2.6a Infection Control, Transfusions

Question 1

Identify indications for blood and blood component therapy for
WHOLE BLOOD

Answer 1

Whole Blood:
Contains RBC’s, plasma proteins, clotting factors and plasma from ONE donor

Rarely used unless there is a significant volume loss

Indicated to replace blood volume and O2 carrying capacity in hemorrhage or shock

Requires: type, crossmatch and must be ABO identical

May need use of blood warmer for rapid infusion

Question 2

Identify indications for blood and blood component therapy for
RED BLOOD CELLS

Answer 2

Red Blood Cells (PRBC’s):

Contains red blood cell with little to no clotting factors

Indicated to restore intravascular volume ad replace O2 carrying capacity

May be leukocyte reduced= lower WBC to reduce risk of reaction

1 unit is approx. 250-350mL and should raise the Hgb approx. 1g/dL if no volume overload or active bleeding. Ex: pt with Hgb of 6, after one unit, raises to 7

Requires: type, crossmatch and ABO identical

May use blood warmer for rapid infusion

Can take 2-4 hrs to infuse one unit

Unit can NOT hang for over 4 hrs

Risks: BB pathogens, volume overload and reaction

Question 3

Identify indications for blood and blood component therapy for
PLATELETS

Answer 3

Platelets (clear, yellow color):

Contain a 6 pack of platelets (6 donors for 1 dose)

Indicated for severe thrombocytopenia or acute or continued hemorrhage

One transfusion will raise platelet level approx. 30,000-50,000/mL

ABO compatibility recommended but not required

Must be used within 5 days of donation

Transfusion may be administered quickly over 15-30 minutes

Risk: BB pathogens, lower risk of reaction due to removal of RBC’s

Question 4

Identify indications for blood and blood component therapy for
ALBUMIN

Answer 4

Albumen (water magnet):

Contains a concentrated amount of protein from plasma and is considered the most common colloid solution

Indicated for expansion of blood volume in patients with shock, trauma and burns

increases osmotic pressure and moves fluid from the ECF to the intravascular space

Type and crossmatch NOT required

Typically dispensed from pharmacy and doe not require blood consent

Risks: hypersensitivity to albumin and BB pathogens

Question 5

Identify indications for blood and blood component therapy for
FRESH FROZEN PLASMA

Answer 5

Fresh Frozen Plasma (yellow color):

Contains all clotting factors, fibrinogen, plasma proteins and electrolytes

indicated for treating coagulopathy, restoring of clotting factors or supplying plasma protein to expand volume

ABO compatible

Crossmatch and Rh compatibility is NOT required

Must be thawed in water bath and used within 2 hours of thawing

Can be infused quickly, 15-30 min

Risk: BB pathogen

Question 6

Identify indications for blood and blood component therapy for
CRYOPRECIPITATE

Answer 6

Cryoprecipitate (yellow color):

Contain a portion of plasma that is rich in clotting factors (VIII and fibrinogen)

Prepared from fresh frozen plasma

Indicated for treatment of coagulopathies such as hemophilia, vonWillebrand disease and disseminated intravascular coagulation (DIC)

ABO math preferred but not required

Rh type is not needed

Infuse as rapid as possible

Risk: BB pathogens

Question 7

Rationale for nursing assessments and interventions indicated for patients receiving blood products

Answer 7

Assessment:
Strict I/O
Lung sounds
Skin
Vitals:
-pre-transfusion (w/in 15 min)
-15 min after initiating
-post-transfusion (w/in 30-60 min)
-hourly or as needed
Temperature over 100.3= notify provider prior to admin.

Interventions:
Begin blood w/in 15 min of leaving blood bank
Admin pre-med as ordered (acetaminophen, Benadryl common with pt hx of reaction)
Use of blood warmer or rapid infuser if indicated
Initiate transfusion slowly (50-75mL/hr) for first 15 min= RN must stay with pt for 15 min starting once the blood reaches the pt
Monitor pt for reaction
Documentation

**If blood comes in cooler, hang time frame longer than 15 min

Question 8

What should the patient be able to teach back regarding the need for the transfusion

Answer 8

.

