Blood Product Transfusions

Question 1

An unidentified male trauma client requires an emergent transfusion. What is the correct transfusion option for packed RBC?
A. Type AB-negative, uncrossmatched blood
B. Type AB-positive, uncrossmatched blood
C. Type O-negative, uncrossmatched blood
D. Type O-positive, uncrossmatched blood

Answer 1

Answer: C
O-: universal donor
AB+: universal recipient

Question 2

Red Blood Cells (RBC) or Packed Red Blood Cells (PRBC)
Platelets
Plasma or Fresh Frozen Plasma (FFP)
Granulocyte (White Blood Cells/WBC)

Answer 2

Types of transfusions - only know ABO compatibility

Question 3

To replace lost blood or anemia
Transplantation of tissues
Compatibility is determined by 2 antigen systems
ABO and Rh
**Donor and recipient blood must be checked carefully for compatibility
Infuse over 2-4 hours - max 4 hrs; start slowly with first 15 so not transfusion rxn
Use filtered pump tubing

Answer 3

Red Blood Cells (RBC) or Packed Red Blood Cells (PRBC)

Question 4

To treat thrombocytopenia or active bleeding
Platelets < 10,000 mm3
Platelets are pooled from multiple donors so do not have to have the same blood type
Use specific shorter tubing
Longer tubing increases the chance that platelets will stick to lumen
Infuse over 15-30 minutes immediately

Answer 4

Platelets

Question 5

To treat deficiency in plasma coagulation factors; elevated PT or PTT
Must be ABO compatible
Infuse over 15-30 minutes immediately after thawing - So clotting factors are still active
Use Y set tubing

Answer 5

Plasma or Fresh Frozen Plasma (FFP)

Question 6

Used with sepsis or neutropenic infection
Rare transfusion
More at risk for transfusion reactions
WBC surfaces have many antigens
Usually requires closer monitoring
Infuse over 1 hour

Answer 6

Granulocyte (White Blood Cells/WBC)

Question 7

When preparing to administer RBCs, the nurse notes that lactated Ringer solution is hanging on the IV pole. Which substance should be used to flush the line before hanging the blood?
A. Lactated Ringer solution
B. Normal saline
C. Heparin by infusion pump
D. Prophylactic antibiotics

Answer 7

Answer: B
Only thing hang with blood is NS

Question 8

A nurse is preparing to administer a blood transfusion. What action is most important?
A. Correctly identifying client using two identifiers
B. Hanging blood product with lactated Ringers
C. Staying with the client for the entire transfusion
D. Keeping blood product refrigerated

Answer 8

Answer: A
Matches sheet get
Stay for first 15 min

Question 9

Assess labs
Informed Consent
Verify order with another RN - one who admin the blood
Ensure venous access - good one
Assess vital signs - before and 15 min after and assess often and when stops
Obtain blood products from blood bank and administer as soon as possible
Safety checks
Inspect blood for discoloration, gas bubbles, cloudiness
Could indicate hemolysis or bacteria

Answer 9

Pre transfusion

Question 10

Must be done by 2 RNs
One of the RNs has to also be responsible for administering the blood product
Verify patient’s identity with another RN
Examine blood bag label, attached tag, and requisition slip for ABO and Rh compatibility with the patient with another RN
Check expiration date with another RN

Answer 10

Safety checks

Question 11

Vital signs
Use appropriate tubing, filters and fluids
Begin transfusion slowly, stay with patient first 15 to 30 minutes - ask if had one before: see if had transfusion rxn
Ask patient to report unusual sensations
Administer blood product per protocol
Assess for hyperkalemia - K can increase with stored blood

Answer 11

During transfusion

Question 12

immediately before starting infusion and again within the first 15-30 minutes

Answer 12

Vital signs

Question 13

Never add or infuse anything with blood products
Prime tubing with Normal Saline (0.9% NS)

Answer 13

Use appropriate tubing, filters and fluids

Question 14

chills, shortness of breath, hives, itching

Answer 14

Ask patient to report unusual sensations

Question 15

When a client undergoing a blood transfusion complains of flank pain and a sense of doom, which adverse reactions should be suspected?
A. A hemolytic transfusion reaction
B. Bacterial contamination of the blood
C. An allergic transfusion reaction
D. TACO

Answer 15

Answer: A

Question 16

Signs:
Fever, chills apprehension, HA, chest pain, low back pain, tachycardia, tachypnea, hypotension, sense of impending doom - feel like something going to happen
Occurs when there is a blood type or Rh incompatibility
Antigen-antibody complexes form and destroy cells and cause inflammatory response
Prevention:
Ensure that all blood products and typed and crossmatched
Adhere to all safety checks prior to blood product administration
Do all good checks and all matches

Answer 16

Hemolytic Transfusion Reaction - Complications

Question 17

Signs:
Fever, chills, tachycardia, hypotension and tachypnea
Occurs when a patient has had multiple transfusions and develop WBC antibodies - not want give more transfusions than necessary: higher risk developing antibodies/adverse rxn
Prevention:
Give leukocyte reduced blood or single donor blood
Use of WBC filters when administering blood products - filtered tubing and not using norm fluid tubing

Answer 17

Febrile Transfusion Reaction - Complications

Question 18

Signs:
Urticaria (hives), itching, bronchospasm, anaphylaxis
Usually seen in patients with other allergies
Can occur immediately or within 24 hours
Prevention:
Give leukocyte reduced blood
Some premedicated with things if known had rxn before

Answer 18

Allergic (anaphylactic) Reaction - Complications

Question 19

Signs:
Tachycardia, hypotension, fever, chills
Caused by contaminated blood and onset is rapid - see if blood looks funny or off

Answer 19

Bacterial Transfusion Reaction - Complications

Question 20

Signs:
Signs of HF
Hypertension, bounding pulses, JVD, dyspnea, restlessness and confusion - decrease O2 sat - having fluid overload
Occurs when blood product is infused too quickly/very susceptible to fluid overload
Prevention:
Infuse blood products slowly - have Give over 4 hours - run slowly with this pat and keep at this and if s/s of fluid overload can turn it down
Diuretics
Monitor I&O - extra volume - see if putting out extra volume so not fluid overloaded

Answer 20

Transfusion-Associated Circulatory Overload (TACO) - Complications

Question 21

Not acute - can happen later
Signs:
Thrombocytopenia, anorexia, N&V, weight loss, and infection
Often Occurs in immunocompromised patients and occurs within 1-2 weeks - not catch right then
Prevention:
Administered irradiated blood products that destroy T cells and cytokine

Answer 21

Transfusion related Graft v. Host disease - Complications

Question 22

If a client develops a skin rash, edema, and wheezing during a blood transfusion, what should the nurse do?
A. Discard the blood bag and tubing.
B. Decrease the rate of the transfusion.
C. Stop the transfusion immediately.
D. Reassess the client in 10 minutes.

Answer 22

Answer: C
Suspect transfusion rxn stop it immediately - not keep infusing causing rxn; also if having fluid overload, priority is stop transfusion

Question 23

Stop the infusion
Don’t flush tubing and put anymore blood into the patient
Take down all blood tubing and save with all labels - send to lab so can inspect it and run tests on it and what caused the transfusion rxn
Oxygen
Diphenhydramine (if allergic rxn)
IV Fluids for shock
Antibiotics (if bacterial)
Antipyretics for fever
Meperidine for rigors/shaking - shivers
Need VS and need notify provider so if getting blood product need know how much got and rxn having and where go from here and what do

Answer 23

Nursing Interventions - depends on time of rxn - Complications