Blood Products Flashcards
Blood Administration: Typing
Blood is grouped according to the presence or absence of specific antigen
Blood Administration: Typing
•Type A: A antigen only on RBC’s
(B antibody in plasma)
•Type B: B antigen only on RBC’s
(A antibody in plasma)
•Type AB: Both A and B antigens on RBC’s
(neither A or B antibody in plasma)
•Type O: Neither A or B antigens on RBC’s
(Both A and B antibody in plasma)
- O negative is the Universal Donor
- AB+ is the Universal Recipient
Rh (Rhesus) Factor
- The presence or absence of the Rh antigen, “D” on the surface of the RBC’s determine the classification of Rh-positive (85%) or negative
- If a person is Rh negative they can only receive negative blood
- If a person is Rh positive they can receive Rh positive or negative blood
Rh Immune Globulin
- For Rh neg. women delivering Rh pos. infant
- Rh partial “D” positive women who deliver Rh pos. infant
- RH neg. women never sensitized at 28-32 weeks gestation, abortion, amniocentesis or other indicated procedures
- Vial (300 mcg)/15 mL per Rh pos. cell exposure
Blood Crossmatching
- Done to decrease the potential for reaction
* Mixing the recipient’s serum with the donor’s RBC followed by the addition of a Direct Coomb’s Test
Blood Administration
•Five types of transfusable blood products:
–Whole blood –Red Blood Cells (RBC’s) –Platelets (PLT’s) –Plasma (FFP) –Cryoprecipitate (CRYO)
Blood Administration
•Use of donated blood products post-collection:
–RBC’s – within 42 days
–PLT’s – within five (5) days
–FFP & Cryo – stored frozen and may be used up to one year
Blood Administration
•Whole blood
- Replenishes both volume and oxygen carrying capacity
- Emergency and acute trauma
- 500mL of volume per unit
Blood Administration
•PRBC’s
- Prevents circulatory overload
- 80% of the plasma has been removed
- Hemoglobin <10g/dl (<7%) (parameter)
- Hematocrit <10 g/dl (<21%) (parameter)
- Each unit should increase the hematocrit about 3%
- Each unit 250-300 mL/unit
- One unit over 2-4 hours [NO longer than 4 hours max]
•Post-Op common
Blood Administration
•Platelets
Given when platelets are less the 20,000 or with active bleeding
30-50mL ~60 units
rotated/agitated to prevent clumping
Irradiated platelets removes WBC that may cause reactions
Blood Administration
•FFP
[fresh frozen plasma]
Contains a lot of clotting factors & provides volume (220mL/unit) for INR > 1.7 and any coagulation deficiencies
often given with blood
Blood Administration
•Albumin
100 mL acts like 500 mL of plasma in providing volume into intravascular space
hypertonic
volume expander
(shock, burns)
Blood Administration
•Cryoprecipitate
Given when Fibrinogen level < 100 milligrams/dl
can increase fibrinogen by 50mg
Bacterial Contamination of Platelets
•Becoming one of the greatest transfusion infectious risk:
–Transfusion transmitted sepsis
•Confirmed in 1/100,000 recipients
•Actual risk higher due to under-reporting
•Immediate fatal outcomes are 1/500,000
- Critical to investigate febrile transfusion reactions, especially when transfusing platelets
- Sepsis risk
Special Attributes
- Leuko-reduced – Cytomegalovirus (CMV) reduced risk (transplant patients)
- Washed – removal of plasma proteins that may cause reactions
- Pathogen Reduced Platelet Product – reduces risk of bacterial contamination and emerging pathogens
Blood Administration
•Autologous Blood
- Safest way to receive a transfusion
- Pre-operative donation
- Donation at least 3 days prior to surgery (7-3 days before sx)
- Can not donate if hemoglobin is <11g/dl
Blood Administration
•Type & Crossmatch
–Time-out verification form must be completed for every blood bank crossmatch
–Completed at bedside
–Two licensed personnel verification signature
–Band completed by both individuals
–Includes:
•Patients full name
•MR #
•Date/time of collection
•Blood band ID #
•Signature of both individualsBlood Administration
•To provide an additional safety layer to blood typing who has never been ABO/Rh tested
–A second blood sample is completed
–Cross checking these two separate and independently drawn specimens provides a secondary protection
