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Blood Transfusion Types

Contact Hours: 5

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Contact Hours: 5

This educational activity is credited for 5 contact hours at completion of the activity.

Course Purpose

The purpose of this course is to provide healthcare professionals with a brief overview of the different blood components, transfusion types, and the role of healthcare providers during the transfusion process.


A blood transfusion is a common medical procedure that is required when an individual experiences excessive bleeding due to an injury or during surgery. It is also given when the body cannot make blood properly on its own. When this occurs, donated blood is transfused to the individual, as their own blood level is insufficiently low to carry oxygen around the body. This life-saving procedure, although safe, has multiple complications that should be considered by practitioners. This course will overview the different blood components, transfusion types, and the role of healthcare providers during the transfusion process.

Course Objectives

Upon completion of this course, the learner will be able to:

  • Identify the four blood groups
  • Understand the different types of blood components available for transfusion
  • Review the testing process for the various blood components prior to transfusion
  • Implement to steps for patient verification prior to blood product transfusion
  • Review the protocol for massive transfusion

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This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.


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Fast Facts: Blood Transfusion Types

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Blood Transfusion Types Pretest

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Activated Factor VIIaInitiates the process of coagulation in conjunction with tissue factor  (TF/factor III)
AgglutinationThe process of forming clumps of particles or cells in a solution, usually by an antibody or a complement.
Antihuman Globulin (AHG) SerumAn antibody to an antibody.
Antibodies (immunoglobulin)A protective protein that is produced by the immune system  in response to the presence of an antigen.
AntigenAny molecule that can trigger an immune response by binding to a specific antibody.
Antiglobulin CrossmatchA type of serologic crossmatch used in patients who do not qualify for either the computer/electronic or immediate-spin crossmatch.
ApheresisA form of medical technology in which the blood of a person is passed through an apparatus that separates out one constituent and returns the remainder to the circulation.
BasophilsA type of white blood cell that is produced in the bone marrow.
Blood TransfusionA medical procedure that replaces blood or blood components lost or damaged due to illness or injury.
Bone MarrowThe spongy tissue on the inside of bones.
CoagulantsA substance that causes coagulation, the process of forming blood clots or solid masses in a liquid.
Cryoprecipitated Antihemophilic FactorA portion of plasma that is rich in clotting factors.
Cyanotic Heart DiseaseA group of heart problems that occur at birth.
Cytomegalovirus (CMV)A common infection caused by a type of herpes virus. 
Disseminated Intravascular Coagulation (DIC)A rare but serious condition that causes abnormal blood clotting throughout the body’s blood vessels. 
ElectrolytesMinerals that carry an electric charge when dissolved in water.
Electronic CrossmatchA crossmatch that is done without the need for test tubes or contact between donor red cells and patient serum. 
EosinophilsA type of disease-fighting white blood cell.
ErythrocytesRed blood cells that transport oxygen and carbon dioxide in the blood.
GranulocytesWhite blood cells that fight pathogens and recycle damaged cells.
Hematocrit (HCT)Measures the proportion of red blood cells in the blood. 
Hyperchloremic AcidosisA type of metabolic acidosis with normal anion gap and high chloride levels.
Hypoxemia    A low level of oxygen in the blood.
Immunoglobin A (IgA)An antibody blood protein that is part of the immune system.
Immediate Spin MethodDiluted red cells and patient serum or plasma are added to a test tube at room temperature, immediately spun, and then examined visually for agglutination.
ImmunoglobulinsProtein that acts as an antibody to fight infections and diseases.
Lactate Ringers (LR)A mixture of water and electrolytes that is given intravenously to treat dehydration and acidosis.
Leukocyte Antigen (Hla) AlloimmunizationFormation of antibodies against non-self antigens.
NeutropeniaA condition characterized by abnormally low levels of white blood cells called neutrophils. 
NeutrophilsA type of white blood cell ( granulocyte ).
Normal Saline (NS)One of the most used IV fluids and is used for most hydration needs.
Plasma ProteinsThe collection of intricate molecules found in blood plasma. 
PlateletsColorless blood cells that help blood clot. 
Red Blood CellsThe most common type of blood cell and the  principal means of delivering oxygen to tissues.
Rh Factor (Rhesus factor)A type of protein found on the outside of red blood cells that is genetically inherited.
Rotational Thromboelastometry (ROTEM)A holistic blood coagulation assay.
ThrombocytopeniaA condition where abnormally low levels of platelets are observed. It causes nosebleeds, bleeding gums, blood in urine, heavy menstrual periods, and bruising
Thromboelastography (TEG)A method of testing the efficiency of blood coagulation.
Thrombotic Thrombocytopenic Purpura (TTP)A type of anemia that is characterized by fever, hemolytic anemia, thrombocytopenia, and renal and neurologic dysfunction.
Tranexamic Acid (TXA)A medication used to treat or prevent excessive blood loss  from trauma, postpartum bleeding, surgery, tooth extraction, nosebleeds, and heavy menstruation.
Transfusion-Related Acute Lung Injury (TRALI)A serious and potentially fatal complication of blood product transfusion in which a patient develops rapid onset lung injury and noncardiogenic pulmonary edema due to activation of immune cells in the lungs. 
White Blood Cell (WBC)A group of blood cells that fight infection and inflammation in the body.

