Administration of Blood Components Flashcards
who regulates collection of blood and blood components used for transfusion or for manufacture of pharmaceuticals derived from blood and blood components?
Center for Biologics Evaluation and Research (CBER)
FDA focus in regard to administration of blood components
blood collection centers and blood safety
what solution can be added to blood component transfusion according to FDA regulations?
normal saline 0.9%
requirements for administration of blood components mandated by?
AABB Standards and CAP requirements
most likely reason for acute intravascular hemolytic transfusion reaction
clerical error leading to ABO error
CAP standard: Is there a documented system in operation to detect and correct significant clerical and analytical errors, and unusual laboratory results, in a timely manner?
TRM.30400
CAP standard: Does the facility have a documented program to ensure that the risk of pretransfusion sample misidentification and other causes of mis-transfusion are monitored and subjected to continual process improvement?
TRM.30550
what 2 orders are required before blood products are transfused?
one to lab to request preparation of product
one to transfusionist to administer product and how product should be administered
IV catheter size for transfusing cellular components
22-14 gauge
prophylactic meds may be given how soon before transfusion?
oral 30-60 minutes
IV 10 minutes
can blood products be administered through the same line as any medication?
no - different line or flushed with normal saline
what is given prophylactically to reduce febrile nonhemolytic transfusion reactions in patients with past reactions and for patients with elevated temps before transfusion?
antipyretics
what is given prophylactically to reduce mild allergic or urticarial reactions?
antihistamines
what is given prophylactically to reduce rigors in patients with past reactions?
corticosteroids
what is the only solution compatible with blood products?
normal saline
what should be the last solution to go through the line before a blood component?
normal saline
indications for blood warning
hypothermia concerns from infusing cold blood components
controlled temperature of FDA approved warming device
below 42C
AABB Standard that applies to blood warmers
3.8
temperature at which red cell component cannot be reissued
10C
can a spiked unit be returned to the blood bank?
NO - infused within 4 hours or discarded
CAP TRM.30000
is there documentation of ongoing evaluation by laboratory director or designee of all of the following?
-control results of routine procedures, reactivity of reagents, instrument function checks, temperature records
CAP TRM.45009
are all storage units monitored 24 hours/day and equipped with an alarm (either remote or in the laboratory) that is tested periodically for its ability to alert responsible staff at all times?
CAP TRM.30800
is there a means to document the disposition of all blood components, derivatives, and tissues obtained, including the method of destruction or transfer of units unsuitable for transfusion or transplant?
when should inspection of blood components occur?
before shipping from donor center to transfusion service upon receipt in the transfusion service at time of allocating to patient at time of sign-out at bedside before transfusion
component inspection for red blood cells
hemolysis in bag and segments
particulate matter and clots
component inspection for platelets
swirling
clots
component inspection for plasma and cryo
fibrin strands
standard blood filter
170 to 260 microns
microaggregate filter
20-40 microns
contraindication for microaggregate filter
platelets and granulocytes
contraindication for leukocyte reduction filter
granulocyte components
purpose of standard blood filter
remove small blood clots and particles potentially harmful to recipient
function of microaggregate filter
removes smaller clots and particles including platelets and granulocytes; originally designed to remove leukocytes
current typical use for microaggregate filter
shed autologous blood collected during surgery or during massive transfusion
function of leukocyte reduction filter
reduces number of leukocytes in red cells and platelets to less than 5x10^6 cells per unit
is pre-storage or bedside filtration preferred in leukocyte reduction?
pre-storage
review during final issue of blood to prevent transfusion mishap
2 recipient identifiers recipient Abo/Rh donor unique unit number compatibility testing results donor Abo/Rh special transfusion requirements expiration date and time
documentation at issue of blood components
visual inspection
time and date of issue
technologist who issued component
name of person picking up component
RBC infusion rate
150-300 ml/hr
plasma infusion rate
200-300 ml/hr
platelet transfusion rate
200-300 ml/hr
cryo transfusion rate
as rapidly as tolerated by patient
granulocyte transfusion rate
75-100 ml/hr
assessment of recipient includes:
baseline physical assessment (vitals, temp, pulse, BP)
assessment for signs and symptoms before transfusion
infusion rate of any blood product for first 15 minutes
2 ml/min
when are vital signs taken during transfusion?
before and after
OR and trauma infusion rate
as fast as 600-1500 ml/min
what may be noted with rapid transfusions?
hypothermia, hypocalcemia
patient unit tag/label must indicate:
2 recipient identifiers
donor unique unit number
compatibility testing result
attached securely to unit
final records check of blood components must include:
2 recipient identifiers recipient ABO/Rh donor unique number compatibility testing results donor ABO/RH date and time of issue special transfusion requirements expiration date and time
what must be in 100% agreement prior to issue of blood components?
identifying information
initial request
recipient’s records
all blood components
actions performed by transfusion service technologist when issuing blood components in urgent situations
issue uncrossmatched blood, indicating on tag that crossmatch incomplete
start compatibility testing as soon as sample is received
contact medical director if uncrossmatched units are found to be incompatible
emergency release blood if recipient’s blood type is unknown
group O
Rh negative to females of childbearing age
males and females over age 50 may receive Rh positive
definition of massive transfusion
8-10 RBCs to adult patient within 24 hours
acute massive transfusion definition
4-5 RBC units to adult patient within 1 hour
massive transfusion to infant definition
exchange transfusion
stop serological crossmatching blood after adult patient has received ___ during massive transfusion
> 10 units of RBC within 24 hours
switching from group O AS-1, AS-3, AS-5 RBC units to ABO identical units can be safely done because?
minimal residual plasma in group O AS units
minimal residual plasma is group O AS units lowers risk of…
passive anti-A and anti-B transmission
what can be given if Rh-negative woman of childbearing age receives Rh-positive blood components to prevent anti-D from forming?
Rh IG prophylaxis
requirements for return/reissue of blood components
primary container not tampered/entered
appropriate temp maintained at all times
one or more retention segments intact
written documentation states blood component passed inspection and is ready to be returned to inventory
what happens to red cells if transfused with Ringer’s Lactate?
red cells clump due to ionized calcium chelating citrate
medications containing calcium or gluconate solution do what if transfused with red cells?
neutralize CPD and cause blood to clot
hypertonic solutions cause what to happen if transfused with red cells?
red cells lyse and break
dextrose solutions cause what if transfused with red cells?
hemolyze, swell and clot
