Blood component therapy Flashcards
what are packed red blood cells and what do they contain
PRBC are RBCs with little plasma (hct 75%); some platelets & WBCs
how long can PRBC be stored
• PRBCs stored at 4 degrees safely up to 42 days
what would PRBC be indicated for
to Inc RBC mass
Symptomatic anemia
The platelets aren’t functional nor are the WBCs.
The WBCs might cause reaction
how are platelets stored & kept well-functioning
• Platelets at room temp last up to 5 days
o To prevent clumping they are gently agitated
platelets can be from single donor or random. Why would single be used
Repeated tx with random donors can lead to alloimmunization
If pt needs repeat Tx then they should be given single donor platelets
indications for platelets
Bleeding d/t dec platelets or to prevent bleed when pt has low platelets
cryoprecipitate is made of
Cryoprecipitate: fibrinogen, AHF (VIII:C), von Willebrand factor, fibrinonectin
indication for cryoprecipitate
Von Willebrand disease
Hypofibrinogenemia
Hemophilia A
what conc does albumin come in and what is it for
Albumin (5% or 25%)
Hypoproteinemia, burns, volume expansion by 5% to inc blood vol (in hypovolemic shock), give 25% albumin to dec hct
why give immunoglobulins
which globulins are you giving specifically
Hypogammaglobulinemia (in CLL or recurrent infects); idiopathic thrombocytopenia; primary immunodeficiency
gamma globulins. IgG
what is whole blood & why is it indicated
Whole blood that is composed of cells & plasma (hct 40%)
Volume replacement & 02 carrying capacity
Usually only for significant bleed >25% blood vol lost
which blood components can be heated to get rid of viral components
• Immune globulin is conc IgG & can be heated to 60* for 10hrs as can albumin to get rid of viruses
not sure if stuff about blood transfusion is important
what health hx is it nec to know for someone giving blood transfusion
• Donor is carefully interviewed for viral hep, STIs, stays in places with higher risks of other diseases, have they received transfusions, skin infect, hypersensitivity (as it can be passed on), pregnancy (shouldn’t give blood as they need it), immunization recently, CA, whole blood donation in past 56 days, aspirin affects platelets
what diseases can be passed on by blood transfusion
o Hep B & C (screening detects this)
o AIDS (blood screened for antibodies to HIV)
o Cytomegalovirus
o Graft vs host disease (only in severely immunocompromised recipients. Can irradiate blood for this)
o Creutzfeldt-Jakob disease (rare, fatal neurodegenerative disease that causes irreversible damage. It is a prion. Like mad cow disease)
physical requirements for blood donor
o Exceed 50kg for a standard donation of 450ml
o Older than 17
o Oral temp not exceed 37.5
o Pulse rate between 50-100
o Systolic 90-180 and diastolic 50-100
o Hg at least 1.94 for woman and 2.1 for men
what are the different kinds of blood donation
directed donation standard donation autologous donation intraoperative blood salvage hemodilution
what is directed donation
blood to friend or family but not necessarily safer bc might not be willing to identify any history of risk factors ie) HIV
how much blood is taken during a standard donation
-how long does it take & what to do or tell them to do
phlebotomy consists of venipuncture and blood withdrawl. Withdrawal of 450 ml of blood usually takes up to 15 min Hold arm up after and apply firm pressure for 2-3 minutes. Donor remains recumbent until they feel able to sit up. Receives foods and fluid and stay for 15 minutes.
autologous donation
how many units can be taken & when are they not taken
patients own blood for future potential surgeries (orthopedic sx). Ideally collected 4-6 weeks early. Iron supplements given to prevent iron depletion. Typically 1 unit of blood/week. Phlebotomies are not performed within 72 hours of surgery
what is the advantage of autologous donation
should everyone do this to prevent risk?