A blood transfusion is a common medical procedure that is required when an individual experiences excessive bleeding due to an injury or during surgery.1 It is also given when the body cannot make blood properly on its own.3 When this occurs, donated blood is transfused to the individual, as their own blood level is insufficiently low to carry oxygen around the body.1

This life-saving procedure, although safe, has multiple complications that should be considered by practitioners.2 Even though the blood is screened for blood-borne diseases before transfusion, there are multiple factors and potential risks to be noted – from the pre-transfusion preparation to the complications during the transfusion process.

This course will overview the different blood components, transfusion types, and the role of healthcare providers during the transfusion process.

Understanding Blood Types

The presence or absence of specific antigens determines a blood type or group.4 Antigens can trigger an immune response if they are foreign to the body; thus, blood type matching is necessary to ensure safe blood transfusion and prevent the immune system from attacking the transfused blood.4

There are 4 main types of blood groups in the ABO system, namely: 4,5

  • Blood group A – Has A antigen on the RBCs and B antibody in the plasma
  • Blood group B – Has B antigen on the RBCs and A antibody in the plasma
  • Blood group AB – Has both A and B antigens on the RBCs, but neither A nor B antibodies in the plasma
  • Blood group O – Has neither A nor B antigens on the RBCs, but both A and B antibodies in the plasma

The ABO system was developed by Karl Landsteiner, which opened doors for blood banking and introduced the concept of blood uniqueness based on the antigens present in the red blood cells (RBCs).6 The ABO group testing is frequently performed in blood banks, and all donors and patients must undergo ABO forward and reverse grouping tests.6 Forward grouping is defined as using known sources of commercial antisera (anti-A, anti-B) to detect antigens on an individual’s RBCs.6 In contrast, reverse grouping is detecting ABO antibodies in an individual’s serum using known reagent RBCs.6

The ABO blood group system frequency varies in specific ethnic populations; for instance, blood  B is 2x common in Blacks and Asians as in Whites.6

When discussing blood types, it is important to discuss the Rh factor or system. It refers to a specific red blood cell (RBC) antigen (D) and a complex blood group system currently composed of 61 different antigenic specificities.6 The Rh antibodies are only produced when exposed to foreign red blood cells.6 The presence or absence of the RhD antigen signifies if the blood group is positive or negative.6 Based on this, there are a total of 8 blood types, including: 4,5

  • A RhD positive (A+)
  • A RhD negative (A-)
  • B RhD positive (B+)
  • B RhD negative (B-)
  • AB RhD positive (AB+)
  • AB RhD negative (AB-)
  • O RhD positive (O+)
  • O RhD negative (O-)
Types of Blood Components for Transfusion

Previously, whole blood transfusion was the only medical practice performed, but now it is rarely used.7 Blood component therapy is more commonly employed for blood transfusion as individuals only need specific blood components for their diseases and treatement.7 This allows multiple patients to benefit from a single pint of donated blood.

