Blood Administration

Question 1

Blood

Answer 1

A chemical, a fluid , and a temperature regulator

Question 2

Whole blood

Answer 2

• Used only when needed or when individual blood components are not available
• generally transfused only when a patient loses a large amount of blood
• Must be ABO- and Rh-identical

Question 3

Blood component therapy

Answer 3

Based on separating or fractionating whole blood into its cellular and plasma components

Question 4

RBCs

Answer 4

• Produced in the bone marrow
• live for about 120 days in the circulatory system
• Broken down by the spleen
• Indications for RBC transfusion include anemia, sickcle-cell anemia, blood loss due to trauma, surgical blood loss and to offset some of the effects of chemotherapy
• Often referred to as “packed RBCs”, transfused to restore or maintain adequate organ oxygenation
• ABO- and Rh- compatible

Question 5

Plasma

Answer 5

• Contains albumin, fibrinogen, globulins , and other clotting properties
• Fresh frozen plasma is obtained by centrifuging whole blood & freezing it within hours after donation, requires ABO compatibility but not Rh consideration , & this blood product is indicated for treating coagulation-factor deficiencies and for expanding blood volume
• Used to treat bleeding and coagulation disorders , to replace fluid volume for patients with massive burns and for those with liver failure, and to replace platelet-aggregation inhibitors in patients who have thrombocytopenic purpura or hemolytic uremic syndrome
• Once thawed it must be transfused within 24hrs
• In addition to maintaining blood pressure & providing essential proteins, plasma serves as the medium for the cellular exchange of vital minerals and electrolytes and for the elimination of cellular waste products.

Question 6

Albumin

Answer 6

-Essential for maintaining blood volume and BP

Question 7

Cryoprecipitate anti hemophilic factor

Answer 7

Transfused to prevent or control bleeding in people who have hemophilia, to correct low fibrinogen levels, and to treat von Willebrand disease and other clotting disorders

Question 8

Platelets

Answer 8

• Helps the clotting process by sticking to the lining of blood vessels
• Aphaeresis or plateletpheresis , a process that involves the use of special equipment to separate a donor’s blood components.
• infused over 15 to 30 mins
• Transfused to treat thrombocytopenia and platelet function abnormalities
• ABO- and Rh- compatible

Question 9

Granuloctyes

Answer 9

• Infused over 45 to 60 minutes
• Prepared by aphaeresis collection or centrifugation of whole blood
• A type of white blood cell used to treat unresponsive infections in patients with low granulocyte counts and as supportive therapy for patients undergoing chemotherapy for some types of leukemia.

Question 10

Type O

Answer 10

• Universal Donors
• No antigens
• Antibody A & B

Question 11

Type AB

Answer 11

• Universal Recipients
• No antibody
• Antigen A & B

Question 12

Rhesus or Rh system

Answer 12

• Presence or the absence of the major D antigen on the surface of the RBC
• A person who has the D antigen is classified as Rh-positive
• A person who does not have the D antigen is classified as Rh-negative
• Rh-negative individuals may donate to Rh-positive recipients but should only receive Rh-negative blood to prevent the formation of anti D antibodies

-When an Rh-negative women is exposed to D antigens, anti D antibodies develop=
>The anti D antibodies can attack the RBCs of subsequent Rh-positive fetuses, resulting in erythroblastosis fetalis, a hemolytic RBC destroying disorder that is fatal to the fetus
>It’s common practice to perform Rh antibody testing during pregnancy and to administer RhoGAM at 28wks gestation and at delivery to prevent the formation of Rh-postive antibodies

Question 13

Hemolysis

Answer 13

• The premature destruction of RBCs within or outside of the vasculature
• Some inherited diseases associated with hemolysis are Sickle-Cell anemia and Thalassemia
• Anemia results when RBCs are destroyed faster than the bone marrow can replace them

