1-9: Blood Administration Flashcards
What kinds of things does the plasma contain?
albumin (protein), fibrinogen (clotting factors), and globulins (antibodies)
What is another name for the “Rh” antigen that can be found on RBCs
D antigen
What would happen if someone with Rh- blood were exposed to someone with Rh+ blood?
antibodies to the antigens could be produced
What would happen if someone with Rh+ blood were exposed to someone with Rh- blood?
There would be no issue
What are the indications for Rhogam?
Women who are Rh- and pregnant
Given at 28 weeks
Where are the antibodies and antigens for each of the blood types?
A:
A antigens on the RBCs
anti-B antbodies in the plasma
B:
B antigens on the RBCs
anti-A antibodies in the plasma
AB:
A and B antigens on the RBCs
no antibodies in the plasma
O:
no antigens on the RBCs
A and B antibodies in the plasma
What problems will arise if hemoglobin is low?
What problems will arise if hematocrit is low?
What is the purpose of giving whole blood or packed RBCs?
to restore circulating blood volume
to improve oxygen carrying capacity
What is the infusion rate for whole blood and packed RBCs?
25-50 mL during the first 15 min, then adjust rate to infuse within 4 hours. Infusion can not exceed 4 hours.
What might we do for a patient who has a hx of transfusion reaction before the transfusion starts?
pre-medicate with antipyretics and antihistamines
After how long of thawing at room temperature can blood NOT be returned to the bank
30 min
What specific lab value should be monitored in patients receiving large volumes of blood
calcium levels- pt can be hypocalcemic because the citrate in whole blood binds calcium
What is the point of giving PRBCs
They increase the hgb by 1 g/dl/unit and the hct by 2-3% per unit
What is the point of giving FFP
- to expand plasma volume
- to correct a coag factor deficiency
- to treat over anticoagulation by warfarin
What is the infusion rate for FFP?
as fast as the patient can tolerate
4-10 mL/min or 1-2 hours
not to exceed 2 hours
When is FFP indicated?
patients with active bleeding or documented coagulation factor deficiencies.
FFP should be given within __ hours of thawing
6
What is the point of giving platelets
- to increase platelet count
- to treat thrombocytopenia
- to treat leukemia and marrow aplasia
- to treat bleeding associated with effects of antiplatelet drugs
What is the infusion rate for platelets?
5 mL/min initially and increase as tolerated. Not to exceed 4 hour infusion.
When should you avoid administering platelets
when the patient has a fever
IV cath smaller than ____ g should not be used for blood administration
20
If the patient has a temperature >/= ____ following blood administration, you must call the physician.
38 C / 100.4 F
What is the crystalloid of choice used to prime blood tubing?
NS
How often should blood administration sets be changed?
after 2 units or 4 hours
At what temperature range should blood be warmed?
32 - 37 C
Tem should not exceed 40 C
How long after an infusion can a reaction occur?
can occur within 5 min or after up to 14 days (!!!)
What should you do if your patient begins to have signs of a transfusion reaction?
- stop the transfusion
- change the tubing and maintain iv access
- assess the pt, obtain VS
- contact the physician
- keep the blood bag and tubing
- give an antihistamine and antipyretic
What are subtle signs of a transfusion reaction
increased HR and temp
What is TRALI?
transfusion related acute lung injury
- neutrophils from blood products are segregated in pulmonary capillaries and activated.
- damages the endothelial layer of the alveoli
- most patients recover within 48 hours with appropriate ventilator and hemodynamic support.
What is TACO
transfusion-related associated circulatory overload
- the increase in fluid from blood products causes an increase in CVP and pulmonary blood volume
- the pressure causes fluid to collect in the lungs
What is the pattern of administration of blood products for thrombocytopenia
- FFP
- platelets
- PRBC
____ of calcium should be administered every _____ units of blood
500 mg, 3-5
Why should acid-base values be monitored closely when administering blood products?
- Lactic acid in the blood pack can cause an acid load on the body
- also… citrate is metabolized to bicarb leading to a metabolic alkalosis.
- alkalosis may lead to hypokalemia
Which type of blood product is used to correct a coagulation factor deficiency?
FFP
Which type of blood product is used to improve oxygen carrying capacity?
Whole blood
Patients with hepatic disease may be prone to what type of complication following a large blood transfusion?
ammonia intoxication
True or false- the most common cause of a transfusion reaction is the inadvertent administration of incompatible blood
true