Multiple components can be derived from whole blood that is transfusable and needs to be stored under ideal conditions for proper handling and safe transfusion.7

  • Red Blood Cells (RBCs)
    • Red blood cells, also known as erythrocytes, are produced in the bone marrow and are used to carry oxygen from the lungs to the rest of the body and take carbon dioxide back to the lungs for exhalation.8 Red blood cells are responsible for the distinctive color of the blood and are commonly transfused in patients with anemia or severe blood loss.8 They must be refrigerated at a specific temperature, and have a shelf life of 42 days; however, they can be treated and frozen for up to 10 years.8
  • Plasma
    • Blood plasma serves as a liquid base for the whole blood and is slightly yellowish in color.9 It contains coagulants, immunoglobulins, electrolytes, and plasma proteins.9 Solid components comprise 8% of the blood plasma, while the remaining 92% is water.8,9 Plasma performs several bodily functions, such as the transportation of nutrients and respiratory gases, regulating body temperature, and maintaining optimal blood pressure and volume.8,9 Plasma has a shelf life of 1 year and must be frozen.8
  • Platelets
    • Platelets are produced in the bone marrow and are small, colorless cell fragments used to prevent bleeding by sticking to the lining of the blood vessels. They have a shelf life of 5 days and require constant gentle agitation to prevent clumping.8
  • Cryoprecipitated Antihemophilic factor
    • Cryoprecipitated Antihemophilic factor, also known as cryo, is part of the blood plasma rich in clotting factors.8 It is transfused in individuals whose blood does not clot properly and is used to prevent bleeding.8 It is also an important source of fibrinogen. Cryo has a shelf life of 1 year and must be frozen.8
Blood Transfusion Types

Red Blood Cell Transfusion

Red blood cells (RBCs) are prepared from the whole blood by removing the blood plasma (liquid portion).8 Red blood cells are used in cases of severe bleeding or to restore oxygen delivery to hypoxic tissues.10 Patients with acute bleeding resulting from an injury, trauma, chronic anemia, or gastrointestinal bleeding benefit the most from RBC transfusion.8

Three types of RBCs can be used for transfusion, each having specific indications.

  • Packed RBCs – This blood component is used to increase hemoglobin levels, and the indications depend on the patient.11 Transfusion is needed in patients with high hemoglobin (Hb,HgB) levels and decreased cardiopulmonary reserve or constant bleeding.11 One RBC unit is sufficient to increase Hb by 1g/dL and the hematocrit (HCT) by 3%.11 Depending on the anticoagulant used, they have a shelf life of 42 days and can be refrigerated or frozen for up to 10 years.8 If the purpose is to increase blood volume, different fluids can be used concurrently or individually.11
  • Washed RBCs – This blood component is free from all traces of white blood cells, platelets, and plasma.11 It is produced by washing the RBCs manually or in a closed, automated system, and then resuspending the washed RBCs in 100 mL SAG-M.7 This blood component  is indicated for patients who are severely IgA-deficient with anti-IgA antibodies for whom an efficient donor is not available.7 Washed RBCs are also recommended for patients with recurrent or severe allergic or febrile reactions to red cells.7
  • White Blood Cell (WBC) Depleted RBCs – This blood component is produced by removing 99.99% of white blood cells using a special filter.11 It can be used in the following cases:
    • For exchange transfusions
  • For patients that need cytomegalovirus-negative blood.11
  • For patients who have experienced nonhemolytic febrile transfusion reactions
    • For prevention of human leukocyte antigen (HLA) alloimmunization to help prevent refractoriness to platelet transfusion

