Blood Component Therapy

Question 1

Packed RBCs

Answer 1

• For very anemic patients
• does not contain plasma or WBCs

Question 2

What is needed before giving PRBCs

Answer 2

Type and cross match
- type—pt blood type
- crossmatch—take small piece of pt blood and mix it with potential donor to ensure no hemolysis (indirect Coombs)

Question 3

What blood type lacks all antigens?

Answer 3

O-

Question 4

What are the 2 components of blood type?

Answer 4

Rh antigen (+ or -)
A, B, or O antigen

Question 5

You can’t receive blood from someone who…

Answer 5

Has an antigen that you don’t

Question 6

Pre-transfusion responsibilities for PRBCs

Answer 6

• know H&H
• verify order and consent
• type and crossmatch w/i 48h of transfusion
• premedicate with Tylenol or Benadryl if necessary
• anticipate giving 300-500 mL
• be ready before blood is on the floor—30 MIN TO START

Question 7

Recommendations for who to receive PRBCs

Answer 7

• hemodynamically stable pt w/o active bleed to get blood when HgB under 6 but hgb highly recc for 6-7
• 7-8 appropriate for heart disease or surgery
• hgb 8-10 no transfusion unless serious comorbidity
• hgb over 10, no hgb usually

Question 8

IV set up for PRBCs

Answer 8

• venous access (20G+)—bigger needle less likely to b/d RBCs
• “y” tube (one for blood, one for NS)
• filter
• NS ONLY (D5 and LR cause hemolysis)

Question 9

INR

Answer 9

• international normalize ratio
• higher INR is thinner blood
• want 2-2.5 for warfarin
• decides if pt on Warfarin is on a therapeutic dose

Question 10

What is a normal feeling for a blood transfusion?

Answer 10

Cold at site

Question 11

What does the nurse do for first 15-30 minutes of transfusion?

Answer 11

Sit with the patient

Question 12

VS for blood transfusions

Answer 12

• take baseline (RN)
• assess after 15 minutes
• take VS q hour and at the end

Question 13

Infusion rate

Answer 13

Start slow (1-2 mL/min–60-120 mL/h) for first 15 minutes than can inc to infuse in 2h if VS normal

Question 14

How long can blood hang and why?

Answer 14

4 hours - take down after bc bacteria can get in and tell HCP

Question 15

Fluid overload patient receiving transfusion

Answer 15

May order diuretics between infusions

Question 16

Who gets a platelet transfusion?

Answer 16

Thombrocytopenic; often platelets under 20k (often cancer)

Question 17

How are platelets stored?

Answer 17

Last 1-5 days, must be kept at room temp

Question 18

Is ABO compatibility a factor in platelets?

Answer 18

NO

Question 19

NC for giving platelets

Answer 19

Agitate bag periodically to prevent clumps; admin as fast as tolerated

Question 20

Fresh frozen plasma

Answer 20

• help with clotting (no plt in it)
• serum
• liquid part that is separated from whole blood and frozen (about 250 mL)

Question 21

Does FFP require ABO compatibility?

Answer 21

YES

Question 22

FFP Storage

Answer 22

• stored for 1 year
• use w/i 24h of thawing

Question 23

Indications for FFP

Answer 23

• risk for bleeding from clotting factor deficit
• fluid volume expander (less common)

Question 24

Normal albumin

Answer 24

3.5-5

Question 25

Albumin

Answer 25

Colloid that increase plasma volume

Question 26

Is compatibility a factor for albumin?

Answer 26

NO

Question 27

Who is most likely to get albumin?

Answer 27

Liver disease

Question 28

How to match albumin?

Answer 28

Needs to be the same concentration (genetically equivalent to plasma)–often 5% but can be 25% (more severe)