Crossmatch Sample Validity
- A crossmatch specimen is valid for three (3) days for all patient over four (4) months of age
- Neonatal specimens are valid for four (4) months
- After the neonate reaches four (4) months, a new specimen must be obtained every three (3) days
Blood Administration Steps
before actually starting infusion
- Check the orders & consent [only physician explains, nurse ONLY ever witnesses - be in room to verify what was said]
- “No Blood” Status
- Check labs
- Blood bank administration band
- Assess Vitals: Temp
- Patient Teaching – S&S - most reactions occur within first 5 minutes, but some take 14 days to appear
- Check your IV site condition & patency
- IV tubing set up NS only
- Bedside check with a licensed personnel (product to patient check) – CANNOT be LPN
- Start blood infusion within 30 minutes of receiving it
•Recorded as Input on I’s&O’s
IV Site
- Check the gauge of the catheter (no smaller than a 22 gauge) 20-18 ideal
- What the site looks like
- Flush
- If a new central line make sure that it has been cleared by x-ray [any lumen but dedicated line req’d]
- Nothing can run with the blood, only normal saline
Pre-Medication
History of an allergic reaction may be ordered to receive:
- Tylenol
- Benadryl
Checking Label
- Patients full name
- Medical Record number
- Blood bank armband number
- Unit number
- Blood component type
- ABO/ Rh type compatibility
- Expiration date
- Signature by two licensed
Blood Administration
to begin, and once begun
- Put on protective gear
- Blood tubing with filter and NS [tubing only good for 2 units or 6 hours]
- Flush line with Saline
- No medication in line
- Start infusion no faster than 50ml over 15 minutes
- Document HR, BP, RR and temp. 15 minutes into transfusion
- Remain with the patient over the 1st 5 minutes [then another coworker of any license can take over for next 10 minutes]
- Administer one unit over 2-4 hours
- Check Vitals and observe patient per protocol
- Blood bags & tubing go into red bag trash
•Fatty blood ok
Blood Administration
- Warmer-Hypothermia
- Blood filters good for up to 2 units or 6 hours
- New IV pumps won’t crush RBC in blood
Complications
- Circulatory overload [PE, arrhythmias - Lasix may be ordered between units]
- Hypothermia [bradycardia]
- Citrate toxicity [high # of transfusions - preservative for blood]
- Hypocalcemia [binds with citrate - tremors, EKG changes, calcium gluconate is antidote]
- Hyperkalemia [calcium leaks from stored RBSs - monitor for arrhythmia]
- Infections
- Lung Injury
- Iron Overload
Transfusion Reaction:
Allergic
(define)
- Mild to severe [life threatening]
- Transfusion recipient has an Immunglobulin E (IgE) antibody directed against an antigen in donor plasma activating release of histamine
- more common in those with other allergies
Transfusion Reaction:
Allergic
(S&S)
- Flushing
- Itching
- Rash
- Wheezing/Stridor
- Hives
- Laryngeal edema •Anaphylaxis
- Tachycardia
- Dysrhythmias
- Cyanosis
•Cardia arrest secondary to respiratory arrest
Allergic Reaction
Treatments
- Stabilize respiratory status
- Treat hypotension (position, fluids)
- Administer Diphenhydramine(Benadryl), Epi and/or other steroids
- Initiate transfusion reaction work-up
- Treat with Diphenhydramine, steroid and/or Epi prior to future transfusions
- may require ICU
Transfusion Reaction:
Febrile
(S&S)
- Chills
- Fever [↑ 1℃ or ⋝38℃]
- Headache
- Palpitations
- Cough
- Chest Tightness [not cardiac related]
- Tachycardia
- Muscle pain
•within 4 hours of transfusion
Febrile Reaction Treatment
•Administer non-aspirin antipyretic (Acetaminophen)
•Meperidine IV may be considered in patients with rigors
•Initiate transfusion reaction work-up
•Future transfusions
–Use leukocyte-reduced products
–Pre-medications
Transfusion Reaction:
Hemolytic
(define)
- Incompatible blood administration resulting in an antigen/antibody response with activation of complement and subsequent intravascular hemolysis
- Most common transfusion error r/t not following all steps of transfusion administration
- Can lead to death!