The following are some of the most recent national and international scientific societies’ recommendations for RBCs transfusion: 10    

Table 1: RBC Transfusion Recommendations10    

Hemoglobin levelClinical setting
Hb level <6 g/dLAcute anemia in surgical and non-surgical patients
Hb level <7 g/dLMinimum threshold for transfusion of RBC in adults and most children.
Hb level <7 g/dLCritically ill patients
Hb level <7 g/dLCardiac surgery
Hb level between 7-9 g/dLA restrictive transfusion strategy should not be used in preterm infants or children with cyanotic heart disease, severe hypoxemia, active blood loss, or hemodynamic instability.
Hb level between 6-10 g/dLPresence of risk factors (heart disease) or symptoms indicative of hypoxia
Hb level <6 g/dLIntra- or post-operative period

Platelet Transfusion

Platelets are commonly transfused in thrombocytopenic patients to treat and prevent hemorrhages.12 It is also beneficial for bleeding patients who have a normal platelet count, but still have platelet dysfunction from the use of antiplatelet drugs.11 Platelets are produced by centrifuging whole blood donations and adding buffy coats from four donations into the plasma of one donor or by an adult therapeutic dose (>240×109 per transfusion) of platelets obtained by apheresis from a single donor.7 Platelets are stored in temperature-controlled incubators, set around 20-24°C, and require constant agitation to prevent clumping.7 It has a shelf life of only 5 to 7 days.7,8

Platelet transfusion can be used therapeutically or prophylactically. Therapeutic platelet transfusion is used to treat acute hemorrhage.12 In contrast, prophylactic transfusion prevents hemorrhage in patients with treatment-induced thrombocytopenia or platelet dysfunctions. This is recommended before surgery or invasive procedures.12

Some patients do not respond well to platelet transfusion for the following reasons: 11

  • Platelet consumption due to disseminated intravascular coagulation (DIC)
  • Platelet destruction due to HLA or platelet-specific antigen alloimmunization
  • Splenic sequestration

Plasma Transfusion[1] 

Blood plasma is involved in multiple bodily functions. It is the liquid portion of the blood that is used to carry RBCs, WBCs, and platelets around the body.8 Plasma is obtained from whole blood donations or component donations from apheresis.7 Plasma must be frozen 24 hours after donation and thawed when needed. It can be frozen for up to a year.8

Plasma transfusion is indicated in the following reasons: 11,13

  • For managing and preventing bleeding in patients with multiple coagulation factors undergoing invasive procedures.
  • Patients on warfarin therapy with bleeding or requiring urgent warfarin reversal.
  • Patients with multiple coagulation factors because of acquired deficiencies due to liver diseases, liver transplantation, or cardiac surgery.
  • Patients with rare plasma protein deficiencies.
  • Patients with selected coagulation factor deficiencies.
  • Patients with Thrombotic Thrombocytopenic Purpura (TTP).

During administration, the plasma is checked for discoloration or particulates and is unusable if turbid.13 It is administered via an infusion set with a filter, and the IV infusion rate should not exceed 1 mL/kg/min.13 Plasma components are transfused based on ABO compatibility, and the transfusion frequency depends on the deficient factors and their respective half-lives.13

Granulocyte Transfusion

Granulocytes are white blood cells visible through microscopies, such as eosinophils, basophils, and neutrophils, due to prominent intracytoplasmic granules.14 It is important to note that granulocyte transfusion is not a common procedure and is only indicated in special cases.

This type of transfusion is used as a replacement therapy to combat bacterial and fungal infections by providing functional neutrophils to the body.14 It is commonly indicated in the following cases: 14,15

  • Bacterial or fungal infections that are unresponsive to traditional treatments and therapies for at least 24 to 48 hours.
  • Patients with congenital neutrophil defects or expectation of neutrophil recovery.
  • Patients with neutropenia (<500 PMNs/uL) or neutropenia caused by reversible myeloid hypoplasia.

