Blood component therapies Flashcards
what are some common blood products
Packed red blood cells (PRBCs)
Platelets
Fresh frozen plasma (FFP)
Albumin
what are packed RBC (PRBC)
`ONLY THE BUSES!
Does NOT have plasma, platelets, or WBC components of blood
what does it mean to order a type and cross-match for PRBC?
type: determining a person’s blood type
cross-match: determining compatibility between the blood samples
- called an indirect Coombs test
universal blood donor
O-
universal blood recipient
AB+
what are the two components of blood types?
ABO and Rh
ABO is “blood types” “A genes” and “B genes”; Rh system – indicates presence vs. absence of rh antigen
what are the two most common blood types?
O Rh Positive (O+)
A Rh Positive (A+)
what are the labs you must monitor for transfusing blood?
H & H
What are the recommendations for hemodynamically stable patients w/o active bleeding:
Hgb <6 g/dL:
Transfusion recommended except in exceptional circumstances.
Hgb 6 to 7 g/dL:
Transfusion generally likely to be indicated.
Hgb 7 to 8 g/dL:
Transfusion may be appropriate in patients undergoing orthopedic surgery or cardiac surgery, and in those with stable cardiovascular disease, after evaluating the patient’s clinical status.
Hgb 8 to 10 g/dL:
Transfusion generally not indicated, but should be considered for some populations (eg, those with symptomatic anemia, ongoing bleeding, acute coronary syndrome with ischemia, and hematology/oncology patients with severe thrombocytopenia who are at risk of bleeding).
Hgb >10 g/dL:
Transfusion generally not indicated except in exceptional circumstances.
What are some pre-transfusion responsibilities?
Assess lab values
Verify order
Confirm type and cross-matching has been done (q 48 hrs)
Positive identification of patient; consent form
Pre-medicate as ordered
Anticipate PRBC = 250-350 ml
correct IV set-up
Be ready before the blood gets to the floor
how long do you have to begin the transfusion of blood once it arrives to the floor for transfusion?
30 minutes
how much time do you have to transfuse blood?
4 hours
what is the correct IV setup for blood transfusion?
- Venous access (20 ga or larger; Lewis says 22 ga – not best practice!) 18 ga is ideal
- “Y” tubing (one for blood; one for NS)
- Filter
- NS only (NO D5/LR!!!)
- prime tubing with NS
- prime and run the blood (250-350 ml)
- run NS after blood is complete to get leftover blood in tubing
what are some transfusion responsibilities?
- If blood not used right away, return to blood bank
- Explain procedure/patient needs to report unusual sensations immediately:
- Chills, SOB, itching, back pain - Take baseline V.S. (RN take initial set)
- Begin infusion slowly (1-2 ml/min – 60-120 ml/hr) first 15 mins
- Constant observation by RN first 15 – 30 minutes (per protocol)
- Assess V.S. in 15 minutes
- If no reaction, increase rate to infuse in about 2 hours (unless risk for FVE)
- Take V.S. q hr & at end of transfusion
- Post-infusion orders?
What is the maximum time of blood bag can hang and why?
4 hours maximum because there’s a risk for bacterial proliferation
why might the HCP order furosemide (Lasix) after a transfusion?
fluid volume overload (FVO)
How are platelets obtained?
- Prepared from fresh whole blood
≈ 30-60 ml - Multiple units can be obtained from one donor
- Must be kept at room temperature; good for 1 – 5 days
- ABO compatibility not a factor
What are the indications for platelet administration?
Bleeding caused by thrombocytopenia
Platelet count < 20,000/mm³
is administering platelets give the patient clotting factors?
No, this is not the same thing as administering clotting factors (prothrombin admin for example)
Why would you administer fresh frozen plasma (FFP)?
if the patient is having clotting factor issues
What are some details about FFP administration and storage?
- Liquid portion separated from whole blood and frozen ≈ 250 ml
- Rich in clotting factors; contains no platelets
- ABO compatibility is required
- Stored for 1 year; use within 24 hrs of thawing
- FFP should be administered at 200 mL/hr or slower if potential for overload.
What are the indications for FFP?
Bleeding caused by a deficiency in clotting factors
Fluid volume expander (to lesser extent)
Which blood product derivative is considered a colloid?
albumin
colloids keep fluid inside the intervascular space by oncotic pressure, also called pulling power
does administering albumin require compatibility to the recipient?
no, compatibility is not necessary
