Blood products and transfusion therapy Flashcards
In the US, ___ million units of blood are transfused annually
15
About 1 out of every 3 Americans will require a blood transfusion during their lifetime
The standard blood donation involves removal of approximately ____ of blood through a large-bore IV
450 mL
Additive to blood donations
Citrate-Phosphate-Dextrose
Solution with Adenine, used to
to help prevent the clotting of the
blood, provide energy, and ensure
longevity of the sample
What does each part of the blood transfusion additive do?
● Citrate – prevents coagulation
● Phosphate – buffer maintains pH
● Dextrose – source of energy
● Adenine – enhances viability of RBCs
To separate the whole blood donation into different blood products, there are a few steps, including two centrifuge spins:
Soft spin: Results in separation of Packed RBCs and Platelet-Rich Plasma
Hard spin: Results in separation of Platelet Concentrate (sensitive to cold) and Cell-Free Plasma which is frozen to form Fresh Frozen Plasma (FFP)
Why are the WBCs removed in transfusion samples?
It will be spun off because they tend to cause more transfusion reactions
Pretransfusion testing process includes
● Recipient and donor blood undergoes the same ABO and D typing. In addition, the patient’s serum is tested for the presence of alloantibodies other than anti-A and anti-B (MANY of them)
● Each selected donor unit is also tested against serum from the patient
● This whole process is called “Type and Crossmatch”
Type and Screen
Screen recipient blood for specific antigens and their
alloantibodies in addition to ABO/Rh typing
Type and Cross
■ Final safeguard
■ Blood from donor is mixed with recipients blood to ensure it is fully compatible
Whole Blood
● Provides good source of RBCs, clotting factors and volume for hemorrhage
when rapid transfusion is needed
● Can be stored at 4 C for about 21- 35 days
● Donor and recipient must be compatible
Whole blood indications
○ Autologous donation (for elective surgery)
○ Hemorrhage
■ Rapid correction of anemia
■ Coagulopathy
■ Major trauma
What can be given as a Transfusion?
Whole Blood
Packed Red Blood Cells (PRBC)
Fresh Frozen Plasma (FFP)
Platelets (Platelet Concentrate)
Platelet Rich Plasma
Whole Blood contraindications
○ Heart Failure – Potential for volume overload.
○ Whole blood should not be used when other blood products (separated blood components) are indicated, such as…
■ PRBC for anemia, FFP for coagulopathy, etc.
Whole blood side effects
○ Volume overload
○ Arrhythmias
○ Heart failure
○ Hypothermia
Packed Red Blood Cells
● Used to increase O2 carrying capacity
● Helps body get rid of CO2
● 1 unit of PRBCs increases Hgb by 1-1.5 g/dL and HCT by 2-3%
Packed Red Blood Cells indications
○ Anemia and/or hypoxia
■ When? Hgb < 7. (If 7- 10, it’s a clinical call, if > 10, not indicated)
■ Severe Thalassemia – abnormal Hgb
■ Sickle cell anemia
Packed Red Blood Cells contraindications
○ Not for use if anemia can be corrected with supplements
■ Ferrous sulfate, B12, Folate
○ An illegal use to increase O2 carrying capacity for
sports – “blood doping”
What transfusion type is used with “blood doping?”