When selecting donors, there are certain guidelines to follow. For instance, the donor should be ABO blood group or RhD system compatible as it contains a substantial number of RBCs.14 Moreover, Cytomegalovirus (CMV) seronegative patients should only receive granulocytes from CMV seronegative donors.14

Granulocytes are collected through apheresis and stored at room temperature for 24 hours but must be transfused as soon as possible.14 It is important to note that granulocytes begin to lose function within 6 to 8 hours, however in emergency situations, the transfusion process may be conducted before the donor’s infectious disease testing results are available.14

The dosage depends on the donor and the mobilization regime provided prior to donation. The ideal dosage for an adult is one apheresis unit per day, approximately 300-400 mL.15 The number of granulocytes per dose can vary greatly. 15 Granulocytes are transfused for five days or more until the infection is resolved, or until neutrophils are recovered and maintain a count of >500/uL for 48 hours.15

Crystalloid use During Blood Transfusion

Fluid resuscitation is necessary in trauma cases with severe blood loss. Crystalloid solutions replace fluids and play a critical role in patient survival.16 A new concept, damage control resuscitation, was recently introduced that suggests that in cases of severely injured hypotensive trauma patients, blood component usage should be initiated early. If  blood products are not readily available, the crystalloid solutions should be administered to improve survival rates.16

Two crystalloid solutions are commonly used for fluid resuscitation: normal saline (NS) and Lactate Ringers (LR). Normal saline has a pH of 5.0 and an osmolarity of 308mOsm/L and consists of 154mM Na+ and Cl-.16 It is used for blood transfusion and storage. Still, many animal and human studies have shown that using NS in moderate to large infusion volumes can lead to hyperchloremic acidosis and interstitial edema.16 

Lactated Ringers has a pH of 6.5 and is slightly hypo-osmolar with 272mOsm/L.16 It has electrolytes in the following concentration: 130mM Na+, 109mM Cl-, and 28mM lactate. Lactated Ringers has a superior acid-base balance compared to NS.16 However, there are contraindications with LR administration, as it cannot be administered with blood products, and is unsuitable for patients with liver dysfunction because lactate is metabolized in the liver, which can lead to elevated lactate levels.17

Pretransfusion Testing and Labs

Pretransfusion testing and labs are important to ensure the right blood is given to the right patient at the right time.18 Many serological tests are involved when the blood is donated or dispensed from the laboratory to the patient’s bedside. This includes compatibility testing, donor selection, screening, and cross-matching.18 It is a multi-step process that ensures all transfusion identifiers are present and the correct donors and units are selected.18

The following are the four testing strategies considered for each blood transfusion type:18

  • Hold – No tests are performed because the requirement for transfusion is unlikely, and the patient does not have a history of blood transfusion or pregnancy.
  • Type and hold – ABO and RhD tests are performed in patients with slight transfusion requirements, and in patients who do not have a history of blood transfusion or pregnancy.
  • Type and screen – ABO, RhD, and antibody screening are performed in patients with a chance of blood transfusion, and in patients who have a history of blood transfusion or pregnancy.
  • Type and screen with crossmatch – ABO, RhD, antibody screening, phenotyping, unit selection, and crossmatching are performed in patients with a high chance of blood transfusion, and in patients who have a history of blood transfusion or pregnancy.

The following include procedures for testing blood samples.

