Blood Flashcards
What temp are PRBCs stored at? How long are they good for?
- Stored at 4°C
- With special preservatives, they can be stored safely for up to 42 days
What temp are platelets stored at? How long are they good for?
- Stored at room temperature
- Last for only 5 days
How are clumps prevented from forming in stored platelets?
To prevent clumping, platelets are gently agitated while stored
What temp is plasma stored at? How long is it good for?
- Frozen to maintain the activity of the clotting factors
- Lasts for 1 year if it remains frozen
What is factor VIII concentrate (antihemophilic factor) used for?
Treating hemophilia A
What is Factor IX concentrate (prothrombin complex), which contains factors II, VII, IX, and X, used for?
Treatment of factor IX deficiency (hemophilia B). Its also useful in treating congenital factor VII and factor X deficiencies
What is plasma Albumin used for?
To expand the blood volume of patients in hypovolemic shock and, rarely, to treat hypoalbuminemia
If you have or had viral hepatitis can you donate blood?
No
If you have had a blood tranfusion in the past 6 months can you donate blood?
Yes, if 12 months no
If you have had previous transfusion in the United Kingdom, Gibraltar, or Falkland Islands can you donate blood?
No, may have an increased likelihood of transmitting Creutzfeldt–Jakob disease
If you have had malaria, can you donate blood?
Yes, after 3 years past Tx for malaria
If you have a recent history of asthma, urticaria, or allergy to medications, can you donate blood?
No, because hypersensitivity can be transferred passively to the recipient
If you have had a tooth extraction or oral surgery within 96 hrs can you donate blood?
Yes, if within 72 hours you cannot
If you have a history of a nonhematologic cancer treated with surgery or radiation, and are without evidence of recurrence for at least 5 years can you donate blood?
Yes
If you have a diagnosis of hemochromatosis can you donate blood?
No
What is the minimum amount of days you should wait between blood donations?
56 days
Why should you ask donors if they’ve used ASA in the past 3 days?
Doesn’t make them ineligible, just contradicts plasma donation
Body weight should exceed ___ kg for a standard 450-mL donation
50
The oral temperature of a potential donor should not exceed ___°C
37.5
What should hemoglobin levels be for potential donors? Differentiate between men and women
Women - at least 1.94 mmol/L
Men - 2.10 mmol/L
What is directed donation?
When someone donates their blood to a specific person
What position is the pt in during phlebotomy?
Pt is semi-recumbant
Post-donation instructions:
know 3
- Leave the dressing on and to avoid heavy lifting for several hours
- Avoid smoking for 1 hour
- Avoid drinking alcoholic beverages for 3 hours
- Increase fluid intake for 2 days
- Eat healthy meals for at least 2 weeks
What is an autologous donation?
A persons own blood is donated for their future self
When are autologous donations generally used?
When pts are having an elective surgery with high potential for blood loss
When is blood for an autologous donation collected?
Ideally 4-6 weeks before surgery, usually 1 unit per week
No phlebotomies performed within ___ hrs before surgery
72
What is intraoperative blood salvage?
Replacement for pts who cannot donate ahead of their surgery
How is intraoperative blood salvage done?
If blood is lost during a surgery into a sterile cavity, it is suctioned out into a cell saver machine where the whole blood or PRBCs are washed (with NS), filtered, and returned to the pt via IV
What is hemodilution?
1 or 2 units are withdrawn through venous or arterial line, and simultaneously replaced with a colloid or crystalloid solution, the blood is reinfused after surgery
What is the advantage of hemodilution?
The patient loses fewer erythrocytes during surgery
What is a febrile nonhemolytic reaction?
Transfusion reaction caused by antibodies to donor leukocytes that remain in the unit of blood or blood component
Who is most likely to have a febrile nonhemolytic reaction?
- Patients who have had previous transfusions
- Rh-negative women who have borne Rh-positive children
S+S of febrile nonhemolytic reaction:
- Chills (minimal to severe)
- Fever (more than 1°C elevation)
- Typically begins within 2 hours after the transfusion is begun
What is the most dangerous transfusion reaction and why does it happen?
- Acute hemolytic reaction
- Occurs when the donor blood is incompatible with that of the recipient
What is happening within the body during an acute hemolytic reaction?
Antibodies already present in the recipient’s plasma rapidly combine with antigens on donor erythrocytes, and the erythrocytes are destroyed in the circulation
T or F:
Rh incompatibility often causes a more severe acute hemolytic reaction
F, less severe
S+S of acute hemolytic reaction:
know 4
- Fever
- Chills
- Low back pain
- Nausea
- Chest tightness
- Dyspnea
- Anxiety
- Hemoglobinuria
- Hypotension, bronchospasm, and vascular collapse may result
- Diminished renal perfusion results in acute renal failure
- DIC may also occur.
S+S of an allergic transfusion reaction:
- Urticaria
- Itching
- Flushing
- Rarely: bronchospasm, laryngeal edema, and shock, and these reactions are managed with epinephrine, corticosteroids, and vasopressor support, if necessary.
