Administration of Blood and Blood Products (LO4) Flashcards
Blood serves the following functions:
Supplies oxygen and nutrients for energy production and for tissue maintenance, growth, and repair
Transports cellular waste, including carbon dioxide, to the organs for elimination
Provides a defense against infection by transporting antibodies
Regulates and equalizes body temperature
Helps to maintain the acid-base balance
Regulates fluid and electrolyte balance
Blood is made up of 2 basic components:
Cellular or formed elements
Plasma
Plasma
is a sticky straw-coloured fluid
approximately 90% water.
Dissolved within the plasma are over 100 different solutes including proteins, nutrients, electrolytes, and respiratory gases.
Plasma makes up about 55% of the volume of blood.
Erythrocytes
(red blood cells)
constitute approximately 45% of the blood’s volume
have a dedicated role in the transportation of respiratory gases.
Leukocytes
white blood cells
make up less than 1% of the entire blood volume
play a major role in defense against infection and disease.
Platelets
(also less than 1% of blood volume)
are necessary for the clotting process and circulate in the vasculature, inactive until a blood vessel ruptures or is damaged
Blood is group classified based
on the types of antigens present or absent on the surfaces of the red blood cell
Pre-transfusion testing includes the following
Blood typing
Antibody detection (and antibody identification if antibody screen is positive)
Crossmatching
ABO Group
- A
- B
- AB
- O
- name antigen and the frequency in population
-A
40%
-B
11%
-A and B
4%
-None
45%
A patient’s antibodies will do what to red blood cells that have corresponding antigen on their surface
A patient’s antibodies will hemolyze (break down or destroy red blood cells) transfused red blood cells that have the corresponding antigen on their surface.
Historically, patients whose blood group was unknown and who required an urgent transfusion were provided with
Group O Rh negative red blood cells (RBC) until the patient’s blood group was determined
In situations where the blood group is unknown:
The Transfusion Medicine Laboratory (TML) will usually issue O Rh negative RBC’s for females of child bearing potential (less than 45 years of age) until the patient’s blood group is confirmed.
All males and females past child bearing potential, can receive O Rh positive RBC’s until the patient’s blood group is confirmed
Crossmatching
is the process of determining the compatibility of blood from a donor with that of the recipient before transfusion
Whole blood
contains all components of blood
the clotting factors and platelets quickly lose their function during storage
A unit contains approximately 450 mL of whole blood plus 63 mL of anticoagulant
Indications of whole blood
indicated in blood loss
not commonly available from blood banks, and therefore red blood cells are more commonly used for treatment of anemia and acute blood loss
One unit of whole blood can increase the patient’s hemoglobin by approximately 10g/L
Infusion Rate of whole blood
The initial transfusion should be slow (5 mL/min for 15 minutes) while assessing the patient for adverse reactions
In the absence of any reactions, the product can be infused as quickly as the patient can tolerate it.
The transfusion must be completed with the 4-hour window
whole blood Compatibility
Normal saline
whole blood Special Considerations
Whole blood must be ABO-identical to the recipient’s blood group. (Group O is not universal donor for whole blood.)
whole blood Administration Set
The administration set must be a blood tubing set that has a 170–260 micron blood filter.
whole blood Storage and Shelf Life
Whole blood cannot be left at room temperature for longer than 4 hours.
As soon as collection from the donor is complete, whole blood must be stored at 1–6° C
the red blood cells will retain their function for up to 21–35 days
Whole Blood – Overview
- major uses
- storage and shelf life
- administration
Major Uses
- To replace:
- Fibrinogen: in patients actively bleeding who have a low fibrinogen level
Storage and Expiration
- Frozen
- Shelf life: 1 year
- Once thawed, expires after 4 hours stored at 20–24°C
Administration
- Blood tubing required
- Transfuse as rapidly as tolerated
Red Blood Cells
along with normal saline are more commonly used than whole blood for acute blood loss
A unit of red blood cells is 240–340 mL and will be more viscous than whole blood
most red blood cell components today have an additive solution mixed with the red blood cells (e.g., AS-3).
With an additive solution, red blood cells will have the same flow rate as whole blood
Red blood cells have minimal amounts of plasma (and ABO antibodies) so you can give ABO-compatible blood rather than only ABO identical
Red Blood Cells indications
Red blood cells units are administered to patients requiring increased oxygen-carrying capacity by increasing the circulating red blood cell mass.