ABO and Rh Typing

To check a patient’s ABO compatibility, both forward grouping (cell typing) and reverse typing (serum testing) are performed.18 This testing should be conducted on two samples collected at different times before finalizing the report. If any discrepancies are found, they should be resolved before moving forward with other tests.18

In the Rh D typing, the patient’s red cells are tested with anti-D sera.18 Weak D testing is only required when the recipient is a neonate born to RhD negative mother.18

Antibody Screening

In antibody screening, an indirect antiglobulin test (IAT) that is performed to detect antibodies to blood group antigens.18 A known blood group antigen profile is used for screening, and the recipient’s plasma or serum is incubated with red cell panels.18

Antibody Identification

Antibody identification is conducted once antibody screening tests are positive.18 To specify an antibody, the sample is tested against multiple reagent red cells that express or lack a particular blood group antigen.18 The antibody specificity is determined based on the reactivity pattern against the reagent red cell panel. Afterword, a probability calculation is performed, in which a p-value of 0.05 to zero down is a minimal requirement.18

Once antibody identification is conducted, confirmation can be done through antibody phenotyping. The recipient is phenotyped for the antigen to ensure they are negative for that specific antigen.18 The method is like forward typing and involves using specific antisera.18 It is also conducted in donors to select negative units for the antibody identified or in thalassemia or pregnancy cases where phenotype-matched blood is a requirement.18

Compatibility Testing

For compatibility testing, different methods can be used, such as: 18

  • Antiglobulin crossmatch – A tube method in which 2 to 5% saline-suspended donor red cells are mixed with recipient serum, and the tube is incubated at 37 C for approximately 45 minutes.18 The resulting product is washed to remove unbound antibodies, and the AHG serum is added to check for agglutination.
  • Electronic crossmatch – Compatibility is verified by the computer, which contains all the donor unit compatibility records. The patient is screened, and the information is entered into the computer, which then displays the best match from the inventory.
  • Immediate spin method – Can be used as the sole method for verification if the recipient does not have or was previously detected with clinically significant antibodies.18 The donor’s saline-suspended cells are mixed with the recipient in major and minor crossmatch at room temperature.
Steps for Patient Verification Prior to Blood Transfusion

Approximately 1 in 13,000 blood units are administered to the wrong patient, some of them leading to fatal outcomes.19 One of the major factors of this problem is patient misidentification or lack of communication among nurses. It is recommended that health care organizations have a process in place to ensure correct patient identification prior to administering blood products, including at least two person-specific identifiers that are used to confirm the patient and the blood product intended to be trasnfused.20

The following are the guidelines to be followed by healthcare organizations prior to blood transfusion: 21

  • Requests for blood components should include the following information for verification of the recipient:
  • First and last name of the recipient
  • Identification of the recipient
  • Location of the recipient
  • The requested blood component
  • The required volume or quantity
  • The clinical indication of the blood requirement
  • Special requirements, if any
  • The pickup for the blood component should include the following steps to ensure the correct recipient receives the required blood component:
    • First and last name of the recipient
    • Identification of the recipient
    • Name of the blood component being requested
  • Blood samples for pre-transfusion testing should not be collected unless the patient is verified through an identification number.
  • The following information should be collected about the person drawing the blood sample:
    • Full name
    • Computer identification code
    • Date and time of collection
  • At the time of blood collection, the label should include the recipient’s information or identifiers.

Patient identifiers are written on a band which is worn by all patients receiving a blood transfusion.21 Identifiers include: 21

  • Last name
  • First name
  • Date of birth
  • Unique patient ID number
Signs of Transfusion Reaction

Adverse reactions of blood transfusions are rare.1 For instance, common mild reactions that occur within 24 hours of transfusion include fever, itching, hives, and rash.1 In addition, there are adverse effects of blood transfusion that require immediate attention, including: 1

