Blood Transfusion Therapy Flashcards
BLOOD
cell
contains fluid that circulates through the heart, arteries, veins, and capillaries.
blood
metallic odor
arterial
bright red and pulsates
venous
dark red and flows steadily
blood components
- RBCs (erythrocytes)
- WBCs (leukocyes)
- platelets / thrombocytes
- plasma
RBCs (erythrocytes)
40 - 50 % of total blood volume
- RBCs/ contain hemoglobin that carries oxygen
- RBCs can live up to 120 days
- WBCs (leukocytes)
1% of total blood volume
- help determine if infection and inflamation is present
- WBCs last 18 - 36 hours within the body
platelets / thrombocytes
they are 1/3 the size of RBCs
- help with clotting to prevent further bleeding
plasma
makes up 55% of blood volume & consists of 95% water
- contains electolytes, PROTEINS, waste products, hormones, water, ions
- good for dehydrated patients and balancing electrolytes
blood transfusion
the introduction of whole blood or blood components into the venous circulation
blood vs. fluid?
IV fluid - can restore intravascular volume but does not affect the oxygen carrying capacity of the blood.
it can be used for hypotension and increase BP.
Blood transfusions - can restore intravascular volume and contribute to the pt.’s oxygen level.
on avg. how much blood is circulating through a human body?
5 liters (10 pints)
who may need blood transfusions?
- cancer patients (leukemia)
- sickle cell patients
- trauma / surgery patients
- burn patients
- postpartum patients
- anemic
how would a patient with low RBCs present?
- pale
- decrease in O2
- decrese in BP
- increase in HR
what size gauge is best used for blood transfusions?
18 Gauge
- a 20 G can also be used
- a 22 G should only be used as a last resort
screening questions
- they may ask if you have tattoos; because tattoo needles can pose arisk of infection, hepatitis transfer.
- they may ask if you have ever had an accidental needle stick.
- they may ask if you have ever been incarcerated.
- they may ask about medications.
- they may ask if you have or are currently missusing drugs.
- they may ask if you engage in homosexual behaviors between men.
- they may ask if you have traveled outside of the country; because it can pose a risk to diseases.
- they will check the amout of hemoglobin and hematocrit.
- they may ask if you are or maybe pregnant.
- they may ask if you have or may have HIV, hepatitis, heart disease, asthma, bleeding disorder.
polycythemia vera - a type of blood cancer that causes the bone marrow to make too many red blood cells. the excess cells thicken the blood, slowen its flow throught the body, and can lead to blood clots. someone with disease cannot donate blood to another person, but may need to have their blood drawn to lessen the amount in circulation. they are at risk for clotting, strokes, MI’s.
defferals
- when a pt. denies the use of blood or blood products.
- educate the patient, document, and try again.
- jehovas witnesses tend to deny the use of blood and blood products
- court systems may sometimes have to determine how to advance care with children
blood types
- A
- B
- AB
- O
compatability of a person’s bood is determined by what two things?
- compatability is determined by two different antigen systems:
- ABO
- Rh
Rh
-determines whther a person’s blood is positive, negative, or Rh null.
can a patient with (+) blood recive (+) blood?
yes
can a patient with (+) blood recive (-) blood?
yes
can a patient with (-) blood recive (-) blood?
yes
a pt. with negative blood must recive negative
can a patient with (-) blood recive (+) blood?
no
you do not want to introduce that into the system of a patient with negative blood.
type A blood contains a
- A antigen
- B antibody
type B blood contains a
- B antigen
- A antibody
type AB blood contains a
- B antigen
- A antigen
type O blood contains a
- B antibody
- A antibody
whole blood
- contains RBCs, WBS, platelets, plasma, and other clotting factors (500mL in volume)
- raley administered, only used in EXTREME ACUTE MASSIVE HEMMORHAGE
- given when patient loses over 1/4th of the bodys circulation
RBCs (red blood cells)
aka packed red blood cells
- given most often
- whole blood cells with 2/3rds of plasma removed; (abt 300mL in volume) left
- helps increse the oxygen caarrying capacity of blood
- used for surgical blood loss, or bleeding in general
- 1 unit of packed rd blood cells raises the pt’s Hemoglobin by 1 and Hematocrit by 3%
-
how long can PRBCs hang for?
no more than 4 hours
whole blood vs. packed red blood cells
- PRBCs are preffered
- PRBCs have a lesser of a chance of fluid volume over load, but should still cautiously be given to patients with HF.
with HF patients the nurse should:
- advocate for the patient
- listen to heart and lung sounds to check for fluid build up
- asses for edema in the ankle (long-term HF)
- admin HCP order of small dose diuretic
which product would have a less chance of fluid volume overload in a patient?
whole blood or red blood cells?
red blood cells
- you may need to administer a diuretic to pull excess water out of the patients circulation
Autologous red blood cells
- when a patient donates their own red blood cells prior to an elective surgery for example for their own individual use.
- example where it may be used: joint replacement surgery.
- it is donated 1-2 months prior and stored with their name.
