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Blood Admin Flashcards

1
Q

What is transfusion therapy

A

The IV administration of whole blood, its components or plasma-derived blood:

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2
Q

Name some reasons for transfusion therapy

A 
To restore intravascular volume
To replenish oxygen-carrying 
   capacity of RBCs
To provide clotting factors 
To provide platelets 
To provide immune factors
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3
Q

Describe the components of whole blood

A

PRBC’s
Plasma
Platelets
Cryoprecipitate (clotting factors made from plasma)

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4
Q

Why administer Packed RBC’s.

A

Increases the oxygen carrying capacity of the blood by increasing the circulating red blood cell mass. Carries oxygen and nourishment to the tissues and take away carbon dioxide. Component of choice for virtually all patients with a deficit of oxygen carrying capacity, e.g. blood loss or anemia

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5
Q

Why are WBC removed from packed cells

A

The majority of the WBC are removed thereby decreasing the risk of cytomegalovirus (herpes) (CMV) infection in immunocompromised patients. This is because the CMV virus is carried in the WBC. Use of RBC (leukocyte reduced) reduces the risk of the patient forming antibodies against WBC (HLA) antigens. This is especially important for potential organ or bone marrow transplant candidates.

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6
Q

What is the difference between serum and plasma?

A

Plasma is blood with blood cells removed.

Serum is plasma without clotting factors, but include all other proteins, hormones, antigens, lights, etc

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7
Q

What is the difference in composition of blood plasma and interstitial fluid

A

Blood plasma has way more proteins, can’t pass through capillary membranes

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8
Q

What are the three main groups of plasma proteins

A

albumin (60% of total plasma protein)

fibrinogen (4% of total plasma protein)

globulins (36% of total plasma protein) 
further fractions (alpha, beta and gamma) can be distinguished within the globulin group.
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9
Q

Where are plasma proteins produced

A

Most of the plasma proteins are produced by the liver. The gamma globulins are produced by cells of the body’s immune system.

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10
Q

What is removed from blood to make plasma?

A

from RBC’s, leukocytes and platelets

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11
Q

What is the role of albumin in blood

A

Maintains plasma colloid osmotic pressure and serves as carrier of intermediate metabolites in transport and exchange of tissue products.

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12
Q

How does Rh factor influence compatibility

A

Rh positive recipient can receive from either neg or positive

Rh Negative can only receive from Rh negative

…Therefor in emergencies people tend to receive Rh negative blood

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13
Q

With RBC’s, what ABO in the universal receiver? Donor?

A

AB + is universal receiver
O- is universal donor

…this rule is reversed for plasma

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14
Q

For platelet transfusion, does ABO or Rh factor need to match?

A

No

but preferably

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15
Q

What does cryoprecipitate contain

A

Contains Factor VIII, Factor XIII and von Willebrand Factor and fibrinogen

… ABO compatibility is not needed, but preferred.

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16
Q

What adverse reaction occurs when ABO typing is wrong.

A

hemolytic transfusion reaction

Host antibodies react against (foreign) antigens, clumping together (agglutinating)

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17
Q

What is a danger for mothers who are Rh negative?

What can be done

A

fetus/baby may be Rh positive leading to rhesus disease (hemolytic disease of newborn) in which in antibes from mother mix into newborns blood.

Mother require Rhogam IM

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18
Q

Bare essential requirements of blood transfusion

A

Two RN check of:

  • Patient- Name (spelt) DOB + MRN
  • Blood- ABO, Rh, Lot #

Dr order,

  • amount, rate of infusion
  • Informed Consent (by physician)
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19
Q

Are transfusion reactions common?

What is normally the issue?

A

0.5 to 3% of blood transfused results in a transfusion reaction

Most reactions at VGH are minor & due to rate of transfusion or allergies

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20
Q

What is TRALI? S and S?

Why does it occur?

A

Transfusion related acute lung injury (TRALI) is a serious blood transfusion complication characterized by the acute onset of non-cardiogenic pulmonary edema and Respiratory distress following transfusion of blood products.

Signs and Symptoms: Fever, pulmonary edema, hypotension, chills occurring 4-6 hours after transfusion

. Cause is unclear - but HLA antibodies play a role. Is a mild to life threatening immune response. Often seen with plasma components not RBC’s.

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21
Q

What is TACO

A

TACO (Transfusion Associated Circulatory Overload) – hypervolemia can develop = dyspnea, orthopnea, tachycardia, sudden anxiety, JVD, crackles at base of lungs, increased BP, possibly leading to pulmonary edema.

r/t rate of transfusion

Note…caution when transfusion given to client with CVD/Heart Failure/COPD.

22
Q

What is a febrile non hemolytic reaction

A

Febrile non-hemolytic reaction a type of transfusion reaction that is associated with fever but not directly with hemolysis. It is most commonly caused by antibodies directed against donor leukocytes and HLA antigens.

23
Q

When is a transfusion reaction most likely to happen?

A

First 5-15 minutes as most likely time for reaction.