  • Low blood pressure
  • Aches and pains
  • Difficulty in breathing
  • High fever
  • Dark urineor hematuria
  • Transfusion-associated circulatory overload – Common in patients with acute renal failure or congestive heart failure. Signs appear 6 to 12 hours after transfusion and include pulmonary edema, elevated brain natriuretic peptide, and response to diuretics.2 In such cases, limiting the number of transfusions and administering diuretics before and between transfusions helps prevent the adverse effect.2
  • Transfusion-related acute lung injury (TRALI) – Patients develop acute hypoxemic respiratory distress within 2 to 4 hours of transfusion. It is rare and can be resolved with supportive care only.2
  • Febrile reaction – If this occurs, the transfusion is stopped and the patient is treated with acetaminophen.2 To prevent febrile reaction, transfusion with leukocyte-reduced blood products is recommended.2
  • Allergic reaction – Patients develop symptoms like wheezing, bronchospasms, pruritus, or urticaria, which can be treated with antihistamines, steroids, bronchodilators, or epinephrine. Washing the plasma from the blood prior to transfusion also reduces reaction risk.2
  • Human immunodeficiency virus infection
  • Hepatitis C infection
  • Fatal hemolysis – Is extremely rare and occurs in only 1 out of 2 million transfusions. It results from ABO incompatibility, and the patient develops a fever, chills, flushing, lower back pain, dyspnea, and becomes tachycardic.2 The transfusion is stopped, and intravenous fluids with normal saline are given. Nurses also mist ensure that the urine output remains greater than 100 mL/hour.2
Massive Transfusion Protocols

Massive transfusion protocols (MTPs) are standard at trauma centers to help rapidly deliver blood to bleeding patients.22 The following are the current MTP standards for transfusion ratio: 22

  • Optimal Ratio of Blood Products
    • The transfusion ratio among the 3 main components (PRBC:FFP:platelets) should be between 1:1 or 1:2.
  • Timing of Delivery of Blood Products
    • Critical trauma patients who require greater than 10 or more packed red cells in a 24-hour period should have blood components readily available in a portable refrigerator.
  • Adjuncts in Massive Transfusion Protocols
    • Patients that require MTP can benefit from adjuncts like Tranexamic acid (TXA), prothrombin complex concentrate, recombinant activated factor VIIa, and the use of thromboelastography (TEG) and rotational thromboelastometry (ROTEM).
  • Blunt vs. Penetrating Trauma
    • Blunt trauma patients have a lower probability of survival due to multiple organ damage and injuries. A reduction in 30-day mortality was observed only in blunt trauma patients when compared with penetrating patients when using a balanced transfusion approach.
Religious Considerations for Blood Transfusion

There are two religions that prohibit blood transfusions, Jehovah’s Witnesses and Christian Scientists. Jehovah’s Witnesses believe that it is against God’s will to accept blood transfusions, and they have no distinction between “taking blood into the mouth and taking it into the blood vessels.”22 Thus, they refuse blood transfusion for themselves and their children due to the fear of losing eternal salvation.22

Christian Scientists believe in healing through prayer and refuse blood transfusion.23

In such cases, the following approach should be taken: 24

  • Although major blood components, like RBCs, plasma, and platelets, are prohibited, there may be blood derivatives that a Jehovah’s Witnesses may be willing to accept. It is the healthcare professional’s responsibility to be completely transparent about the risk and benefits of all blood components and allow the patient or designated caregiver to make an informed decision regarding care.
  • The discussion should be held at a private location with no distractions.
  • The healthcare professional should build rapport and avoid making assumptions and confrontations.
  • The acceptance or refusal of blood products and their derivatives should be recorded prior to hospitalization or surgery. These records should be available electronically and supplied to blood banks and pharmacies.
Nursing Considerations

The following guidelines can be useful for nurses and in the preparation of institutional standard operating procedures: 25

  • Nurses should monitor transfusion recipients based on their medical history or clinical conditions.
  • Nurses should check the blood recipients’ vital signs, including blood pressure, pulse, respiration, and temperature, prior to initiating the transfusion, 15 minutes after the initiation of the blood transfusion, and upon completion of the blood transfusion.
  • During the transfusion, the flow rate is monitored and regulated as prescribed.
  • Recipients should be monitored for signs or symptoms of transfusion adverse effects, especially in the first 15 minutes of the initiation of the blood product transfusion.
  • Posttransfusion assessment is important, and samples should be collected based on the prescribed orders and the patient’s condition.25

Blood transfusion has completely revolutionized healthcare and helped trauma and surgical patients.2 However, this simple procedure can lead to adverse effects if there is a lack of communication and poor identification measures in a healthcare organization. Thus, interprofessional team communication is important.2

The key principles that should be followed during every stage of the blood transfusion process include positive patient identification, good documentation, and excellent communication.19 Positive patient identification involves verifying at least two identifiers, including the patient’s full name, identification number, and related paperwork.19

Strict adherence to guidelines should be performed by nurses and everyone involved in the transfusion process to ensure the right blood is supplied to the right patient at the right time.