o Primary adv is prevention of viral infections from other blood also safe for ppl who have a history of transfusion reacitons, prevents alloimmunization and avoidance of complications to patients with alloAbs
o Needless autologous donation is disciouraged bc expensive, takes time, and uses resources inappropriately
o Might be inadequate-need more from random donors anyway
what is intraoperative blood salvage
• - provides replacement for patients who cannot donate blood before surgeru and for those underging vascular, orthopedic, or thoracic surgery
o During a surgical procedure, blood lose into a sterile cavity (hip joint0 is suctioned into a cell-saver macine. PRBCs or whole blood are washed with saline, filtered, and returned to patient as IV infusion
med surg ssecond section
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what is the consideration with using older blood
• Caution with old blood cells cause continual destruction of RBC causes release of K out of cells into plasma. Lab test of K ordered before administering unit of blood
what are the 3 blood system types
ABO, RH, & human leukocyte antigen
how does ABO system work
what happens with incompatible RBCs
- ABO uses presence or absence of specific antigens on surface of RBC
- When type A antigen is present, blood group is type A
- Antibodies that react against the A and B antigens are present in the plasma of people whose RBC do not carry the antigen. These antibodies (agglutinins) react against the foreign antigens (agglutongens).
- Incompatible RBC agglutinate (clup together) and result in life-threatening hemolytic transfusion reaction
who is the universal recipient
type AB have neither antibody and can receive all blood types
what surface antigens does a person with O blood have and therefore what blood can they receive
have both A & B antibodies so they can only receive O blood
what is the RH system and which Rh antigen is most common and likely to cause reaction
if pt has this antigen are they positive or negative
- Nearly 50 types of Rh antigen may be present on surface of RBC, D cell is widely prevalent and most likely to illict an IR.
- Presence or absence of D that determines Rh type
- With D makes you positive
- No antibodies to D antigen (unlike ABO)
how is a pt sensitized and what makes them have a reaction
how long would this take
- Person with Rh neg blood must first be exposed to Rh pos blood before Rh antibodies are found. If exposed to enough blood (200ml) then can cause severe reaction
- These Abs take up to 2 weeks to form
must all blood that is given be matched to the pts Rh
• Rh pos blood may be used for a person with Rh neg without adverse effect if that person has not been previously exposed to Rh pos eg in trauma
implications of Rh negative mom who is having a baby
when would she get tx & what would this entail
- Rh neg mom previously exposed to Rh antigen can transfer Rh antibodies across placenta resulting in fetal hemolysis (breakdown of RBC with resultant anemia and jaundice) often fatal to infant
- To prevent current or future fetal hemolysis, Rh (D) immunoglobulin (RhoGam) given IM to mom to suppress or destroy the fetal Rh pos blood cells that passed on
what is HLA and what are they found on
what are complications of HLA
- Highly immunogenic antigens can cause transfusion complications
- HLA Ab are on surface of leukocytes
- May be found on lymphocytes, granulocytes, monocytes, and platelets
complications:
o Febrile nonhemolytic reaction (FNH)
o Immune mediated platelet refractoriness
o Tranfusion-related acute lung injury (TRALI)
o Transfusion-associated graft-versus-host disease (tA- GVHD)
what is the most common reaction to blood therapy
why is it caused
and who does it gen occur in
Febrile Nonhemolytic Reaction
- Caused by antibodies to donor leukocutes or platelets that remain in the unit of blood or blood component.