This is why you start with a slow transfusion rate

24
Q

Nursing priorities leading up to transfusion

A

Thorough head-to-toe assessment

Know why patient needs blood product

Thorough medical/transfusion history

Baseline lab work

Report if patient febrile Prior to transfusion

Check appearance (color, clots, leaks, expiry date, Rh factor, blood group, patient’s ID)

Start immediately after 2 nurses ID

Normal saline line at bedside (dextrose can cause coagulation of donor blood

25
Nursing priorities during transfusion
Baseline vitals then Q5, Q15, q1h & monitor carefully Stay with patient first 15 minutes Do not transfuse too fast or under too much pressure (e.g. need IV catheter gauge- 18 g or 20 g- for blood) Do not administer any medications in same line
26
TRANSFUSION pneumonic
TIMING of blood – initiate within 30 min, complete within 4 hr RATE of transfusion: Adult 50 ml/hr first 15 min); Peds 1mg/kg/hr ASSESSMENT of patient, medical Hx, prior transfusions & IV site NEVER infuse without INFORMED CONSENT SIGNS & symptoms of transfusion reaction (↑HR & TEMP first signs) FLUID overload – Respiratory assessment, Ins & outs UNDERSTAND – reasons/goals of transfusion: Teach patient SERUM ELECTROLYES: K and Ca ID X 2 nurses - Patient, DOB, Unique #, Bld grp, RH factor, Bld serial #, exp date, observe blood for color, consistency, leakages OBSERVE patient carefully - vital signs before, @ 5 min, @15, hrly NORMAL Saline @ bedside for emergencies
27
DO lines need to be changes between units of blood?
Yes, and only straight filtered lines w/o y's
28
What rate are transfusions started at ?
no greater then 50mls/hr for an adult
29
How long after blood is taken out of blood bank fridge until it must be infused?
4hrs
30
If transfusion reaction occurs, what do you do?
Depends on severity, but in general.. Stop the transfusion, disconnect IV at IVI site, start normal saline, VS’s and call the doctor.
31
What might a Acute hemolytic reaction present? RESPONSE?
Respiratory distress, fever, chills, nausea, chest tightness, chest/back pain, DIC, anxiety, shock / hypotension, burning along vein, oliguria, renal failure Stop, assess/vitals, Physician, ABC's, NOTIFY
32
What might febrile nonhemolytic reaction present as? Why does it occur
Fever, chills and muscle stiffness Due to reaction to cytokines or leukocytes or antibodies that may be present in donor blood Often begins about 2 hours after transfusion is started, non-life threatening but uncomfortable!
33
What would be some signs of a mild allergic reaction? Can the transfusion continue?
Urticaria, itching and flushing With antihistamines (if effective) transfusion can continue
34
What IV fluid is used when administering IVIG
D5W
35
What are some steps to take after a transfusion reaction has occurred and patient is stabilized?
You would recheck all the labelling, ID on patient etc., inform the blood bank, notify physician (should have already anyway!), keep the blood component/product to send to the blood bank for analysis, blood cultures if it’s a suspected infection and fill out all documentation forms per policy of the institution.
36
To make sure we use all blood provided what are the nurses options for finishing the transfusion?
* Once blood is almost done spike a 50ml bag of NS and run at same rate (too fast will push aggregates from filter into patient. * OR let blood run until drip chamber is empty (pump problems?)
37
How long after blood's arrival to the unit must the infusion begin?
30mins
38
What is autologous vs allogenic blod
autologous is patient donates to themselves allogenic is from a donor
39
Why might blood products be irradiated during processing? Must this always happen
exposed to radiation (gamma rays) to destroy the lymphocytes ability to divide. Used for immunodeficient patients (leukemia, Hodgkins Disease, and Non Hodgkin's Lymphoma, premature infants) Irradication destroys the ability of transfused lymphocytes to respond to host foreign antigens thereby preventing graft vs host disease in susceptible recipients. Clients with functional immune systems will destroy foreign lymphocytes, making irradiation of blood and blood components unnecessary.
40
Why is Lasix sometimes ordered between units of blood products?
To avoid circulatory overload
41
How do the symptoms of a mild reaction to a blood transfusion differ from a major reaction?
o Mild ➢ Onset up to 1 hr. after trans ➢ Erythema, hives, urticaria, itching, pruritus o Major ➢ Onset 5-15 minutes ➢ Coughing, wheezing, dyspnea, vomiting, nausea, decreased LOC etc.
42
What are common meds used during a transfusion reaction?
o Antihistamine – decreased the release of histamine o Corticosteroids – decrease inflammation and the natural immune response o Epinephrine - vasopressor o Antipyretics – decrease fever
43
What is fresh frozen plasma
Fresh Frozen Plasma: (FFP) is an unconcentrated form of blood plasma containing all of the clotting factors except platelets. FFP once obtained from a unit of whole blood or through plasmapheresis (centrifuge) and frozen solid at −18 °C (0 °F) or colder within eight hours of collection It is free of RBC's and Leukocytes Indicated during massive transfusion, cardiac bypass, liver disease or acute disseminated intravascular coagulation in the presence of bleeding and abnormal coagulation.
44
What products come from fractionation of plasma?
Albumin, gamma globulins, IVIg, Factor VIII, clotting factor derivatives, special globulin products
45
What is Rhogam? How does it work?
a medicine given by intramuscular injection that is used to prevent the immunological condition known as Rh disease (or hemolytic disease of newborn The medicine is a solution of IgG anti-D (anti-RhD) antibodies that take out any fetal RhD-positive erythrocytes which have entered the maternal blood stream from fetal circulation, before the maternal immune system can react to them, thus preventing maternal sensitization.
46
What is the standard filter size?
150-260 micron filter
47
How often does the IV line need be changed?
After each unit of blood product OR After up to 4 units of plasma
48
How do you mix red cells
Gently rotate bag Should be done prior to admin
49
When can Y's be used in blood admin
for rapid infusion
50
Can an extension set be used
yes, but use a straight set and less then line with less then 2mls of prime
51
Indications for transfusion of PRBC, Plasma, platelets and Cryo
??????
52
Is bloodwork required post blood transfusion?
Yes, Generally collect blood work within 2 hours of administration

3rd Lab (5 decks)

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