Infusion Rate
The initial infusion should be slow for the first 15 minutes to assess for adverse reactions, then administered as quickly as the patient tolerates
A slower rate should be considered for patients at risk for overload.
A unit of red blood cells must be administered within 4 hours.
red blood cells Compatibility
Normal Saline
red blood cells special considerations
In massive transfusions, if possible warm blood with approved blood warmer prior to transfusion to prevent hypothermia.
cAdministration Set
The administration set must be a blood tubing set that has a 170–260 micron blood filter.
If administering at a fast rate, 16–18 gauge cathlon is required
in small vein patients a 20–22 gauge may be used.
red blood cells shelf life
Depending on the anticoagulant and additive solution used, red blood cell units have a shelf life of 21–42 days.
red blood cells Storage
Red blood cells must be stored at 2–6° C. During inter-facility transfers, the blood should be stored in a Canadian Blood Services styrofoam box with ice packs.
Red Blood Cells – Overview
Major Uses
- Bleeding or anemic non-bleeding patients with signs and symptoms of impaired tissue oxygen delivery:
- -Tachycardia
- -Shortness of breath
- -Dizziness
Storage and Expiration
-2–6° C in approved refrigerator only
-Shelf life: Maximum 42 days
Administration
- Blood tubing required
- Initiate transfusion slowly for first 15 minutes unless massive blood loss
- Transfuse over no more than 4 hours
- Typically over 1½–2 hours with slower rates for patients at risk for circulatory overload
Fresh Frozen Plasma
- Fresh frozen plasma (FFP) is separated from whole blood by centrifugation or sedimentation and must be frozen within 8 hours of collection
- A unit of fresh frozen plasma (FFP) contains approximately 250 mL (minimum 100 mL) of anticoagulated plasma.
Fresh Frozen Plasma Indications
Fresh frozen plasma (FFP) is separated from whole blood by centrifugation or sedimentation and must be frozen within 8 hours of collection
A unit of fresh frozen plasma (FFP) contains approximately 250 mL (minimum 100 mL) of anticoagulated plasma.
Fresh frozen plasma is indicated for patients requiring plasma coagulation factors, patients on Coumadin requiring emergency invasive procedures before Vitamin K can reverse its effects, or patients with plasma protein deficiencies.
Infusion Rate Fresh Frozen Plasma
Recommended infusion time is 30 minutes to 120 minutes but must be infused within 4 hours.
Compatibility Fresh Frozen Plasma
Normal Saline
Special Considerations Fresh Frozen Plasma
FFP should be thawed in a water bath at 30–37° C (in a watertight protective plastic over wrap using gentle agitation); this may take 20–30 minutes.
Once thawed, FFP must be used immediately and cannot be refrozen.
Administration Set
The administration set must be a blood tubing set that has a 170–260 micron blood filter.
Storage and Shelf Life
FFP can be stored up to 12 months at temperatures -18° C and for 24 hours at 1–6° C once thawed.
Fresh Frozen Plasma – Overview
Major Uses -Liver disease coagulopathy --Massive transfusion --Plasma exchange procedures for certain diseases (e.g., TTP/HUS*) Frozen
Storage and Expiration
-Shelf life: 1 year; Once thawed, expires after 5 days stored at 1–6° C
Administration -Blood tubing required Initiate transfusion slowly for first 15 minutes unless massive blood loss -Transfuse over no more than 4 hours -Typically over 30 minutes–2 hours
Cryoprecipitate
produced by Canadian Blood Services from fresh frozen plasma
An insoluble precipitate, cryoprecipitate, is separated from the plasma and refrozen
One unit of cryoprecipitate contains 80IU of Factor VIII and 150 mg of fibrinogen in 5–15 mL of plasma.
Indications of cryoprecipitate
Cryoprecipitate is indicated in patients requiring a source of fibrinogen or Factor VIII.
It can only be used as a source of Factor VIII when virally inactivated fractionation products or recombinant Factor VIII (used for Hemophilia A) are not available.
Infusion Rate of cryoprecipitate
Recommended infusion time is 10–30 minutes per dose but must be complete within 4 hours.
Compatibility of cryoprecipitate
Normal saline
Administration Set of cryoprecipitate
The administration set must be a blood tubing set that has a 170–260 micron blood filter.
Storage and Shelf Life
Cryoprecipitate can be stored up to 12 months at temperatures of -18° C and for 4 hours at 20-24° C.