- Often occurs in pt who had previous transfusions (exposure to multiple antigens from blood products) and in rh neg woman who have borne Rh positive children
onset of febrile nonhemolytic rxn
and how to prevent it
30min after initiation to 6hrs affter completion of transfusion
to prevent use leukocyte reduced products in pts who have experienced this complication before
mnfts of febrile nonhemolytic rxn
fever >1 degree above baseline, flushing, chills, headache, muscle pain; occurs most freq in immunosuppressed pts
intervention if febrile nonhemolytic rxn
stop transfusion
antipyretic
monitor temp q4h
what is acute hemolytic rxn and how quickly would it occur
• Antibodies already present in the recipients plasma rapidly combine with antigens on donors erythrocytes and the erythrocytes are destroyed in circulation. There is either an ABO or Rh incompatability
ocurs within 15mins of transfusion initiation. ABO incompability is faster
mnfts of acute hemolytic rxn
- Symp: fever up to 41*, chills, severe low back pain and chest pain, nausea, chest tightness, dyspnea, and anxiety, tachycardia, sensation of heat and pain along vein receiving blood, chills,bronchospasm , HoTN, DIC, vascular collapse, possible death
- As erythrocytes are destroyed, th Hg is released from the cells and excreted by the kidneys, therefore hg appears in the urine (hemoglobinuria) hypotension, bronchospasm, and vascular collapse may result
- Dimished renal perfusion results in ACF and DIC
how much blood is nec for acute hemolytic rxn
• Can occur in as little as 10ml of PRBCs
interventions for acute hemolytic rxn
stop transfusion and remove blood tubin and product.
notfy
VS q15
correct arterial P and coagulopathy according to orders
catheter
I/O hourly
assess for shock
dialysis may be nec
blood and urine samplessent to lab along with the blood that caused rxn
delayed hemolytic transfusion rxn onset
how does it work
• Occurs within 2- 14 days when level of antibody has been increased to the extent that a reaction can occur
there is immune response against non-ABO donor Ags. gen the result of destr of transfused RBCs by alloAbs not detected during cross match
• The hemolysis of the erythrocutes is extravascular via the RES and occurs gradually
how to prevent delayed hemolytic transfusion rxn
mnfts
careful cross match
can be missed as it occurs so late
unexplained fever,
unexplained dec in Hgb/Hct
inc biliruin levels
jundice
nurs intervention for delayed hemolytic trnsfusion rxn
monitor lab values for anemia (next time could be full acute hemolytic rxn)
allergic rxn (mild to moderate)
onset in
mnfts
• Thought to be from sensitivity to plasma protein within blood component being transfused
onset during transfusion to 1hr after transfusion
• Symp: itching, urticarial, and flushing, local erythema
prevention & interventions
- If severe- epinephrine, corticosteroids, and vasopressor support
- can Give pt antihistamines before as preventative meas
stop transfusion notifu give antihistamines VS q15 transfusion can be restarted if fever, dyspnea, wheezing not present
what happens in severe allergic rxn
is it faster than mild to mod allergic rxn
caused by recipient allergy to donor antigen usually IgA
agglutination of RBCs obstr caps & blocks blood flow causing issues w all organ systems
onset withing 5-15mins of initiation of transfusion
mnfts of severe allergic rxn
coughing nausea V dyspnes resp distress wheezing HoTN l/o consciousness possible cardiac arrest
interventions for severe allergi rxn
how to prevent
life threatening! stop transfusion keep IV acess Notify and notify blood bank too antihistamines, corticosteroids, epinephrine and antipyretics as ordered VS until stable CPR?