Preventing measures:
> Prime tubing with 0.9% sodium chloride
>Iv access catheter is 18-20 gauge to avoid vein damage or transfuse the blood through a central venous catheter. Larger gauge catheters encourage blood flow and reduce the risk of hemolysis
>Use the port closest to the patient to reduce the risk for precipitation or hemolysis in the primary tubing (Administer fresh frozen plasma and platelets directly into the IV catheter)
>Administer all blood components through a sterile, pyrogen-free filter
>Never Use a microwave oven or hot water baths to warm blood or blood products
>With exception of 0.9% sodium chloride solution,never add or infuse medications and IV solutions unless they have met 2 criteria:
(1) They must be FDA approved for use with blood products
(2)documentation must be available to show that the addition is safe and does not adversely affect the blood or component

> Never use dextrose-containing solutions with blood because glucose causes red blood cell aggregation.

> Never add or infuse lactated Ringers or other solutions containing calcium with blood products or other citrate containing components. The calcium in such solutions may react with the citrate and lead to clot formation in the blood product.

Question 14

Bacterial Contamination

Answer 14

• They are stored at rm temperature
• if there are signs of hemolysis, a color change in the bag as compared with the blood in the tubing segments, a cloudy appearance, or the presence of suspended matter, do not spike the container or administer the blood. Return the blood to the blood bank
• platelets are the most likely of all blood products to become contaminated with bacteria.
• Always cleanse the Y-port injection sites with alcohol
• Start the transfusion within 30 mins of it’s issue from blood bank. If the blood is not going to be transfused, return it to the blood bank within 30 mins of issue
• make sure the unit is transfused within 4hrs
• Symptoms are high fever (>3.5 degrees Fahrenheit), chills, vomiting, diarrhea, and hypotension. Stop transfusion and notify HCP & blood bank

Question 15

Circulatory overload

Answer 15

• Results when the patient is unable to tolerate the rate or volume of the blood product being transfused
• Mild symptoms are breathing difficulty, cough, rapid heart rate, and hypertension
• Older adults, young children, and patients with cardiac or Renal conditions are at a higher risk for this complication
• Stop or slow the transfusion rate, elevate the head of the patient’s bed, provide supplemental oxygen as needed, and notify the physician
• For patients who are predisposed to fluid overload, the physician may prescribed a diuretic between or after each unit is transfused

Question 16

Hypothermia

Answer 16

• Develops hen large volumes of cold (34-45 degrees Fahrenheit) blood are infused rapidly
• Warming up blood components
• Maybe it’s all in abnormal cardiac rhythms and cardiac arrest

Question 17

What is the first step in properly identifying a recipient of whole blood or a blood component?

Answer 17

Obtain a blood sample for a type and cross match. This is a process that determines the intended recipient ABO group and Rh type

Question 18

Prior to obtaining a blood sample what should the phlebotomist ask the patient?

Answer 18

• name

- A second identifier, such as Social Security number or preferably date of birth

Question 19

Managing transfusion reactions

Answer 19

• STOP 🛑 the transfusion And maintain IV access by infusing normal saline solution through a new tubing at a slow rate
• For any suspected transfusion perform a physical assessment and compare your patient’s current vital signs with those taken immediately before the transfusion started
• Notify the physician of your assessment findings and the patient’s symptoms and notify the blood bank when you suspect a transfusion reaction
• For hemolytic an allergic reaction, obtain blood and urine samples ASAP
• Document transfusion reactions

Question 20

Febrile non-hemolytic transfusion reaction’s

Answer 20

• Most common in patients who are immuno suppressed or pregnant, these reactions develop as the recipient antibodies react to the antigens contained in donor blood usually to leukocytes or plasma proteins
• chills followed by a temperature increase of more than 1.8 degrees Fahrenheit from baseline developed within two hours after the transfusion has begun. The fever is clinically benign, causing no lasting effects or problems
• When you suspect this type of reaction, stop the transfusion and administer fever reducing (antipyretic) medication
• Continue checking the patients vital signs every four hours
• The use of leukocyte -decreased blood decreases the likelihood of this type of reaction
• This is the most common type of transfusion reaction. The There is stick fever usually develops within two hours after the transfusion started.
• Other classic symptoms include chills, headache, Flushing,anxiety, and muscle pain.
• This type of reaction is usually a result of sensitization to the plasma, platelets or white blood cells.
• Although this type of reaction is non life-threatening, it could be frightening and uncomfortable for the patient