Cryoprecipitate – Overview
Major Uses
- To replace:
- Fibrinogen: in patients actively bleeding who have a low fibrinogen level
Storage and Expiration
- Frozen
- Shelf life: 1 year; Once thawed, expires after 5 days stored at 1–6° C
Administration
- Blood tubing required
- Transfuse as rapidly as tolerated
4.1 Rights of Transfusion
- Patient - Is this the right patient?
- Product - Is this the right product?
Check the blood for any clots, leaks, or discolouration
Check the expiry date
- Amount - Is this the right amount?
- Rate - Is it set at the right rate?
- Time - Is it the right time?
monitoring of a patient receiving blood products:
Only transport those patients receiving blood products that have been stable for last 24 hours
Ensure that vital sign assessment is performed 15 minutes after the initiation of transfusion
Repeat vitals every 30 minutes, including a temperature
Repeat vitals more often for patients who are at greater risk of overload or experienced previous reactions
Ensure that a physician’s order is present specifying the infusion rate and that the rate is no faster than 2 hours per unit
All infusions must be complete within 4 hours of initiation
A pressure infuser cannot be utilized unless a physician is present during transport
Only normal saline can be infused through the same IV line as a blood product
All blood tubing must be changed every 2–4 units of blood
Steps Upon Completion of Transfusion
Disconnect blood tubing once infusion is complete, as used tubing can be a breeding ground for bacteria
Dispose of used blood tubing and bags in a biohazard bag and return to the hospital
Continue to assess patient for symptoms of reactions for 6 hours post transfusion
Documentation
include the following on your PCR:
Start and finish time of each bag
Type of product being infused
Blood unit number
Rate the transfusion was run at
Volume transfused during transport
Vital signs and assessment findings
Any reactions and treatment provided
List Potential Complications of Blood and Blood Product Transfusions
Adverse effects, generally referred to as transfusion reactions, are infrequent and vary in severity.
Death due to transfusion is rare
AIDS has occurred following transfusion, but blood donors are now tested
Adverse reactions can be classified as one of the following:
Immediate transfusion reactions
Delayed transfusion reactions
deaths from blood transfusion
The majority of deaths are due to severe intravascular hemolysis (the destruction of red blood cells) following the administration of ABO mismatched blood
Viral hepatitis is the second most common cause of death related to blood transfusion; the association with transfusion may not be recognized, and the hepatitis may develop many months after the transfusion
Immediate Transfusion Reactions
Reactions that occur during or within 24 hours of the infusion of blood products
They include the following: Acute hemolytic transfusion reactions Febrile reactions Allergic reactions Air embolism Overload Chills Hypothermia
Acute Hemolytic Transfusion Reactions
rare
usually due to the transfusion of ABO incompatible blood following the improper identification of the recipient, either when the crossmatch specimen is taken or when the blood donor is transfused
Signs of acute intravascular hemolysis include
fever, chills, hypotension, hemoglobinuria (the presence of hemoglobin in the urine which may cause a reddish discoloration of the urine), flank pain, and shortness of breath
disseminated intravascular coagulation (DIC)
results in abnormal bleeding such as around an IV site
Febrile Reactions
during transfusion is the most common adverse reaction following a transfusion
Febrile Reactions may be due to
Destruction of transfused red blood cells
Destruction of transfused white blood cells
Bacterial contamination of the blood
Reaction to proteins
Urticaria during blood transfusion
(hives)
fairly common. Unless extremely severe or accompanied by bronchospasm or other signs of impending anaphylaxis, the development of urticaria is not serious
Treatment consists of discontinuing the transfusion of the blood product and keeping the IV line open with normal saline.
Anaphylaxis
A life-threatening anaphylactic reaction (hypotension, bronchospasm, flushing, and laryngeal edema) rarely occurs during a transfusion of blood
Treatment consists of discontinuing the transfusion of the blood product, keeping the IV line open with normal saline, providing high flow O2, etc.
Air Embolism
The use of closed plastic systems for the collection of whole blood and for the preparation of blood components has virtually eliminated air embolism as a complication of blood transfusion
deaths have occurred when air has been deliberately introduced into the blood bag, or the administration set, to increase the rate of blood flow to the patient
Delayed Transfusion Reactions
a delayed reaction occurs after 24 hours and in some cases is not identified until much later.