to prevent: transfusion of saline washed or leukocyte depleted RBCs
graft vs host disease:
what is it
when does it occur
what is it: donor lymphocytes destroyed by recipients IS. If pt is immunocompromized the donor lymphocytes are seen as foreign but the pts IS cant destroy them and in turn the pts lymphocytes are destroyed
when does it occur: days to weeks
mnfts of graft vs host disease
interventions
skin rash
fever
jaundice d/t liver dysfx
bone marrow suppression
give methotrexate and corticosteroids as ordered
what is often the max rate for transfusion ml/kg/hr
2-4ml/kg/hr
iron overload when might this occur and whats is happening
might occur w multiple transfusion or hronic transfusion therapy
the iron from the donated blood binds to the protein and isnt eliminated
mnfts of iron overload
nursing intervention
cardiac dysfx SOB arrythmias heart failure inc serum transferring inc liver enzymes jaundice
monitor for above issues
what is TRALI
is it common
Transfusion-Related Acute Lung Injury
• Potentially fatal, idiosyncratic reaction
• Most common transfusion related cause of death
• Thought to involve antibodies in plasma of donor to the leukocutes in the recipients blood. Sometimes reverse happes- abs in recipient agglutinates to anitgens on the few remaining leukocutes in blood component being transfused
• Another theory- initial insult to patients vascular endothelium causes neutrophils to aggregate at the injured endothelium
• Various substances within the transfused plasma (lipids, cytokines) then activate the netutrophils
• End result of this process is interstitial and intra-alveolar edema, as well as extensive sequesteration of WBCs withn the pulm capillaries
TRALI onset and mnfts
what kind of blood product is it more likley to occur with
• Onset abtupt- within 6hours
mnfts: SOB, hypoxia (arterial o2 sat), less than 90%, hypotensin, fever and pulm edema
• Diagnostic criteria include hypoxemia, bilateral pulm infiltrates and no evidence of cardiac cause for the pulm edema
more likely with plasma
what are people who receive long-term blood therapy at risk of
- Long term are at a greater risk for infection and more sensitive to donor antigens, bc exposed to more donors
- Iron overlaod is a complication for long term. One unit is 250 mg of iron
what does excess iron damage
• Excess iron can cause organ damage particularily in liver, heart, testes and pancreas
to dec febrile reactions what should happen to the blood during processing
use WBC filtered products
how can you prevent iron overload and how does it manifest (prob not important)
mnfts: heart failure, endocrine failure
- -prevent by chelation therapy
how to manage risk of cytomegalovirus
WBC filters
P&p
P
FOR PREop blood donation how soon before sx does the pt donate. how long does it last
- Preop is the most common type of autologous donation. Last donation may occur 72 hour before surgery
- Donated blood stored at 1-6 degrees for 35-42 days
what lasts longest CPD or CPDA-1 or CPDA-1 additive system
what are they
which are more common
all types of blood preservatives
CPD–citrate phosphate and dextrose has a shelf life of 21 days
CPDA-1–CPD plus adenine has shelf life of 35 days
the above two are more common
CPDA-1 add. sys. has CPD plus various preservative combinations
what is the concern with using older blood
continual destruction of RBC causes release of K out of cells into plasma. Lab test of K ordered before administering unit of blood
what are the 3 blood system types
ABO
Rh
HLA
if pt has type A blood what antigens do they have and what antibodies
A antigens
B antibodies
what antigens and antibodies does O blood have
A and B antigens
who is th universal donor and who is the universal recipient
O- is universal donor
AB+ is universal recipient
what kind of blood could a AB- pt receive
A-
B-
O-
who has more transfusion options (can receive more)? pt with neg or pos blood
positive can receive more
are there antibodies if you are Rh neg?
how does this relate to pregnant moms?
- No antibodies to D antigen (unlike ABO)
- Person with Rh neg blood must first be exposed to Rh pos blood before Rh antibodies are found. If exposed to enough blood (200ml) then can cause severe reaction
t or f. you should never give blood that is incompatible with osmeones Rh group
sort of false. obviously give compatible if it is possible but…Rh pos blood may be used for a person with Rh neg without adverse effect if that person has not been previously exposed to Rh pos eg in trauma
what might happen with rapid transfusion of cold blood
what might be used
dyshtymias and dec in core temp
can use blood warmer if lg transfusion
what do you need to confirm before giving blood (lab related)
type and cross match in past 72hrs
hct, coagulation, platelet…I also think K?? and other things too?
if pt has had transfusion sensitivity to blood in the past what might they be given before their blood
anithistamine s or antipyretics
what do you need in relation to pts IV access
how is this different for peds
- Verify IV cannula is patent
a. Administer blood to adult using 14-24 guage short peripheral
b. Transfuse a neonate or ped with a 22-24 gauge
c. A 1.9 fr is the smallest CVAD that can be used
what to assess before giving blood
- Verify order of specific blood, date time to begin, duration and pre or posttransfusion meds
- Health hx and known allergies. Type and cross match 72 hours before
- Verify IV cannula is patent
Administer blood to adult using 14-24 guage short peripheral - Assess lab values- Hct, platelets,etc.
