Blood transfusion Flashcards by brooke posey

What are the types of blood donation?

 Standard
 Directed
 Autologus
 Immediate preoperative hemodilution
 Intraoperative Blood Salvage or Collection

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How is blood typed for blood donation?

◦ ABO group

◦ Rh factor

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 Surrounds RBCs
 Contain iso-antibodies that will fight off any antigens
that match

plasma

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A patient with Type A blood can receive a transfusion of Type AB blood?

False. Only from type O and type A

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A patient with Type AB blood can receive a transfusion of Type O blood?

True. Type AB can receive from type O, A, B, and AB

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If your blood is positive for which diseases can it not be used?

 Immunodeficiency Virus (HIV- 1 &amp; 2)
 Hepatitis B core antibody (anti-HBc)
 Hepatitis C core virus (HCV)
 Hepatitis B surface antigen (HbsAG)
 Human T-Cell Lympotropic Virus, Type I
 (anti HTLV-I/II)
 Syphilis
 Chagas’ Disease
 West Nile Virus
 Cytomegalovirus (CMV)
 Zika

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What diseases are transmitted through transfusion?

Hepatitis – viral hepatitis B, C
AIDS – HIV
Cytomegalovirus (CMV)
Graft vs Host Disease (GVHD)
Creutzfeldt-Jakob disease (CJD)

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What are the types of blood products?

 Whole Blood
 Packed Red Blood Cells
 Platelets
 Cryoprecipitate
 Fresh Frozen Plasma

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What is needed for the pre-transfusion assessment?

 Patients’ transfusion history
     Any transfusions in the past
     Any reactions noted
 Physical assessment
    Focus on oxygenation &amp; perfusion
 Know the patient’s baseline VS
 Complete skin assessment
 Teaching focus
    Explain the procedure
    Answer any questions
    Reassure the patient and reduce anxiety

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What signs and symptoms/reactions should the nurse assess for during the blood transfusion process?

 S/S of transfusion reaction:
◦ Monitor VS per protocol
 BP (decreases)
 HR  (increases)
 RR (decreases)
◦ Skin assessment – hives, flushing
◦ GI – N/V
◦ Chest pain
◦ Wheezing
◦ Headache, fever

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What are the complications and adverse reactions that can occur during & post transfusion?

 Acute hemolytic reactions
 Delayed hemolytic reactions
 Febrile nonhemolytic reaction
 Allergic reactions
 Bacterial contamination
 Circulatory overload
 Transfusion-related acute lung injury
 Iron overload

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What interventions should be done if a transfusion reaction is suspected?

 Stop the transfusion
 Infuse 0.9%NS
 Obtain VS
 Assess for additional S &amp; S
 Notify prescriber - if the patient is
unstable call the Rapid-Response Team
 Notify blood bank of suspected reaction
 Follow the facility policy

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 Caused by a major ABO incompatability

 Hemolysis

acute hemolytic reaction

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what are the signs & symptoms acute hemolytic reaction?

◦ Fever, chills, low back pain, chest pain,
dyspnea, bronchospasm, nausea, anxiety,
hypotension, tachycardia, hemoglobinuria

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What are the nursing interventions for acute hemolytic reactions?

◦ Foley catheter
◦ Low-dose dopamine (based on VS)
◦ Administer platelets &/or fresh frozen plasma

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 Usually occurs within 2 weeks post transfusion
 Slow breakdown of RBCs
 Decrease in hematocrit

delayed hemolytic reaction

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What are the signs & symptoms of delayed hemolytic reactions?

 Fever, anemia, jaundice, increased bilirubin levels

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What are the nursing interventions for delayed hemolytic reactions?

no interventions needed

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 Caused by patient’s antibodies reacting to leukocytes in donor blood

febrile nonhemolytic reactions

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Febrile nonhemolytic reactions occurs more frequently in which types of patients?

◦ Received transfusions in the past

◦ Rh (-) women that gave birth to Rh (+) children

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What are the signs & symptoms of febrile nonhemolytic reactions?