Transfusion Reaction:
Hemolytic
(S&S)
Sentinel event [must be reported]
- Chills / Fever (> 1° C)
- Rigors [uncontrolled shaking caused by pyrogens]
- Chest Pain
- Hypo/hypertension
- Diaphoresis
- Tachycardia
- Flank Pain [indicated renal failure]
- Hemoglobinuria
- Unexplained bleeding**May occur up to 14 days post infusion
Hemolytic Reaction Treatments
- Stabilize respiratory status
- Maintain CV support with vasopressors
- Invasive cardiac monitoring
- Fluids to maintain renal perfusion and U/O
- Treat for S/S of DIC (disseminated intravascular coagulation
Transfusion Reaction:
Sepsis
(define)
- Transfusion of bacterially contaminated blood components
- Bacteria usually originates from the blood donor
- May also result from donor unit processing
- More likely to occur in blood components (platelets) stored at room temp rather than refrigerated
•most common with plts and ffp
Transfusion Reaction:
Sepsis
(S&S)
- Sudden onset Chills
- Very High Fevers
- Unexplained bleeding
- Abdominal cramping
- Diarrhea
- Rigors
- Hypotension
- Shock
- Signs of renal failure
Sepsis Reaction Treatments
- Maintain respiratory status
- Maintain CV support with vasopressors
- Initiate transfusion reaction work-up
- Culture and gram stain indicated blood component
- Draw blood cultures [2 separate sites]
- Prompt initiation of IV antibiotics
Transfusion Associated Circulatory Overload (TACO)
define
- An increase in pulmonary blood volume and hydrostatic pressure resulting in pulmonary edema
- Occurs due to -rapid- transfusion of large volumes of blood [during or within 1st 6 hours]
- 2nd most common cause of transfusion-associated death
Transfusion Associated Circulatory Overload (TACO)
S&S
- Occurs during or within 6 hours of transfusion
- Acute respiratory distress
- Evidence of positive fluid balance
- X-ray evidence of pulmonary edema
- Elevated CVP
- Elevated Brain Natriuretic Peptide (BNP)
TACO Treatment
- Stop transfusion ASAP
- Place patient in high fowlers position
- Give supplemental oxygen
- Administer diuretics as ordered
- Initiate transfusion work-up [monitor potassium]
•Prevention:
–Closely monitor patients receiving transfusions and transfuse smaller amount of blood at a slower rate
Transfusion Related Acute Lung Injury (TRALI)
- Infusion of donor antibodies directed against recipient antigens or neutrophil antigens causing capillary leakage and pulmonary damage
- Occurs more commonly with products containing large volumes of donor plasma – FFP and platelets
•results in partial lung tissue damage, some may be permanent
TRALI Presentation
- Acute respiratory distress/failure within 6 hours of transfusion
- Dramatic onset WITHOUT fluid overload
- Dyspnea
- Cyanosis
- Bilateral infiltrates on x-ray
- Hypoxemia SpO2 < 90% on room air
- Tachycardia
TRALI Treatment
- Stabilize respiratory and cardiac status
- Diuretics and steroids as indicated
- Initiate transfusion work-up
- mortality ~10%
- starts reversing in 2-3 days
- diuretics used to dry out further
- steroids used to decrease inflammation
Transfusion Reaction
•STOP INFUSION!!!!
- Take Vitals q15 minute [note s&s]
- NS at KVO [first aspirate all blood back out of line]
- Notify MD
- Notify Blood Bank
- Collect Blood and urine samples
- Follow MD instructions and facility protocols
- Place on strict I&O
- Do not discard blood or tubing
- Documentation [incident report and nursing note]