Delayed Transfusion Reactions include
Hepatitis
Sepsis
Iron overload
Delayed hemolytic reaction
Post transfusion purpura
Transfusion-associated graft-versus-host disease
Transfusion Associated Circulatory Overload (TACO)
The infusion of blood products can cause fluid overload and resultant pulmonary edema
Circulatory overload occurs when the rate of infusion is excessive for that patient’s cardiovascular status especially in the elderly or very young
Transfusion Associated Circulatory Overload (TACO) symptom
These patients complain of shortness of breath (which can also be present with anaphylactic and acute hemolytic reactions)
Transfusion Associated Circulatory Overload (TACO) treatment
Treatment consists of discontinuing the transfusion of the blood product and keeping the IV line open with normal saline
The patient should also be placed on high flow O2 and placed as high as possible in the sitting position.
Chills and treatment
Chills may occur as a result of a febrile reaction or in patients with a normal temperature
In either case the transfusion should be discontinued
Treatment consists of discontinuing the transfusion of the blood product and keeping the IV line open with normal saline
Hypothermia and treatment
Hypothermia may occur if cold blood is rapidly transfused
Treatment consists of discontinuing the transfusion of the blood product and keeping the IV line open with normal saline
Possible Transfusion Reaction
-Fever, chills, or rigors (shaking)
Bacterial contamination
Acute hemolytic transfusion reaction
Transfusion related acute lung injury (TRALI)
Febrile non-hemolytic transfusion reaction
Possible Transfusion Reaction
-Urticaria and other allergic symptoms
Anaphylaxis
Minor allergic reaction
Possible Transfusion Reaction
-dyspnea
Transfusion related acute lung injury (TRALI)
Transfusion associated circulatory overload (TACO)
Anaphylaxis
Bacterial contamination
Acute hemolytic transfusion reaction
Possible Transfusion Reaction
-Hypotension
Transfusion associated circulatory overload (TACO)
Possible Transfusion Reaction
-Hemolysis, hemoglobinuria
Acute hemolytic transfusion reaction
Possible Transfusion Reaction
-Pain
Acute hemolytic transfusion reaction
IV site
Lumbar
Transfusion associated circulatory overload (TACO)
Chest
Possible Transfusion Reaction
-Nausea and vomiting
Acute hemolytic transfusion reaction
Acute anaphylaxis
Febrile non-hemolytic transfusion reaction
Risk and Description
-Minor Allergic Reaction
1 in 100
Mild allergic reaction to an allergen in the blood component/product.
Risk and Description
-Anaphylaxis
1 in 40,000
Potentially fatal reaction caused by an allergen that the patient has been sensitized to.
Risk and Description
-Febrile Non-Hemolytic Transfusion Reaction
1 in 300
Mild, usually self-limiting, reaction associated with donor white blood cells or cytokines in the blood component/product. Usually presents with fever and/or rigors.
Risk and Description
-Bacterial Sepsis (platelet pool)
1 in 10,000 will become symptomatic
1 in 60,000 will be fatal
Potentially fatal reaction caused by bacteria inadvertently introduced into the blood component/product or originating from the donor. More common in platelets due to room temperature storage.
Risk and Description
-Bacterial Sepsis (red blood cells)
1 in 250,000 will become symptomatic
1 in 500,000 will be fatal
More common in platelets due to room temperature storage.
Risk and Description
-Acute Hemolytic Transfusion Reaction
1 in 40,000
Potentially fatal reaction caused by blood group incompatibility.
Can also be caused by chemical hemolysis
(e.g. incompatible solutions) or mechanical hemolysis (e.g. improper storage).
Can result in renal failure, shock, and coagulopathy.
Risk and Description
-Transfusion Related Acute Lung Injury (TRALI)
1 in 12,000
Acute hypoxemia with evidence of new bilateral lung infiltrates on X-ray and no evidence of circulatory overload.
Patients often require ventilatory support.
Usually occurs within 1–2 hours of start of transfusion and rarely after 6 hours.
Usually resolves within
24–72 hours, with death occurring in 5–10%. Cause not fully understood.
Postulated to be related to donor or recipient antibodies acquired through pregnancy or transfusion.
Risk and Description
-Transfusion Associated Circulatory Overload (TACO)
1 in 100
Circulatory overload from excessively rapid transfusion and/or in patients at greater risk for overload (e.g. very young, elderly, impaired cardiac function). Preventative measures include slower transfusion rates and pre-emptive diuretics for patients at risk.
Risk and Description
-Hypotensive Reaction
Rare
Bradykinin mediated hypotension.
Characterized by profound drop in blood pressure, usually seen in patients on ACE inhibitors unable to degrade bradykinin in blood component/product.