◦ Fever (beginning within 2 hours after start of
transfusion), flu-like symptoms, chills
tachycardia, headache, N & V, back pain

How can febrile nonhemolytic reactions be prevented in the future?

by reducing the number of leukocytes in donor blood

An allergic reaction from a blood transfusion can occur from?

antibody reaction to a specific protein in the donor unit

What are the signs & symptoms of a blood transfusion allergic reaction?

S & S:
o Mild-urticaria (hives), pruritus, nasal rhinitis, flushing
o Severe-bronchospasms, wheezing, laryngeal edema, shock

What are the nursing interventions for mild allergic reaction?

o Mild reaction-antihistamine may be ordered, | transfusion continued

What should be done if anaphylactic type symptoms continue?

o Call the Rapid-Response Team o Be prepared to administer epinephrine, corticosteroids, vasopressors

What should be done to prevent future allergic reactions from occurring?

o Re-medicate with antihistamines o Product is washed to remove plasma proteins which trigger the response

What acronym should we remember for blood transfusion reactions? What does it stand for?

A(allergic). F(febrile). H(hemolytic)

An allergic reaction can include?

* facial flushing * hives/rash * increased anxiety * wheezing * decreased BP

Febrile reactions can include?

* headache * tachycardia * tachypnea * fever/chills * anxiety

A hemolytic blood transfusion reaction can include?

* decreased BP * increased RR * hemoglobulinuria * chest pain * low back pain * fever * tachycardia * chills

Which blood transfusion complication can occur during donation or processing?  Symptoms can occur up to several hours after the completion of the transfusion

Bacterial contamination

What are the signs & symptoms of bacterial contamination?

◦ Fever, chills, hypotension,abdominal cramps, | renal failure, shock

What can be done to prevent bacterial contamination?

◦ Aseptic technique | ◦ Infuse within time limit set by the facility

What are the nurse's responsibilities to prevent bacterial contamination from happening?

◦ Early recognition of sepsis | ◦ Advocating for appropriate treatment

Which blood transfusion complication is a rapid infusion of too much volume can cause pulmonary edema?  Heart failure patients are most susceptible

Circulatory overload

What are the signs & symptoms of circulatory overload?

 Dyspnea, orthopnea, JVD, bibasilar crackles, tachycardia, hypertension, anxiety  Be prepared to administer IV diuretics & morphine

What are the nursing interventions for circulatory overload?

 Careful monitoring of lung sounds  Slower delivery of the transfusion  Administer diuretics as ordered  If signs of pulmonary edema: ◦ Position the patient upright with legs dependent ◦ Apply oxygen ◦ Call the physician or Rapid-Response Team

Which blood transfusion complication is a reaction that results from leakage of proteins and fluids into the lungs causing pulmonary edema?

Transfusion-related acute lung injury

What are the signs & symptoms of transfusion-related acute lung injury? When does it usually occur?

◦ Fever, chills, dyspnea, hypoxia, acute respiratory failure without S & S of LV failure, bilateral pulmonary infiltrates, tachycardia, hypotension *occurs within 2-6 hours after starting transfusion

What intensive care treatment should be done for transfusion-related acute lung injury?

◦ Probable mechanical ventilation ◦ Pronation therapy ◦ Vasopressor therapy

What are some alternatives to blood transfusion?

 Erythropoietin  Thrombopoietin  Granulocyte Colony-Stimulating Factor (G-CSF)  Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF)

◦ Stimulate production of erythropoietin | ◦ Dose & frequency titrated to Hgb level

Erythropoietin

What are the medication examples for erythropoietin?

◦ Medications: epoetin alpha, Epogen, Procrit

◦ Recently approved for use in thrompocytopenia

Thrombopoietin

What are the medication examples for thrombopoietin?

◦ Medications: romiplostim (Nplate), eltrombopag | Promactal

◦ Administered SQ – daily | ◦ Increase hematopoiesis in bone marrow

Granulocyte Colony-Stimulating Factor (G-CSF)

What are the side effects for Granulocyte Colony-Stimulating Factor (G-CSF)?

Monitor CBC | ◦ Side effects – bone pain, increased WBCs

◦ Stimulates more RBS & platelet production

Granulocyte-Macrophage Colony-Stimulating | Factor (GM-CSF)

What are the side effects for Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF)?

◦ Side effects – bone pain, fever, muscle pain