfusions: 1. whole blood (FWB) , 2.
red blood cells (Packed RBC), 3. platelets, and 4. plasma. Most of the blood used
for transfusions comes from whole blood donations given by volunteer blood donors.
https://www.mayoclinic.org
Red blood cell transfusions may be given to patients who suffer from an iron
deficiency (i.e. anemia). This transfusion would boost a patient’s hemoglobin and
iron levels, while also improving oxygen levels in the body.
Platelet transfusions are often administered to patients who suffer from leukemia or
other types of cancer. This is because they may have lower platelet counts due to
chemotherapy treatments. Other patients may suffer from illnesses that stop the
body from creating enough platelets. Because of this, they may receive regular
transfusions in order to stay healthy.
Plasma transfusions provide vital proteins and other substances that are crucial to
a patient’s overall health. Plasma transfusions are often administered to those with
liver failure, severe infections, or serious burns.
5
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
Patients who suffer from illnesses that cause anemia will typically require
blood transfusions as part of treatment. These can include illnesses such as
leukemia or kidney disease.
The procedure starts when an intravenous (IV) line is placed into the patient’s body.
With this IV, the patient can receive new blood.
Nurses will usually perform this task under the direction of a physician’s order.
By reviewing the following steps, you can begin to learn more about the process of
blood transfusions. Each of you will be given a detailed checklist step by step
procedure lifted from ANSAP booklet 11th edition.
6
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
Like any other skill, blood transfusions require a lot of time and practice to master.
While in school, try not to feel disheartened if you don’t get it right the first time. And
don’t hesitate to ask for help.
Here are some of the general guidelines you should follow when performing a
blood transfusion in a controlled setting.
7
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
count along with the blood typing to save time and result is already
available.
Send the blood sample to the blood bank
Ensure the blood sample has the correct date/timing/labeling
Wait for the blood bank to match and prepare needed units based on
the sample you sent them.
4. Assemble supplies
Special Y tubing with an in-line filter
0.9% NaCl (Normal Saline) solution
Blood warmer
8
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
Once the blood bank notifies you that the blood is ready, you must
schedule its delivery from the blood bank
Packed red blood cells (pRBCs) can only be hung ONE UNIT AT A
TIME.
Remember: Once the blood has been released for ther patient, youte
nurse have 20-30 minutes to start the transfusion and up to 4 hours to
complete the transfusion
2. Observe ten (10) RIGHTS (Rs) when preparing and administering Intravenous
fluids and any blood or blood components this will ensure prudence and
safety in BT Administration.
Educate the patient
Relay the signs and symptoms of a transfusion reaction. If these occur,
the patient should notify their RN during the transfusion
Rash, itching, elevated temperature, chest/back/headache,
chills, sweats, increased heart rate, increased respiratory rate,
decreased urine output, blood in urine, nausea, or vomiting
4. Explain the importance of the benefits on Voluntary Blood Donation (RA 7719
– National Blood Service Act of 1994)
a. Republic Act No. 7719, also known as the National Blood Services Act of
9
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
10
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
Research has linked too much iron with NAFLD, Hepatitis C and other
liver diseases and infections. Though there are many other factors
involved in these problems, donating blood can help relieve some of
those iron stores and avoid extra issues in your liver.
b.6. Giving blood can help your mental state
While there are several physical benefits to donating blood, the most
powerful health benefit is arguably in the psychological realm. Donating
blood means that someone (or multiple people) somewhere will be getting
the help they desperately need.
Donating blood, especially on a regular basis, can be similar to volunteer
work. The person give of their time (and their literal blood) to help
strangers in need
This kind of regular, altruistic interaction has major psychological
benefits. Getting out of the usual environment to do something good for
someone else is stimulating in the best kind of way. Volunteering has
been shown to have positive effects on happiness. In people over 65-
years-old, volunteering also reduces the risk of depression and
loneliness.
6. Using a clean line tray, get compatible blood from hospital blood bank.
7. Wrap blood bag with clean towel & keep it at room temperature.
9. Get the baseline vital signs – BP, R, temperature before transfusion. Refer to
M.D. accordingly
Assess and document the patient’s status
Baseline vital signs (HR, RR, Temp, SPO2, BP), lung sounds, urine
output, and color
10. Give pre-med 30 minutes before transfusion as prescribed.
11
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
12
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
13. If main IVF is with dextrose 5% initiate an IV line with appropriate IV catheter
with plain NSS on another site, anchor catheter properly and regulate IV
drops.