If too much blood is infused too quickly, _________ can occur
hypervolemia
How to avoid circulatory overload in blood transfusions:
- PRBCs are safer to use than whole blood
- Slow admin rate
- Diuretics are administered after the transfusion or between units of PRBCs for people who are at risk for circulatory overload
S+S of transfusion circulatory overload:
know 4
- Dyspnea
- Orthopnea
- Tachycardia
- Sudden anxiety
- JVD, crackles at the base of the lungs,
- Inc BP
- Pulmonary edema can develop if transfusion is continued
What should you do if the fluid overload is severe?
know 3
- Pt upright with the feet in a dependent position
- Transfusion is discontinued
- Physician is notified
- TKVO with slow NS infusion
- Oxygen and morphine may be needed to treat severe dyspnea
Why are platelets are at greater risk of bacterial contamination?
They are stored at room temperature
Within what timeframe should PRBCs be transfused?
4 hrs
S+S of bacterial contamination:
may not occur until transfusion is done, occasionally not until several hours after
- Fever
- Chills
- Hypotension
What is the response to bacterial contamination from blood transfusion?
- As soon as the reaction is recognized, any remaining transfusion is discontinued
- NS TKVO
- Fluids
- Broad spectrum abx
What is transfusion-related acute lung injury (TRALI)?
A potentially fatal, idiosyncratic reaction in which the underlying pathophysiologic mechanism is unknown but involves antibodies in the donor’s plasma reacting to the leukocytes in the recipient’s blood, sometimes vice versa
What is the onset of TRALI?
Usually within 6 hours of transfusion, often within 2 hours
S+S of TRALI:
know 3
- Acute SOB
- Hypoxia (spO2 < 90%)
- Hypotension
- Fever
- Eventual pulmonary edema
What s supportive therapy is used to treat TRALI?
- Oxygen
- Intubation
- Fluid support
TRALI is most likely to occur with transfusion of…
…plasma
When do delayed hemolytic reactions occur?
Usually occur within 14 days after transfusion
S+S of delayed hemolytic reaction:
know 3
- Fever
- Anemia
- Increased bilirubin level
- Decreased or absent haptoglobin
- Possibly jaundice
- Rarely, there is hemoglobinuria.
Delayed hemolytic reactions are not generally dangerous, but why are they important to recognize?
Because subsequent transfusions with blood products containing these antibodies may result in a more severe reaction
Infusion rate for a routine blood transfusion? Adult vs Peds
- Adult – maximum rate is 50 mL/hr
- Peds – maximum rate is 1 mL/kg/hr, not to exceed 50 mL/hr
When should you take vitals when giving a pt a blood transfusion?
- 30 min before
- 5 min after initiating
- 15 min after initiating
- Once every hour while transfusing
When can you inc the flow rate of blood transfusing?
After 15 min with no symptoms of a reactions
Can IV medication be added to a blood transfusion?
No meds should be added to or come in contact with blood products, admin IV meds before or after, or use a different IV access
If an A antigen is present on the RBCs the blood group is:
A
If a B antigen is present on the RBC the blood group is:
B
If A and B antigens are both present on the RBC the blood group is:
AB
If no antigens are present on the RBC the blood group is:
O
What antibodies do people with type A blood have?
Anti-B antibodies
What antibodies do people with type B blood have?
Anti-A antibodies
What antibodies do people with type AB blood have?
No antibodies
What antibodies do people with type O blood have?
Both anti-A and B, can only receive from other O’s
Who is the universal donor? The universal recipient?
- O- is the universal donor
- AB+ is the universal recipient
What determines the Rh factor?
The Rh type is determined simply by either the presence of absence of the D antigen (Rh positive or Rh negative)
What is another name for the Rh factor?
The D antigen
T or F:
Similar to the anti-A antibodies that are naturally present in type B blood, antibodies to the D antigen are also naturally present
F, antibodies to the D antigen are only formed after someone with Rh- blood is exposure to Rh+, an reaction will occur upon subsequent exposure, just like the immune response
What is given to an Rh- mum (that has been exposed to Rh+) who is carrying an Rh+ baby to prevent fetal hemolysis?
Rh(D) immunoglobulin (RhoGam) is given to suppress/destroy fetal Rh+ blood cells and prevent fetal hemolysis
What is human leukocyte antigen (HLA)?
Highly immunogenic antigens, they are located on leukocyte surfaces but also present on all cells
What are HLA complications:
- Febrile non-hemolytic reaction (FNH)
- Immune mediated platelet refractoriness
- Transfusion related acute lung injury (TRALI)
- Transfusion-associated graft versus-host-disease (TA-GVHD)
In order to give blood, a blood sample must be sent to the lab within _____ for typing and compatibility screening
72 hrs
The rapid admin of cold blood may lead to:
Dysrhythmias and a reduction of core temp
Should you heat blood in the microwave?
Fuck yeah, get ‘er toasty
jk… do NOT heat blood up in the microwave
What gauge used for blood admin in:
a) General population
b) Rapid transfusion
c) neonate, peds, older adult
a) 18-20 gauge used for general population
b) 14-18 for rapid transfusion
c) 22-24 for neonate, peds, older adult