Question 9

Antigens?

Answer 9

Molecules on the red blood cell
Defined as A or B or BOTH
Neither A or B

Question 10

Antibodies?

Answer 10

Immune-globulins which are Y-shaped proteins in plasma
Produced by the immune system in response to the antigens
Fight against things not wanted
The body will not make antibodies against itself, only unknowns

Question 11

Rh Factor?

Answer 11

Rh factor is a blood type descriptor of NEG OR POSITIVE
Rh+ means the D antigen is present on RBC’s
Rh+ blood types can receive blood from Rh+ or Rh- donors
Rh- blood types can only receive blood from Rh- donors

Question 12

Identify and explain complications of blood component therapy
HYPERSENSITIVITY REACTION

Answer 12

Hypersensitivity reaction:
Recipient antibodies react to the donors proteins. May occur during or after transfusion. Pre-medicate if known hx with acetaminophen, Benadryl

Flushing
Hives/Urticaria
May progress to anaphylaxis (admin steroid, epi, assess airway, CPR, RR

STOP TRANSFUSION
Notify provider

Question 13

Identify and explain complications of blood component therapy
FEBRILE REACTION

Answer 13

Febrile reaction:
Antibodies w/in the recipient react against the donor WBC’s. Greater risk with more transfusions. Leukocyte reduced RBC’s reduce incidence. Often occurs w/in 15 min

Sudden chills
Fever (>1 degree C)
HA
Flushing
Anxiety
Muscle pain
Decreased BP
Increased HR

STOP TRANSFUSION
Notify provider

Question 14

Identify and explain complications of blood component therapy
HEMOLYTIC REACTION

Answer 14

Hemolytic reaction:
Most dangerous= systemic response= life threatening
Typically related to ABO incompatibility
Happens quickly
Blood flow to vital organs become blocked due to clumping of RBC’s blocking capillaries
Free hemoglobin is released into circulating blood and may lead to renal failure due to blockage of renal tubules
May lead to disseminated intervascular coagulation (DIC) and death

Facial flushing
Burning sensation in veins
HA, urticaria, chills, fever
Hematuria
Low back, ab or chest pain
N/V
Lower BP
Increased HR
SOB

STOP TRANSFUSION, take blood product and tubing to blood bank

Infuse with NS but NOT the NS bag that was hung with the blood

Question 15

Identify and explain complications of blood component therapy
TRANSFUSION RELATED ACUTE LUNG INJURY

Answer 15

Transfusion related acute lung injury (TRALI):
Rare occurrence with a delayed reaction, most common reaction associated with death
Mechanism is not fully understood but believed to be associated with antibodies in human leukocyte antigens (HLA)
Women who have experience pregnancy are at greater risk
FFP or plasma transfusions are more commonly associated than PRBC’s

Sudden development of non-cardiogenic pulmonary edema with symptoms:
Severe SOB, cyanosis, resp failure and ARDS
Fever
Lowered BP

Question 16

Identify and explain complications of blood component therapy
NON REACTION COMPLICATIONS

Answer 16

Non-reaction complications:

Transfusion-associated circulatory overload (TACO):
Caused by giving transfusion faster than the circulation can handle
SOB, cough, crackles, JVD, increased BP and HR, weight gain
TX: lower infusion rate, increase HOB, diuretics, O2, morphine
Older adults and heart failure increases risk

Electrolyte imbalances:
Increase K+, high concentration in PRBC’s
Decrease Ca+, blood products are anticoagulated with sodium citrate and citric acid which bind to Ca+
Mass transfusion

Infection:
Caused by infectious blood products
Symptom onset is delayed
Not common in the US due to careful donor screening
May include hepatitis, HIV/AIDS, CMV, malaria

Sepsis:
Caused by contaminated blood
Chills, fever, vomiting, diarrhea, wheezing, SOB, cyanosis, shock
Draw blood cultures, antibiotics