1-9: Blood Administration

Question 1

What kinds of things does the plasma contain?

Answer 1

albumin (protein), fibrinogen (clotting factors), and globulins (antibodies)

Question 2

What is another name for the “Rh” antigen that can be found on RBCs

Answer 2

D antigen

Question 3

What would happen if someone with Rh- blood were exposed to someone with Rh+ blood?

Answer 3

antibodies to the antigens could be produced

Question 4

What would happen if someone with Rh+ blood were exposed to someone with Rh- blood?

Answer 4

There would be no issue

Question 5

What are the indications for Rhogam?

Answer 5

Women who are Rh- and pregnant

Given at 28 weeks

Question 6

Where are the antibodies and antigens for each of the blood types?

Answer 6

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

Question 7

What problems will arise if hemoglobin is low?

Question 8

What problems will arise if hematocrit is low?

Question 9

What is the purpose of giving whole blood or packed RBCs?

Answer 9

to restore circulating blood volume
to improve oxygen carrying capacity

Question 10

What is the infusion rate for whole blood and packed RBCs?

Answer 10

25-50 mL during the first 15 min, then adjust rate to infuse within 4 hours. Infusion can not exceed 4 hours.

Question 11

What might we do for a patient who has a hx of transfusion reaction before the transfusion starts?

Answer 11

pre-medicate with antipyretics and antihistamines

Question 12

After how long of thawing at room temperature can blood NOT be returned to the bank

Answer 12

30 min

Question 13

What specific lab value should be monitored in patients receiving large volumes of blood

Answer 13

calcium levels- pt can be hypocalcemic because the citrate in whole blood binds calcium

Question 14

What is the point of giving PRBCs

Answer 14

They increase the hgb by 1 g/dl/unit and the hct by 2-3% per unit

Question 15

What is the point of giving FFP

Answer 15

• to expand plasma volume
• to correct a coag factor deficiency
• to treat over anticoagulation by warfarin

Question 16

What is the infusion rate for FFP?

Answer 16

as fast as the patient can tolerate

4-10 mL/min or 1-2 hours

not to exceed 2 hours

Question 17

When is FFP indicated?

Answer 17

patients with active bleeding or documented coagulation factor deficiencies.

Question 18

FFP should be given within __ hours of thawing

Answer 18

6

Question 19

What is the point of giving platelets

Answer 19

• to increase platelet count
• to treat thrombocytopenia
• to treat leukemia and marrow aplasia
• to treat bleeding associated with effects of antiplatelet drugs

Question 20

What is the infusion rate for platelets?

Answer 20

5 mL/min initially and increase as tolerated. Not to exceed 4 hour infusion.

Question 21

When should you avoid administering platelets

Answer 21

when the patient has a fever

Question 22

IV cath smaller than ____ g should not be used for blood administration

Answer 22

20

Question 23

If the patient has a temperature >/= ____ following blood administration, you must call the physician.

Answer 23

38 C / 100.4 F

Question 24

What is the crystalloid of choice used to prime blood tubing?

Answer 24

NS

Question 25

How often should blood administration sets be changed?

Answer 25

after 2 units or 4 hours

Question 26

At what temperature range should blood be warmed?

Answer 26

32 - 37 C Tem should not exceed 40 C

Question 27

How long after an infusion can a reaction occur?

Answer 27

can occur within 5 min or after up to 14 days (!!!)

Question 28

What should you do if your patient begins to have signs of a transfusion reaction?

Answer 28

- 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

Question 29

What are subtle signs of a transfusion reaction

Answer 29

increased HR and temp

Question 30

What is TRALI?

Answer 30

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.

Question 31

What is TACO

Answer 31

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

Question 32

What is the pattern of administration of blood products for thrombocytopenia

Answer 32

1. FFP 2. platelets 3. PRBC

Question 33

____ of calcium should be administered every _____ units of blood

Answer 33

500 mg, 3-5

Question 34

Why should acid-base values be monitored closely when administering blood products?

Answer 34

- 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

Question 35

Which type of blood product is used to correct a coagulation factor deficiency?

Answer 35

FFP

Question 36

Which type of blood product is used to improve oxygen carrying capacity?

Answer 36

Whole blood

Question 37

Patients with hepatic disease may be prone to what type of complication following a large blood transfusion?

Answer 37

ammonia intoxication

Question 38

True or false- the most common cause of a transfusion reaction is the inadvertent administration of incompatible blood

Answer 38

true