Blood Products Flashcards
PRBC used for…
replacing erythrocytes
1 unit of PRBCs increases Hgb & HCT by…
Hgb: 1g/dL
HCT: 3%
**takes 4-6 hrs after transfusion completes
How do we assess effectiveness of PRBCs?
- anemia resolved
- increased erythrocytes
- increased Hgb
- increased HCT
“washed” RBCs
- leukocyte-poor
- leukocyte, proteins, plasma have been reduced
-usually prescribed for hx of allergic rxn or hematopoietic stem cell transplant
- restore oxygen-carrying capacity of blood
- restore intravascular volume
How fast do you infuse PRBCs?
2-4 hrs
Platelet Transfusion used to..
tx thrombocytopenia and platelet dysfx
patients that receive multiple units of platelets can become…
alloimmunized to different platelet antigens
-normal during pregnancy, but ADR for blood transfusion
What would patients benefit from who are alloimmunized?
platelets that match their specific HLA (human leukocyte antigen)
alloimmunized
immune response to foreign antigens after exposed to genetically different cells/tissues
Crossmatching for platelet transfusion
-no req’d, but usually done
how fast do you infuse platelets?
rapidly over 15-30 mins
-admin immediately after rec’d from blood bank
How do we measure effectiveness of platelet transfusion?
- improved platelet count
- normally evaluated 1 hour and 18-24 hrs after infusion
For each unit of platelets, what is the expected increase in platelet count?
5k-10k per unit of platelet
FFP used for…
fresh-frozen plasma
- used to provide clotting factors OR volume expansion
- there are no platelets in FFP
How fast is FFP infused?
- over 15-30 mins
- within 2 hours of thawing (clotting factors not viable after that)
Rh/ABO compatibility for FFP
REQUIRED
how do we monitor effectiveness for FFP?
- monitoring coag studies, esp PT and PTT
- resolved hypovolemia
Prothrombin
Vitamin K-dependent glycoprotein produced by liver necessary for fibrin clot formation
PT
measures the amount of time it takes in seconds for the clot formation and is used to monitor warfarin therapy or to screen for dysfx of extrinsic clotting system
(such as liver dz, vit k deficiency, and DIC)
PT norm value
11 to 12.5 seconds
-within 2 seconds (+/-) of the control is considered normal
INR
international normalized ratio
- test to measure the effects of some anticoags
- standardizes the PT ratio
INR norm value
- 8 to 1.2
2. 0 to 3.5 for warfarin therapy
When collecting coag blood work….
direct pressure to venipuncture site for 3-5 minutes
What type of diet would shorten PT?
- green leafy veges
- increases vit k absorption….therefore shortening clotting time
Vitamin K
clots
-antidote to warfarin
aPTT
measures effectiveness of heparin
-identifies which specific factor is causing the increased PT
Increased aPTT
deficiency of clotting factors, helpful to find which ones specifically to get to the cause of prolonged bleeding time
Critical values for aPTT
saunders: 87.5 seconds and greater are put on bleeding precautions for thrombocytopenia
nrsng: over 70 seconds is a critical value
When monitoring intermittent heparin therapy, what are the guidelines for blood draw?
- 1 hr before next scheduled dose
- do not draw from arm infusing heparin
- direct pressure on VP site for 3-5 mins
aPTT norm value
25-39 seconds (saunders)
28-35 seconds (nrsng)
Cryoprecipitates used for..
replacing clotting factors, esp VIII and fibrinogen
What are cryoprecipitates prepared from?
FFP, stored frozen for up to 1 year
-after thawed, must be used
How are cryoprecipitates infused?
1 unit over 15-30 mins
How do you measure effectiveness for Cryoprecipitates
-monitoring coag studies and fibrinogen levels
Granulocytes used for…
tx patients with sepsis or neutropenic patients with infection unresponsive to ABX
How do you measure effectiveness of granulocytes?
WBC and differential counts
When documenting blood transfusions…
- client’s tolerance
- resp to transfusion
- effectiveness of transfusion
Autologous
- patients own blood before sx
- decreased risk of dz transmission and potential of complications
- not an option for patients with leukemia and bacteremia
How often can you donate for autologous before sx?
- every 3 days as long as Hgb safe range
- within 5 weeks of transfusion date and end 3 days before tranfusion
blood salvage
- autologous involves suctioning blood from body cavities, joints, or other closed body sites
- may need to be “washed” to remove tissue debris before reinfusion
Designated donor
- selecting your own compatible donor
- does not risk of infection transmission, but feel more comfortable
How is compatibility done?