Question 21

Acute intravascular hemolytic reaction

Answer 21

• An antigen antibody immune mediated reaction
• ABO incompatibility typically causes the most severe symptoms
• usually begins within 10 minutes of initiating the transfusion, after as little as 10 mL of blood is infused
• antibodies present in the recipients plasma rapidly combine and react with antigens on donor red blood cells thus hemolyzing, or destroying them
• Initial symptoms are pain at the IV site, elevated heart rate, chills, fever, and anxiety , nausea, back pain, chest tightness, and difficulty breathing
• Notify the physician and collect urine and blood specimens to be analyze for evidence of hemolysis
• as the hemoglobin is destroyed, red blood cells are excreted through the urine. Vascular collapse, hypertension, and renal failure may follow
• Continue to check vital signs at least every 15 minutes, observe your patient for signs of bleeding, monitor hourly and urinary output, and provide interventions to reverse the symptoms of shock.
• As a body tends to control the loss of blood, a systemic response called disseminated intravascular coagulation develop, causing a massive systemic hemorrhage
• Can be avoided with meticulous attention to blood sample labeling, Blood component labeling and patient identification.
• This type of reaction is usually immediate. It begins after the transfusion of as little as 10 mL of blood. The cause is compatibility of the recipients blood with that of the donor.

Question 22

Allergic Reaction

Answer 22

• develop at any time during the transfusion and up to one hour after the completion
• Symptoms are hives, itching and Flushing
• If you suspect an allergic reaction, stop the transfusion and notify the HCP and the blood bank
• Checks may occur as often as every five minutes
• For a patient who has had previously allergic reactions to blood transfusions, administering antihistamines before transfusion may prevent future reactions
• Future severe reactions can be avoided when The blood bank uses saline washing to remove any remaining plasma proteins from the blood components

Question 23

Transfusion related acute lung injury (TRALI)

Answer 23

• The leading causes of transfusion related deaths
• Symptoms of TRALI include chills and respiratory distress, which can lead to respiratory failure
• The symptoms may develop at any time during a transfusion to within six hours after the transfusion is completed
• Suspect this type of reaction when your patient has difficulty breathing or the onset of pulmonary edema in the absence of fluid overload or cardiac dysfunction
• Treat the patient with oxygen and airway support

Question 24

Delayed hemolytic reaction

Answer 24

• Developed within 14 days following transfusion as a result of an antibody response to non-ABO donor antigens that were not detected during crossmatch
• Symptoms include fever of unknown origin, and unexplained decrease in hemoglobin or hematocrit levels, an increase in serum bilirubin levels and the appearance of jaundice
• Notify the HCP and the blood bank when you suspect this type of reaction because in acute hemolytic reaction may develop with future transfusions, a more specific crossmatch process is essential prior to future transfusions
• They should be monitored for worsening anemia

Question 25

Graft versus host disease (GVHD)

Answer 25

• Develops primarily immune-compromised individuals, when T lymphocytes in the transfused component attack and react against tissue antigens in the recipient
• Can manifest following a transfusion of any blood product containing even minute amounts of viable T lymphocytes
• include skin rash, fever, jaundice due to liver dysfunction and bone marrow suppression
• Irradiating blood components is the only known and approved method up of inactivating T lymphocytes

Question 26

Post transfusion purpura

Answer 26

• Arising 7 to 10 days after blood transfusion
• A traumatic, sudden, but self limiting destruction of native and transfuse platelets results from an immune response to platelet-specific antigens