Anemia and Blood Transfusions Flashcards
normal WBC value
4.5-11
normal platelets value
140,000 - 400,000
normal hemoglobin value
male 13-18
female 12-16
normal hematocrit value
male 43%-49%
female 38%-44%
describe the basic pathophysiology of anemia
decreased red blood cell count results in decreased hemoglobin. less hemoglobin = less ability to carry oxygen. impairs gas exchange in the body.
which types of anemia come from impaired production of RBCs?
iron deficiency anemia
megaloblastic anemia
what types of anemia come from destruction of RBCs?
hemolytic sickle cell disease
thalassemia
disseminated intravascular coagulation
what is the most common type of anemia?
IDA
what are common causes of blood loss in adults that lead to iron deficiency anemia?
ulcers, IBS
menorrhagia - heavy period
GI cancer
chronic nsaid use = bleeding risk
what are common causes of iron malabsorption?
gastrectomy
celiac disease
H2 inhibitors and antacids
clinical manifestations of iron deficiency anemia
fatigue, weakness
pallor
tachycardia and tachypnea
SOB
smooth red tongue
pica
koilonychias - spoon shaped nails
what causes megaloblastic anemia?
B12 deficiency, usually due to malabsorption in the GI tract. Lack of intrinsic factor impairs B12 absorption, this is called pernicious anemia.
Folic acid deficiency. Can come from poor diet, alcohol abuse, and malabsorption from GI surgery.
main symptom of megaloblastic anemia
red sore tongue
symptoms of B12 deficiency (neuro)
Neuropathy
Altered mental status
Depression
Visual disturbances
Balance issues
Dementia- very late sign
what makes up 1 unit of whole blood?
450 mL of blood
50 mL anticoagulant
what products are made of blood plasma?
immunoglobulins
clotting factors
albumin
what is done with donated blood?
test for blood-borne pathogens
determine blood type - ABO and Rh
how common is it to be Rh+?
85% of people are Rh+
how quickly must blood be administered?
must be started within 30 minutes and finished within 4 hours of removal from temp controlled storage
assessment before blood transfusion
history of infusion reactions
history of cardiac, pulmonary, or vascular diseases
obtain baseline VS
respiratory assessment, cardiac assessment for fluid volume status - look for edema and JVD
skin assessment
preparing for blood transfusion
- check order and make sure blood type matches
- double check that informed consent was signed
- explain procedure and what reactions to watch out for
- ensure IV gauge is 20 or 18
- ensure correct tubing for blood
- obtain baseline VS
- second RN must verify blood type match, pt ID, and expiration
- check appearance of blood for bubbles, color, cloudiness
when is transfusion reaction most likely to occur?
within first 15 minutes / first 50 ml
when should blood tubing be changed?
after 4 hours of use or after 2 units of blood
at what rate should blood be infused?
no faster than 5mL/min for first 15 mins, while observing patient carefully
may increase rate after first 15 minutes such that it infuses within 4 hours, but be cautious for high risk patients
what to look for in transfusion reaction
restlessness
hives
N/V
back or torso pain
SOB
flushing
fever
hematuria
can you add medications to blood products?
never
what to do after administering blood
obtain VS
dispose of materials by hospital policy
make sure everything is documented
monitor for response and effectiveness
what is the most common transfusion reaction?
Febrile Nonhemolytic Reaction
what happens during febrile nonhemolytic reaction?
temp increases by 1 degree C
antibodies react to leukocytes in donor blood
pt has chills, fever, muscle stiffness
what is the most dangerous transfusion reaction?
acute hemolytic reaction
what happens during acute hemolytic reaction?
recipient and donor blood are not compatible
signs and symptoms include:
- uncontrolled bleeding
- hypotension
- chills, fever
- increased HR
- chest pain
- blood in urine
- heat in vein of transfusion site
what to do if acute hemolytic reaction occurs
stop transfusion immediately
maintain blood volume
maintain renal perfusion
prevent and manage DIC
signs of allergic reaction to transfusion
hives
itching
flushing
how to treat allergic reaction to transfusion
administer antihistamines
resume transfusion unless reaction is severe
give epi, corticosteroids, pressors for severe allergic reaction
how to prevent hypervolemia with blood transfusion
- slow administration
- diuretics after administration