Packed Red Blood Cells
Packed Red Blood Cells side effects
○ Volume overload
○ Heart failure
○ Hypothermia
Fresh Frozen Plasma
Concentrated plasma without platelets or RBCs
○ Contains multiple coagulation factors and other important proteins
○ Can store at -18 C for up to 1 year
Fresh Frozen Plasma indications
○ Liver disease coagulopathy
○ TTP - Plasma exchange
○ Manage bleeding in Pts that require replacement of multiple coag factors
(like in DIC)
○ Patients on Warfarin with bleeding or anticipating surgery
○ Rare specific plasma protein deficiencies
○ Occasionally after surgeries, like cardiac surgery
Fresh Frozen Plasma contraindications
○ Not indicated for correcting labs (PT/ PTT) without active bleeding being present
○ Not to be used alone to reverse Warfarin if Vitamin K can be used
○ Not to be used in Protein S deficiency
Fresh Frozen Plasma side effects
○ Headaches
○ Paresthesias
○ Pruritus
○ Urticaria
Platelet Concentrate
● Concentration of platelets, with either 1 unit obtained from a pooling from 6 donors, or from a single donor through the process of apheresis
● Irradiated platelets are given to immunocompromised
● Stored at room temp for up to 5 days only
○ Platelets lose function when refrigerated
○ Increased risk for bacterial infection
● Platelet transfusions should be administered sparingly, only when truly indicated
Platelet Concentrate indications
○ Significant Thrombocytopenia
○ Treat of active bleeding due to platelet dysfunction or absence
○ Prophylaxis in those at risk for bleeding – thrombocytopenia
○ Leukemia patients with thrombocytopenia
○ Aplastic anemia
○ ITP – autoimmune destruction of platelets
Platelet Concentrate contraindications
○ Microangiopathic Hemolytic processes
■ TTP – Thrombotic thrombocytopenic purpura
■ HUS – Hemolytic uremic syndrome
○ HIT – Heparin induced thrombocytopenia
○ History of PTP- post transfusion purpura
○ Avoid in DIC as it can make conditions worse
A rare adverse reaction where the body quickly destroys newly transfused platelets (which leads to worsening thrombocytopenia)
PTP - post transfusion purpura
Platelet Rich Plasma
● PRP is plasma with concentrated platelets and growth factors
● These growth factor proteins are believed to promote healing of joints and soft tissue
● Blood is drawn from patient, centrifuged, and PRP removed and concentrated
● The PRP is then injected into the injured area
Transfusion Process
● Informed consent must be obtained
● Check vital signs
● Type and Crossmatch
● Check expiration date of blood product
● Obtain blood samples within 30 minutes of beginning
● Compare name and ID number on label and wristband
● Double check ABO blood type and Rh compatibility
Nurse must remain with patient for first ____ minutes to watch for signs and
symptoms of transfusion reaction
15
You are most likely to have transfusion reactions in first ____
15 minutes
Important transfusion reactions
○ Acute hemolysis
○ Febrile reaction
○ Allergic reactions
○ Anaphylaxis
○ Transfusion-Associated Circulatory Overload
○ Sepsis
○ Transfusion-Related Acute Lung Injury
○ Delayed hemolytic reaction - later transfusions
How to deal with acute hemolysis of a transfusion reaction
Supportive care
How to deal with a febrile reaction with transfusion
APAP
How to deal with an allergic reaction with transfusion
Diphenhydramine
How to deal with an anaphylaxis with transfusion
Epinephrine, prepare for ACLS
How to deal with a Transfusion-Associated Circulatory Overload with transfusion
Diuretics and Oxygen
How to deal with a Sepsis with transfusion
IV abx, IV fluids
How to deal with a Transfusion-Related Acute Lung Injury with transfusion
O2, pressors if needed
How to deal with a Delayed hemolytic reaction with transfusion
IVIG with possible EPO
Hemolytic reaction: Acute
■ ABO Incompatibility
■ Severity depends on how much blood is given before the transfusion is
halted, particular problem in surgery
■ 1 in 70,000 units transfused
■ Fatal reaction is 1 in a million
Hemolytic reaction: Delayed
■ Essentially incompatibility to a given antigen, but slower response, or
within days of the transfusion
■ Alloantibodies form to other antigens and present as a problem on future
transfusions. These are not as severe as ABO incompatibility
T/F The donor blood is also screened for several blood-borne infectious
disorders, so as not to transmit the disease
T
What diseases are screened for in a blood transfusion?
HIV
Hep B and C
Lymphotropic viruses
West nile
Syphilis
Chagas disease
Bacteria
Transfusions should only be
given when ____
benefits outweigh
the risk