  1. Blood transfusion. Vic.gov.au. Published 2012. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/blood-transfusion
  2. Lotterman S, Sharma S. Blood Transfusion. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK499824/
  3. Treatments for Blood Disorders – Treatments for Blood Disorders | NHLBI, NIH. www.nhlbi.nih.gov. https://www.nhlbi.nih.gov/health/blood-bone-marrow-treatments
  4. American Red Cross. Blood Types. Redcrossblood.org. Published 2019. https://www.redcrossblood.org/donate-blood/blood-types.html
  5. NHS. Blood Groups. nhs.uk. Published October 17, 2017. https://www.nhs.uk/conditions/blood-groups/#:~:text=There%20are%204%20main%20blood
  6. Harmening D. Modern Blood Banking & Transfusion Practices. 7th ed. F.A. Davis Company; 2019.
  7. Target Information Systems Ltd. JPAC – Transfusion Guidelines. Transfusionguidelines.org. Published 2014. https://www.transfusionguidelines.org/transfusion-handbook/3-providing-safe-blood/3-3-blood-products
  8. Blood Components. www.redcrossblood.org. https://www.redcrossblood.org/donate-blood/how-to-donate/types-of-blood-donations/blood-components.html#:~:text=The%20transfusable%20components%20that%20can
  9. Mathew J, Varacallo M. Physiology, Blood Plasma. Nih.gov. Published January 20, 2019. https://www.ncbi.nlm.nih.gov/books/NBK531504/
  10. Franchini M, Marano G, Mengoli C, et al. Red blood cell transfusion policy: a critical literature review. Blood transfusion = Trasfusione del sangue. 2017;15(4):307-317. doi:https://doi.org/10.2450/2017.0059-17
  11. Blood Products – Hematology and Oncology. MSD Manual Professional Edition. https://www.msdmanuals.com/professional/hematology-and-oncology/transfusion-medicine/blood-products
  12. Solves Alcaina P. Platelet Transfusion: And Update on Challenges and Outcomes. Journal of Blood Medicine. 2020;Volume 11:19-26. doi:https://doi.org/10.2147/jbm.s234374
  13. FFP, Octaplas (fresh frozen plasma) dosing, indications, interactions, adverse effects, and more. reference.medscape.com. https://reference.medscape.com/drug/ffp-octaplas-fresh-frozen-plasma-999499
  14. Manjee K, Gniadek TJ. Educational Case: Granulocyte Transfusion. Academic Pathology. 2020;7:237428952090950. doi:https://doi.org/10.1177/2374289520909500
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  19. JPAC. JPAC – Transfusion Guidelines. Transfusionguidelines.org. Published 2014. https://www.transfusionguidelines.org/transfusion-handbook/4-safe-transfusion-right-blood-right-patient-right-time-and-right-place
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  24. Crowe EP, DeSimone RA. When blood transfusion is not an option owing to religious beliefs. Annals of Blood. 2022;7:22-22. doi:https://doi.org/10.21037/aob-21-58
  25. York N. New York State Council on Human Blood and Transfusion Services* and New York State Board for Nursing † GUIDELINES for MONITORING TRANSFUSION RECIPIENTS Fourth Edition 2012 *New York State Council on Human Blood and Transfusion Services. https://www.wadsworth.org/sites/default/files/WebDoc/857758683/monitorning%20txrecip0812final.pdf
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