- 44% of blood donated is never used.
- gives patients assurance that they wont be reciving “contaminated blood” from somone else because it comes from themselves.
patients have to be healthy enough to resore their H&H before surgery so that they wont be reciving what they gave away.
clotting factors and cryoprecipitate
- provides clotting factors that the patient is deficient in.
- help form blood clots to treat microvascular bleeds and low fibrinogen levels.
platelets
- helps patient to clot and stop bleeding
- good for bleeding disorders with platelet deficency (thrombocytopenia)
- multiple donors and/or one single donor can give 6-10 units
- only given when platelet count is less than 20,000
if a patient recives to much platelets they could be at risk for what?
- blood clot
- stroke
- MI
- DVT
fresh frozen plasma
- contains protein, hormones, and some antibodies
- frozen immediately after donation, then thawed and given quickly
- blood volume expander
- used to tx disseminated intravascular coagulation (DIC)
- reverses the effects of bleeding, liver failure, coumadin/warfarin therapy
- warfarin can be used to tx AFIB and it keeps the blood thin enough so that clots do not form in circulation
- warfarin increases a patients PT/INR and may need to be reversed when to high by giving fresh frozen plasma
Disseminated intravascular coagulation
- bleeding from every orifice
A patients comes into the ER with a hemoglobin of 4 d/t warfarin therapy bc her hx of AFIB. Besides red blood cells, what can the nurse assume will be administered?
fresh frozen plasma
- helps to try and avoid a heart attack because the blood is not profusing.
- also give fluids to help build up the patients vasculature and decrease the stress on her heart.
- also the vitamin k, the antidote for warfarin.
albumin and plasma protein fractions
- expands blood volume (good for hypotension)
- blood pressure should increase
- tx trauma, shock, third spacing, hypoalbuminemia, burns and infection
- albumin is a medication that is packaged in a glass vial and needs to be vented before admin
1 unit of PRBs
- Increase Hgb 1g/100mL
- Increase Hct by 3%in non-hemorrhaging adult
1 unit of platelets
- increases platelet count by 5000 to 10000/mL in a 70 kg (154lb) client
Packed RBC’s
- Preferred method for replacing RBC’s
Indications: Increase RBC, symptomatic anemia
Action:
* Increase Hgb 1g/100mL in non-hemorrhaging adult
* Increase Hct by 3% in non-hemorrhaging adult
Composition: RBC’s, small amount of plasma, few platelets and WBC’s
Volume/Time: 250 – 350 mL/< 4hours
ABO/Rh Incompatibility: Yes/Yes
FF Plasma
Indications: Bleeding
Action: Replace plasma to control bleeding
Composition: All coagulation factors
Volume/Time: 200 – 250 mL/< 4hours
ABO/Rh Incompatibility: Yes/No
does not contain RBCs or platelets
Platelets
Indications: Bleeding and bleeding prevention
Action: Replace plasma to reduce the risk of bleeding
* Each unit increases platelet count by 5000 to 10000/mL in a 70 kg (154lb) client
Composition: Platelets, plasma with some RBC’s, WBC’s
Volume/Time: 200 – 500 mL/< 4hours
ABO/Rh Incompatibility: Yes/NO
(bc there is not that many RBCs to cause a reaction)
low platelet count = thrombocytopenia
Albumin
Indications: Need volume
Action:
* Provides temporary increase in blood volume
* Reduces hemoconcentration
* Reduces blood viscosity
Composition: Albumin and NS
Volume/Time:
* 5% = 250-500mL/1-3 mL/min
* 25%= 50 – 100– mL (0.2 – 0.4 mL /min)
ABO/Rh Incompatibility: No/No
- helps increase volume within circulatiion but does not effect the oxygen carrying capacity of blood.
- be careful of to much because it can cause fluid volume, pulmonary edema, circulatory overload
Autologous Transfusion
- collection and infusion of pts own blood
- can be a preop autologous blood donation, an intraop autologous blood donation or a postop blood salvage
- same administration procedure as regular blood transfusions
-
your patient’s Hgb & HCT is 6.2 & 18.4; the doctor orders 3 units of packed RBC’s. what actions do you take?
a mild temperature reaction is not uncommon. true or false?
true.
s/s of an alergic reaction:
MILD:
* facial flushing
* hives / rash
SEVERE:
* increased anxiety
* wheezing
* decreased BP
s/s of a febrile reaction:
- headache
- tachycardia
- tachypnea
- fever / chills
- anxiety
s/s of a hemolytic reaction:
- decreased BP
- increased RR
- tachycardia
- hemoglobulinuria
- chest pain
- apprehension
- low back pain
- fever
- chills
A circulatory overload transfusion reaction is most common in what group of patients?
heart failure
transfusion reations and complications:
- Hemolytic Transfusion Reactions
- Allergic Transfusion Reactions
- Febrile Transfusion Reactions
- Bacterial Transfusion Reactions
- Circulatory Overload
- TRALI
- Massive Blood Transfusion Reaction
- Hypocalcemia
