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CLIN PATH > BLOOD TRANSFUSION 2 > Flashcards

BLOOD TRANSFUSION 2 Flashcards

1
Q

Retrieval, Transport and Handling of Blood Bags.

A
  • properly signed out
  • carried inside styrofoam container or with thermal insulation inserts
  • keep handling of the bag to a minimum
  • maintain blood components in a controlled temp environment until it is ready for transfusion
  • thawing in water or under the faucet is never allowed to avoid contamination
  • blood recipient & designated blood unit=properly identified before transfusion
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2
Q

RBC should be compatible with I.V. solutions

A
  • 5% dextrose in water (may induce hemolysis)
  • Lactated ringer’s (may induce clotting in BT set or bag)
  • Use only 0.9% NaCl for injection.
  • No medications should be added to bag or line.
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3
Q

Blood warning: only temp-monitored devices should be used if the ff indications are present:

  • Adults
  • Children
  • Infants
  • Rapid blood infusion through
  • Patients with
A
  • Adults receiving blood >50 mli/kg/hr.
  • Children receiving blood >15 ml/kg/hr.
  • Infants undergoing exchange transfusion.
  • Rapid blood infusion through CVP lines.
  • Patients with cold aggluttinins.
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4
Q

Problem with no. 3.

A

hypothermia

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5
Q

Reasons why Pressure devices, Blood pressure cuffs, are not recommended

A
  • cause leakage

- induce hemolysis

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6
Q

Microaggregate Blood filters must always be used when infusing blood components to prevent:

A

a) alloimmunization to WBC
b) HLA antigens
c) CMV transmission

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7
Q

TRANSFUSION MUST BE STARTED WITHIN

A

30 min

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8
Q

If transfusion cannot be performed, blood bag MUST BE RETURNED TO THE LAB within ___ to avoid deterioration or disintegration of blood cells or components.

A

30min

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9
Q

Crossmatched blood (2”% bag & more), that is not transfused within 3 days should be

A

CROSSMATCHED AGAIN, especially if the patient had received transfusion on the 1st day

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10
Q

As soon as the transfusion is started, the following time allotment must be strictly followed:

  • Components:
  • Fresh Frozen Plasma:
  • Platelet:
A
  • Components (& whole blood) should be infused w/in 4 hrs.
  • Fresh Frozen Plasma — infused within 2 hours.
  • Platelet — should be infused on Fast Drip.
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11
Q

Transfusion reaction in Mild and Severe Allergic.

A

MILD

  • facial flushing
  • hives/rash

SEVERE

  • increase anxiety
  • wheezing dippnea
  • low BP
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12
Q

Transfusion reaction in Febrile reactions

A
  • headache
  • tachycardia
  • tachypnea
  • fever
  • chills
  • anxiety
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13
Q

Transfusion reaction in Hemolytic reaction

A
  • hemoglobulinuria
  • chest pain
  • apprehension
  • low back pain
  • low BP
  • elevated respi rate
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14
Q

With all reaction (allergic, febrile, and hemolytic) STOP BLOOD and maintain line with

A

N.S

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15
Q

Disconnect the intravenous line from the needle. Instead

A

= Do not disconnect the unit from the IV set.
= Attach a new IV set and prime with saline and reconnect the line.
= Open the line to a slow drip.

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16
Q

Nursing Responsibilities in Blood Transfusion reaction

A

> STOP transfusion
Maintain IV site-disconnect from IV and flush with NS
Notify blood bank/MD
Recheck ID
Monitor VS
Treat sx per MD orders
Save bag and tubing-send to blood bank
Fill Up Blood Transfusion Reaction Logbook

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17
Q

Do not discard the unit of blood that has been discontinued. It is necessary for

A

investigation

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18
Q

Management when there is transfusion reactions.

A

= STOP TRANSFUSION; KEEP IV LINE OPEN WITH 0.9% SALINE
= NOTIFY PHYSICIAN
= CHECK VITAL SIGNS Q15min
= REVIEW FOR CLERICAL DISCREPANCY
— NOTIFY & RETURN BLOOD W/ TUBINGS TO BLOOD BANK
= FILL UP TRANSFUSION REACTION FORMS, LOGBOOK ( for 5 years)

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19
Q

Transfusion reaction investigation w/in 24hrs

  • POST-TRANSFUSION BLOOD ->
  • centrifuge, check plasma for hemolysis/icterus ->
  • extract 2nd post-transfusion blood. Confirm that hemolysis is not due to poor circulation technique ->
  • Post transfusion blood= + hemolysis
  • Pre-transfusion blood= - hemolysis
A

INTRAVASCULAR HEMOLYSIS

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20
Q

Transfusion reaction investigation w/in 24hrs

  • POST-TRANSFUSION BLOOD ->
  • CBC ->
  • Leukopenia/neutropenia, or thrombocytopenia
A

Donor’s antibodies against: (HLA), (HPA), (HNA)

21
Q

Transfusion reaction investigation w/in 24hrs

  • POST-TRANSFUSION BLOOD ->
  • Perform ABO/Rh typing on PRE and POST TRANSFUSION SPECIMENS; & on donor’s blood ->
  • If different
A

search if another px may be at risk; notify blood supplier

22
Q

Transfusion reaction investigation w/in 24hrs

  • POST-TRANSFUSION BLOOD ->
  • Direct Antiglobulin test (DAT) ->
  • If DAT antibody mediated hemolysis
A

INCOMPATIBLE RED CELLS TRANSFUSED

23
Q

Transfusion reaction investigation w/in 24hrs

  • Patient’s Urine –>
  • Check for hemoglobinuria & bilirubinuria
A

Acute hemolytic transfusion reaction

24
Q

Transfusion reaction investigation w/in 24hrs

  • POST-TRANSFUSION BLOOD ->
  • Indirect Antiglobulin Test (IDAT) ->
  • If IDAT (+), perform antibody identification ->
  • Antibody identified
A

