Blood Transfusion Practice Questions with Answers and NCLEX® Review

Introduction to Blood Transfusion

The need for blood transfusion varies widely between clients and depends on their condition. Blood transfusions are one of the safest and most effective ways to treat clients suffering from anemia or low blood counts due to cancer treatment. They can also be used to treat other conditions like sepsis and even prevent death from trauma-induced shock.

However, there are risks involved with blood transfusions — and when done improperly, they can lead to complications like infection or allergic reactions. These complications can sometimes be fatal if not treated promptly.

The most common types of transfusions include whole blood, plasma, platelets, red blood cells (RBCs), and umbilical cord blood.

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There are two general types of transfusions: autologous transfusion and allogeneic transfusion. Autologous transfuses use the client’s blood, collected before surgery or other procedures when possible. This type of transfusion is generally used for planned surgeries because it reduces the risk of complications associated with mismatched blood types or rare diseases that could interfere with the process (such as HIV). 

Allogeneic transfusions use someone else’s donated blood. This type is typically used in emergencies where time is short, and donors must be found quickly (such as clients injured from car accidents).

Blood Transfusion Steps

Before beginning a blood transfusion, you must teach the client about infusion reactions, assess for allergies and/or transfusion reactions, and obtain a consent form.

The nurse must be aware of how much blood is contained in the unit, and the prescription of how many units should be transfused. Important information is obtaining the client’s health history—including any previous transfusions and/or reactions to transfusions.

Before

• • Two RNs verify order:
    • Name
    • Identification number
    • Blood product (blood type & Rh factor)
  • Vital signs (As per each agency policy):
    • Before infusing
    • Five minutes after beginning the infusion
    • Fifteen minutes after the infusion begins and increase the rate
    • Thirty minutes after the infusion begins
    • Hourly
    • At completion
  • Prep:
    • ●Eighteen G or larger- IV catheter
    • ● Blood tubing with filter
      • 0.9% sodium chloride (normal saline) ONLY

• IF client needs other medications start a second IV access

During

• STAY at the bedside for the first fifteen minutes
  • Reaction
    • Stop the infusion
    • Infuse saline
    • Follow agency protocol
    • Call Health Care Provider (HCP)

After

• Flush with 0.9% sodium chloride (normal saline)

Blood Product Administration

Blood administration consists of two parts: pre-transfusion and post-transfusion.  Pre-transfusion administration involves preparing the client for a blood transfusion, while post-transfusion administration refers to the steps taken immediately following a successful transfusion.

Blood transfusions can be administered intravenously (IV), via intramuscular injection (IM), or intraosseous (IO). The most common type of transfusion is intravenous.

Several types of blood products can be used for transfusions, including whole blood, red blood cells, platelets, fresh frozen plasma, cryoprecipitate, and albumin solutions.

Blood Transfusion Reactions

Transfusion reactions are classified as: 

• Hemolytic – When RBCs are destroyed.
• Nonhemolytic – When RBCs aren’t destroyed, but when they don’t function properly.
• Allergic – When a client has an immune response to a protein in the donated blood.
• Immune-mediated hemolytic anemia – Hemolytic anemia caused by antibodies against RBCs.
• Immunologic – When T cells attack RBCs.

Allergic reactions are the most common type of transfusion reaction and are usually more mild than other types of reactions.

Transfusion reactions are rare – but when they happen, they can be deadly. Therefore, nurses must be aware of the different transfusion reactions to safely administer blood products.

Allogeneic vs Autologous Transfusion

Allogeneic and autologous blood transfusions are two different methods of getting a client’s blood. 

Autologous (self) blood transfusions occur when a client’s blood is returned to that client. Allogeneic (donor) blood transfusions are when someone else’s blood is given to a client.

Blood collection from a single client (that is transfused back into the same client when needed) is typically done for clients with particular religious views (like Jehovah’s Witnesses) who do not allow blood transfusions from other individuals.

Blood Types and RH Factor (Antibodies)

There are four major blood types: A, B, AB, and O. Each type is divided into subtypes based on whether they have a Rhesus factor (RhD positive or negative). When a client receives a blood transfusion, the nurse must ensure that the blood type matches the client’s blood type. If it is not a match, the body will reject the blood.

• Individuals with type A have A substances on their surface
• Individuals with type B have B substances on their surface
• Individuals with type AB have both A and B substances
• Individuals with type O have neither A nor B substances

The Rh factor is a protein on the surface of red blood cells. It helps to determine whether or not a client’s blood is Rh-positive or Rh-negative. 

If an individual has rh-negative blood, it means that they lack the Rh factor protein. If they have rh-positive blood, it means that they possess the Rh factor protein.

If a client receives a transfusion of blood from an individual with a different Rh factor type than theirs, then antibodies can be created in the body that attacks the transfusion (because the body perceives it as an invader). 

This is called an immune response, and it can cause serious complications for the client receiving the transfusion.

Blood Transfusion Conclusion

Transfusions are one of the safest and most effective ways to treat anemia. The need for blood transfusions varies widely between clients, depending on their condition. 

Before transfusing a client, you must know how much blood is contained in the unit and the prescription of how many units should be transfused. Important information is obtaining the client’s health history — including any previous transfusions and/or reactions to transfusions.

Allergic reactions are the most common type of transfusion reaction, and they are usually more mild than other types of reactions. These reactions can still be harmful. Nurses should be aware of transfusion reactions when infusing blood products.