- Pt signed consent
- Know why getting it
- pretransfusion vitals
- Assess need for IV fluids or meds while transfusing
- Assess understanding
after the blood is released from blood bank how long do you have before you need to hang it
30mins
what do you need to identify when you have the blood
- Verbally compare and correctly verify patient, blood product and type.
a. 2 ID and
b. transfusion record number and pt id number match
c. name and bday on all documents
d. unit number on blood bag with blood bank form are same
e. blood type matches on tranfsion record and blood bag. Right bag
f. check expiration date
g. just before initiating, check pt ID, info with blood unit label information, do nt give without id bracelet
h. both individuals verify pt and unti ID
what do you ask pt to do before initiating infusion. or empty?
- Empty urine drainage bag or have pt void
how do you prepare the blood bag before hanging it
f. Prepare blood- gently agitate blood unit bag, turning back and forth, upside down, remove protective covering from access port. Spike w other Y connection. Close normal saline clamp above filter, open clamp above filter to blood unit and prime tubing
what kind of tubing do you use to give blood
y tubing (with giant drip chamber) and in line filter.
which VS do you notify the dr of if it is high
temp if pt is febrile
if youre giving blood through a 24 gauge what needs to be done
blood bank might have to divide the unit (as the infusion rate will be slower and you need it to infuse in 4hrs)
what is the only thing that blood is compatible with therefore what to do if pt needs med at the same time
how does dextrose affect blod
0.9 NS
they should get second line for meds
dextrose–>coagulation
you go to admin blood but something happens and you cant hang it in the 30mins. what to do?
immed return it to blood bank and get it when you can give the blood
rate for initial 15mins
what should you do during this time
2ml/min or 20gtt/min
stay with pt during first 15
according to VIHA freq of VS monitoring
what to do at the same time
at 5min, 15, 1hr?
check their IV site and infusion status
check for signs of transfusion rxn eg chills, flushing, itching, dyspnea
t or f your pt is having a reaction to blood. you run the NS through the pts existing tubing
F. change the tubing as youd ont want the blood in the tubing to run into the pt
you have run one unit of blood and need to do another one. what will youc hange
tubing and set. d/t 4hr time limit and danger of bacteria
your blood has infused what to do
now you have another bag to give what o
clear line with NS and discard bag appropriately
TKVO with NS and get the other bag
which blood products do you not need ABO testing
cryo
albumin
which blood product do you need ABO but not Rh compatibility
fresh frozen plasma that is single donor
which blood products do you not eed Rh compatibility
fr frozen plasma
cryo
colloid components (albumin
which blood components cant transmit HBV or HIV
colloid components. everything else can
what to document after transfusion
- pretransufion meds, VS, location and condition of IV site, pt education
- type and vol of blood component, blood unit/donor/reciipient ID, compatability, expiration date, pt response.
onitoring for adverse rxn
TRALI onset
6hrs generally
what might fever indicate
acute hemolytic rxn
febrile nonhemolytic
bact sepsis
what might tachy indicate and or tachypne, dyspnea
acute hemolytic rxn
cic overload
what might drop in BP indicate
infectious disease transmission
acute hemoytic rxn
anaphylaxis
what might hives, skin rash (including on trunk and on back indicate
early singns of allergic rxn, anaphylaxis, GVHD (which occurs after transfusion)
observe pt for wheezing chest pain, possible cardiac arrest..this indicates?