Do phenotyping of transfused unit(s) for corresponding antigen

25
Q

Transfusion reaction investigation w/in 24hrs

  • DONOR’S BLOOD ->
  • If febrile = do culture & sensitivity ->
  • inject 10-20ml of culture broth into the unit(s) ->
  • agitate units and withdraw broth ->
  • gram or acridine orange stain
A

IDENTIFY ORGANISM

26
Q

Transfusion reaction investigation w/in 24hrs

  • DONOR’S BLOOD ->
  • If febrile = do culture & sensitivity ->
  • inject 10-20ml of culture broth into the unit(s) ->
  • agitate units and withdraw broth ->
  • use broth for inoculation of culture
A

IDENTIFY ORGANISM

27
Q

Transfusion reaction investigation w/in 24hrs

  • DONOR’S BLOOD ->
  • Perform an anti humanglobulin (AHG) crossmatch with pre-and post transfusion specimens
A

Compare pre and post

28
Q

Transfusion reaction investigation w/in 24hrs

  • DONOR’S BLOOD ->
  • Visually inspect for hemolysis, clots or discoloration ->
  • Both tubing & donor unit (+) hemolysis
A
  • physical hemolysed unit

- addition of a solution to the unit that had caused red cell destruction

29
Q

Transfusion reaction investigation w/in 24hrs

  • DONOR’S BLOOD ->
  • Visually inspect for hemolysis, clots or discoloration ->
  • Tubing (+) hemolysis, donor unit (-) hemolysis
A

Faulty infusion device

30
Q

Transfusing red blood cells (RBCs) that have been in storage for > 14 days has been associated with increased risk of

A
  • organ failure in critically ill children
  • risk of immunologic
  • vasoregulation
  • adverse hypercoagulation effects increased
31
Q

Estimated volume per unit of blood products:

  • Packed RBC (PRBC):
  • Whole blood:
  • Fresh Frozen plasma (FFP):
  • Platelets:
  • Cryoprecipitate:
A
  • Packed red blood cells (PRBCs): 300 mL/ unit
  • Whole blood: 450-500 mL / unit
  • Fresh frozen plasma (FFP): 250-300 mL / unit
  • Platelets: 40-50 mL/ unit Crvyoprecipitate: 10-12 mL/ unit
  • Cryoprecipitate: 10-12mL/ unit
32
Q

Blood Volume by Age

  • Premature infant:
  • Full-term neonate:
  • Older infant:
  • > 12 mo:
A

Premature infant: 100 mL/kg
Full-term neonate: 85 mL/kg
Older infant: 75 mL/kg
>12 mo: 70-75mL/kg

33
Q

Transtusing a pediatric patient with 4 cc/kg will increase

A

hemoglobin by 1 g/dL

34
Q

Transfusing 1 unit in an adult patient will raise

A

hemoglobin by 1 g/dL (or HCT by 3%)

35
Q

FFP transfuse volume

A

10-15 mL/kg

36
Q

Routine FFP transtusion rates should not exceed ___ because of the risk of hypotension caused by low ionized calcium during the FFP infusion.

A

1 mL kg / min

37
Q

Hypotension from excess FFP can be treated with

A

10 mg/kg CaCl or 100 mg/kg calcium gluconate IV over 5-10 minutes

38
Q

For patients with massive bleeding who are at risk for death secondary to hemorrhage, give FFP as __ as possible, paying attention to ionized calcium levels because large volumes ot plasma and red cells will decrease ionized calcium concentrations.

A

fast

39
Q

For patients with known clotting factor deticiencies, __ of FFP will raise tactors levels 15%-20%

A

10-15 mL/kg

40
Q

Pheresed platelet units have a volume of

A

6-10 random donor units

41
Q
  • An excellent source of fibrinogen and tactor VIII, tactor XH, and Von Willebrand’s tactor
  • Administering 1-2 bags tor every 5-10 kg will raise fibrinogen levels 60-100 mg/dL
A

Cryoprecipitate

42
Q

A “massive transfusion” in a child is when approximately __ circulating blood volume is replaced within 24 hours

A

one

43
Q

Some clinical parameters may predict the need tor a massive transfusion during active bleeding

A
  • Severe tachycardia or hypotension tor age
  • Base deticit 6 or more
  • Lactate = 4 mmol/L
  • International normalized ratio 1.5 or more
  • Hemoglobin 9 g/dL upon admission or less
44
Q

Cons ider us ing massive transtusion strategies when a child is anticipated to need more than two traditional __ mL/kg transfusions of PRBCs during one resuscitation (equivalent to about > 6-8 PRBC units for an adult)

A

15

45
Q

When transfusing through small IV catheters (22 gauge and 24 gauge), bolusing with a __mL sy ringe may be the most efficient way to deliver fluids and blood products rapidly

A

10-20

46
Q

Why use 1:1:1 ratio if a patient is at risk tor massive transfusion, PRBCs, FFP, and platelet transtusion?

A
  • Helps avoid coagulopathy and 1s associated with reduced mortality trom hemorrhage in adults
  • Use of blood products in this ratio should continue until the lite-threatening bleeding has stopped; at this point use more restrictive transfusion criteria. Formulas tor calculating volumes of each product should be used
47
Q

It FWWB is available, consider using it as a substitute for

A
  • PRBCs,
  • FFP, and
  • platelets
48
Q

has been used to reduce blood loss and restore hemostasis in combat casualties with coagulopathy associated with hemorrhagic shock

A

Factor VIla

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