14. Open compatible blood set aseptically and close roller clamp. Spike blood bag
carefully; fill the drip chamber at least half full; prime tubing band remove air
bubbles (if any). Use needle g 18 or 19 for side drip (for adults) or of 22 for
pedia (if blood is given through the Y injection port, the gauge of needle is
disregarded)
15. Disinfect the Y – injection port of IV tubing (plain NSS) and insert the needle
from BT administration set and secure with adhesive tape. ( Some hospitals
uses infusion pumps.
16. Close roller clamp of IV fluid of plain NSS and regulate to KVO while
transfusion is going on.
17. Transfuse the blood via the injection port to regulate at 10-15 gtts. Initially for
15 minutes and then at the prescribe rate (usually based on the patient’s
condition)
18. Observe patient for 10-15 minutes for any immediate reaction. Remain with
the patient at bedside for the first 15 minutes because this is when most
transfusion reactions can occur. After this 15 minutes period, the nurse may
increase the rate from KV0 to 2ml/min or 120ml per hour. if the patient is
stable and doesn’t display signs of a transfusion reaction
19. Observe patient on an on-going basis for any untoward signs and symptoms
such as flushed skin, chills, and elevated temperature, itchiness, urticarial,
and dyspnea. If any of this symptoms occurs stop the transfusion, , open
the roller clamp of the IV line with Plain NSS, and report to doctor
immediately
20. Swirl the bag hourly to mix the solid with the
plasma. N.B. one BT set that should be used
for 1-2 units of blood.
22. Continue to observe the monitor patient post transfusion, for delayed reaction
could still occur Obtain post-transfusion vital signs and document the patient’s
status
23. Re-check Hgb and Gct, bleeding time, serial platelets count within specific
hours as prescribed & or per institution’s policy.
24. Discard blood bag and BT set and sharp according to Health Care Waste
Management (DOH/DENR). Dispose of used Y tubing in a red biohazard bin
25. Document the procedure, pertinent observations and nursing intervention and
endorse accordingly
Document vital signs after 15 minutes, then hourly, and finally, at the
completion of the transfusion
26. Remind the doctor about administration of Calcium Gluconate if patient had
several units of blood transfusion (3-6 or more units of blood)
Why do we give calcium gluconate after blood transfusion?
Hypocalcemia - an adverse effect of massive blood transfusion examined.
The potential for hypocalcemia among patients receiving large amounts of
donated blood products over a short time period is due to the presence of the
anticoagulant citrate in the bag that donated blood is collected to. Citrate –
acts as anticoagulant by chelating calcium.
14
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
After the procedure, patients may experience some soreness near the puncture site,
but this side effect should dissipate quickly. In addition, the patient’s doctor might
request a checkup after the transfusion.
Allergic reactions
Fever
Acute immune hemolytic reaction
Blood-borne infections
However, the most common reaction to a blood transfusion is mild soreness around
the IV site.
You can avoid some of these adverse reactions by following the appropriate steps.
What they say is true: practice makes perfect.
15
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
Many of our pro blood transfusion tips involve organization, patience, and a detail-
oriented nature. Here are a few pro blood transfusion tips from Dr. Siegel that may
assist you in the future.
Ordering the wrong dose of platelets. There are two different kinds of
platelet products, and some hospitals offer both kinds. Because of this, ordering
platelets by the unit can create confusion about how much is needed. To avoid
this confusion, some clinicians order platelets by the dose.
The higher your PT or INR, the longer your blood takes to clot. An elevated PT or
INR means your blood is taking longer to clot than your healthcare provider
believes is healthy for you. When your PT or INR is too high, you have
an increased risk of bleeding
Being impatient with the blood typing and screening process. If the
patient’s blood has a positive antibody screen, the overall process can be much
lengthier. Once the antibodies are identified, and blood lacking the corresponding
antigens is found, the donor blood will also have to be physically cross-matched
with the patient’s sample. The process can take some time for blood-bank staff to
complete.
16
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
As the nurse carrying out a doctor’s order, you will be responsible for prepping the
patient and ensuring appropriate history, lab work, documentation, and supplies are
available before the transfusion. These crucial steps can help prevent adverse
transfusion reactions.
In the nursing field, you never know when you may encounter life-or-death situations.
Reflect on your goals and which specialization is best for you. Ensure that you work
in a facility that suits your needs. And, of course, make sure you pick the right
school.
17
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
18
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
19
HandOut on Blood Transfusion
NCM 118 RLE
Prof. Ma. Susan Chan, MAN
20