RBC’s are combined with recipient’s serum and Coombs serum
-if compatible, no RBC agglutination occurs
Universal donor
O-
Universal recipient
AB+
Rh+ can receive….
can receive from +/-
Rh- can receive…
can receive from - only
Infusion pumps for blood transfusions
- special IV tubing to prevent hemolysis of RBC
- IV pump used if designed for opaque solutions
- special manual cuffs made for blood products may be used to increase flow rate
special cuffs for blood products should not exceed
300 mm Hg
do not use standard BP cuffs because…
do not exert equal pressure
Blood warmers
prevent hypothermia and ADR when multiple units of blood are administered
-do not microwave or hot water
S/S of immediate blood transfusion rxns
- chills/sweating
- muscle aches, back, chest pain
- rashes, hives, itching, swelling
- rapid, thready pulse
- dyspnea, cough, wheezing
- pallor, cyanotic
- apprehension
- tingle/numb
- HA
- N/V/D
- abdominal cramps
S/S of transfusion rxn in unconscious pt
- weak pulse
- fever
- tachy/bradycardic
- hypotensive
- visible hemoglobinuria
- oliguria/anuria
delayed tranfusion rxn
- days to years
- fever
- mild jaundice
- decreased HCT
What do you do as the nurse if you are giving a transfusion?
- stay with the patient for first 15 mins of infusion
- monitor for S/S of rxn
- first 15 is most critical
- V/S q30 mins-1 hr per hospital protocol
What do you do as the nurse if you suspect a transfusion rxn?
- stop infusion immediately
- remove tubing down to IV site, KVO with NS
- Notify HCP and BB
- stay with pt and observe S/S, V/S q5 mins
- prepare to admin emergency drugs per protocol
- obtain urine sample and/or other labs as ordered
- send all tubing, labels, blood product to BB
- document
TACO
Transfusion-associated Circulatory Overload
-too rapid transfusion, patient can’t tolerate
S/S of TACO
- cough, dyspnea, wheezing
- HA
- HTN
- tachycardic, bounding pulse
- JVD
What do you when TACO suspected?
- slow infusion
- pt upright, feet dependent
- notify HCP
- admin O2, diuretics, morphine as ordered
- monitor for dysrhythmias
- phlebotomy in severe cases
Septicemia
-transfusion contaminated with microorganisms
S/S of Septicemia
- rapid onset of chills and high fever
- V/D
- hypotensive
- shock
What do you do if you suspect septicemia?
- notify HCP
- obtain blood cultures and cultures of blood bag
- admin O2, IVF, ABX, vasopressors, corticosteroids as ordered
Iron overload
-delayed transfusion rxn that occurs with multiple transfusions (anemia, thrombocytopenia)
S/S of iron overload
- V/D
- hypotensive
- altered hematological values
What do you do if you suspect iron overload?
-deferoxamine admin IV or subQ
deferoxamine
removes accumulated iron via kidneys
- urine turns red as iron is excreted
- d/c after iron returns to normal
Dz transmission from transfusion
- hep C most common
- HIV
- Herpes virus type 6
- Epstein-Barr virus
- human T-cell leukemia
- CMV
- Malaria
**testing has decreased risk of these significantly
Hypocalcemia
- Citrate/Calcium love each other
- Citrate in transfused blood binds with calcium and is excreted
- Serum calcium is assessed before and after transfusion
S/S of Hypocalcemia
- hyperactive reflexes
- paresthesia
- tetany
- muscle cramps
- positive Trousseau’s sign
- positive Chvostek’s sign
Trousseau’s sign
“Throw the hand back”
-carpal spasm produced by occlusion with BP cuff
Chvostek’s sign
tapping on facial nerve, twitching of eyes, mouth, or nose
Hyperkalemia
- older the blood, greater the risk
- pt’s already at risk shoudl receive fresh blood
-assess date of blood and K levels before and after transfusion
S/S of hyperkalemia
- paresthesia
- weakness
- abd cramps
- diarrhea
- dysrhythmias
What do you do if you suspect hyperkalemia?
- slow infusion
- notify HCP
What do you do if you suspect hypocalcemia?
- slow infusion
- notify HCP
Citrate Toxicity
rapid admin of multiple units of stored blood may cause hypocalcemia and hypomagnesemia
-leads to myocardial depression and coagulopathy
Citrate
anticoag used in blood products that are metabolized by the liver
Most at risk for citrate toxicity
liver dysfx
neonates with immature liver
What do you do if you suspect Citrate Toxicity
- slow/stop infusion to allow citrate to be metabolized
- hypocalcemia and hypomagnesemia tx’d with replacement therapy
Hgb norm value
12-16.5
HCT norm value
male: 42-52%
female: 35-47%