anaphylaxis
headache or muscle pain in presence of fever indicates
febrile nonhemolytic rxn
N or V might indicate
acute hemolytic
anaphylactic
infectious disease transmission
DIC, renal failure, anemia. hemoglobinuria (shown by CBC, hct, hgb)
late signs of acute hemolytic rxn
pt has jaundice, inc livr Es, liver damage, bone marrow suppression
graftvs host disease. would occur followig transfusion
what might tingling, dysrhtyhmi, HoTN indicate
hypocalcemia. from citrate combining with calcium
WHERE TO GET BLOOD SAMPLE (if nec) if pt is having transusion rxn
from arm opposite IV
which conditions might you give antipyretics or analgesics for
relieve fever and discomfort in acute hemolytic rxn, febrile nonhemolytic rxn, GVHD, bact sepsis
when to give corticosteroids for transfusion rxn
for severe allergic rx
other than blood what kind of sample miht you send to lab after transfusion rxn
first voided urine sample
Hgbinuria indicates acute hemolyti rxn. degree f damage to kidneys is influenced by ph of urine and rate of urine excretion
procedure of pt has transusion rxn
- If you think transfusion reaction- stop IV immediately
- Remove blood component and tubing containing blood product and replce with saline
a. Unless mild allergic reaction, stop transfusion, give antihistamines, restart or dc transfusion per protocol - Maintain with NS
- Vitals
- Notify HCP and blood bank
- Obtain blood samples if needed
- Return back to blood bank
- Monitor vitals q15min
- Administer meds according to severity:
Epi
Antihistamine
Abx
Antipyretics/analgesics
Diuretics/morhine
Corticosteroids
IV fludis - Obtain first voided urine sample and send to lab
what is the problem that can occursto babies with Rh neg mom and Rh pos baby in 2nd preg called
hemolytic disease of the newborn
erythroblastosis fetalis
what might allow fetal blood to cross into mom
amniocentesis
percutaneous blood sampling
what should Rh neg mom get at first visit when preg when will this test be repeated
exception to this
anti D ab titre
repeat at 28wks
will occur more freq if high titre first assessment (q2wk) and may have to deliver v early if high risk
when is the first RhIG given
when is the next dose
28wks
72hrs after give another dose
the rhogam will destroy the abs
if baby is losing blood in utero what can be done
intraueterine transfusion-O neg or fetus’ blood type
when is ABO compatibility a concern in preg
when placenta is loosened. gen ABO compability isnt a concern
hw to detect Rh issue
rising anti Rh titer or inc level of Abs
how might baby present if Rh issue
might not be pale at birth as red cell production. if anemic will get hypoglycemic
not jaundiced at birth as maternal circ evacuates bilirubin keeps up in utero. liver and spleen might be enlarged
how are babies treated for blood issues
early feeding to remove bilirubin from BMs
phototherapy triggers liver to fx
exchange transfusion
consideration when spiking a blood bag
spike it at chest height
when getting post blood blood work what is ideal timing
6hrs after
how many mls of NS do you need on hand
500ml
if giving more than 2 units blood what is often done between
diuretic
can you send pt to procedure if they have blood going
no. go with them or order portable
should you use the tape f the lot number for chartig
no
from handout VIHA
if pt has mild allergic rxn do you need blood or urine spec
no
before ordering blood from transfusion services what needs to be prepared
informed consent on chart
bag of 500ml NS and IV tubing at bedside
IV (20gague or larger)
transfusion admin set at bedside
what 3 items are you checking at bedside and what are you checking them for
check issuing requisitiion
label on blood product
attahed product tag
check for pt surname, given name, initials unique # or PHN for outpts DOB blood group and Rh factor or lot # blood serial number date of donation/expiry date
how to id the pt
check label on blood product and the attached product tag with pts name band and have pt spell their last name and give DOB if possible
after IDing the pt whatto dowhen hanign blood
sign and date the issuing req and then immed hang it
is it 4hrs after hanign or 4hrs after issuance that it must infuse
after issuance
nurses role in informed consent for blood
we can witness signature
we cant tell them about it eg why theyre getting it, what theyll get etc before the dr speaks to them
