Blood transfusions Flashcards
Where does blood come from?
What cannot be completely removed from donated blood?
Canadian Blood services
There will be a small trace of WBCs left over
What are indications for a tranfusion?
Blood loss (e.g. surgery, MVA)
Replacement of blood components
Improve oxygen carrying capacity
What are the risk of blood transfusions?
Risks are low, but may transmit disease/infection and their is a possible of transfusion reactions
When we administer one unit of PRBCs, how much does Hb go up by?
10 units within an hour or two
What does pheresis mean?
Indicates what was removed from plasma
e.g. leukopheresis - removed white blood cells
(in her context = separation of blood contents)
The majority of blood is _______, 55%; then ____ make up 40-45%
What is the last ~1%?
plasma - 55%
RBCs - 45%
1% - platelets and WBCs
Process of separation of blood components is called ______ - practical and economical - causes less reactions
Pheresis
Where are blood cells generated?
How long does it take to regenerated blood cells
Mostly from the vertebrae (bone marrow)
Takes 2 months to regenerated blood cells
Note: in-utero - blood cell generation is from the liver
Marrow generates these blood cells/
RBCs, WBCs, platelets
What are the different donation types?
Autologous - donate your own blood
Direct donation - from a family member with the same blood type
Standard blood donation - donated through blood services from the general population
At what frequency can we donate blood?
How long is autologous blood stored for?
Does autologous decrease the chance of reactions?
q2 months - as that is how long it takes to replace RBCs
Autologous blood is stored for 10 years
It doesn’t decrease the risk by an appreciable amount
Who’s role is it to obtain informed consent for a blood transfusion.
Doctor’s
Used for RBC’s and volume (acute massive blood loss).
Whole blood
For symptomatic anemia.
PRBCs
For deficiency of clotting factors in bleeding patients.
FFP - fresh frozen plasma
For active hemorrhage, DIC (disseminated intravascular coagulation)
Platelets
Whenever you go to the lab, we do not trust a ______ to go and get the blood. we get it ourselves.
porter
What is the volume of a single unit of whole blood?
450mL + 50 mL of anti-coagulant
One unit of PRBCs will increas HB approximately __g/L in a non-bleeding ___kg man.
10g/L
70
If a person has ulcerative colitis, what blood product would they receive?
PRBCs - only losing a bit of blood every day - low Hb
What are the important physical assessments before a transfusion?
What other information do we want to know/share?
vitals - T°; respiratory assessment Hx of transfusion rxn Pregnancy number Health status - esp. heart status Teach patient what to report, and be there to provide reassurance
Why is the number of pregnancies important to know before a transfusion?
High number of pregnancies can increase reaction risk due to exposure to fetal circulation.
`Why do we want to know about heart health before a transfusion?
Because we are giving fluid –> increase blood volume –> makes heart work harder
What is the difference between blood typing and cross-matching?
Blood typing - test for type (ABO) and Rh factor
Cross-matching = test for other minor antigens
What is the most common blood type?
What is the least?
Which is the universal donor?
Acceptor?
O+ - most common
AB- - least common
universal donor - O-
Universal acceptor - AB+
If your blood sticks together when anti-Rh serum is added, you are Rh__.
If you blood does not clump when anti-Rh serum is added, you are Rh__.
+
-
Why is the Rh factor particularly important regarding births?
If the mother is Rh-, and the child is Rh+ - will get a reaction - this increases in risk for every pregnancy
How do we get around the issue of an Rh- mother and an Rh+ baby?
Give gamma globulin at 28 weeks and then a few hours (72) before birth
(tested baby’s blood during the first trimester)
Will there be a reaction from an Rh- mother to the birth of her first baby?
No, only the second birth
What is the gamma globulin given?
RhoGAM
What solution will not cause RBC lysis?
normal saline
What is the most important baseline vital?
Temperature
PRBC volume?
Whole blood volume?
231mL
450mL
We prime the blood tubing with what solution? Why?
The greatest chance of transfusion reactions occurs when?
What is the initial rate?
Saline - doesn’t lyse RBCs
Greatest chance for reactions within first 15 minutes
Initial rate is 50mL/hour - or 8 drops/minute
When inspecting blood bag, gas bubbles indicate what?
What does abnormal colour or cloudiness indicate?
Bacterial growth - bubbles
Hemolysis - off-colour, cloudy
We must start the blood transfusion within what time frame?
How long can blood be transfused for?
30 minutes
4 hours
How is blood tubing different from regular tubing?
Has a filter that screens out fibrin clots and other particles
What labels to we verify before giving blood?
Label attached to unit of blood
Separate chart label
Canadian blood services (CBS) blood product label
What is the most serious blood transfusion reactoin?
What is the most common?
Acute Hemolytic reaction
Febrile non-hemolytic
What are the risks to the nurse from blood tranfsusion?
Coming into contact with a bodily fluid and contracting a disease
Documentation:
- Document ____ and _____ transfusion began and ended
- Amount and type of blood products infused
- ______ ____ pre, intra and post procedure’
- any ________ information or unusual signs and symptoms
- Results of _____, if known
date, time
vital signs
reaction
therapy
How often do we take vitals during the transfusion?
q15 for the first hour
q30 post the first hour
What are the 6 types of transfusion reactions?
Febrile, non-hemolytic acute hemolytic Allergic reaction circulatory overload Transfusion related acute lung injury (TRALI) Delayed hemolytic reaction
Most common transfusion reaction. cause? More common with this blood product. Prevention? Treatment?
Febrile, non-hemolytic
Caused by WBCs from donor
Most common in platelet transfusions
Prevention - WBC reduction in blood processing
Treatment:
- slow transfusion, give acetaminophen and closely monitor
Most dangerous transfusion reaction. Cause? What is the most important response? What is the treatment? Delay?
Acute hemolytic
Cause is wrong blood type given
Most important to stop transfusion immediately
Treatment - Given low dose dopamine to maintain BP and improve renal blood flow
Delayed hemolytic reactions can occur >14 days post op
Results from sensitivity to plasma protein within blood component being tranfused
Should you stop the transfusion?
Allergic reaction
Stop transfusion right away
- if mild, may recontinue with anti-histamine (diphenhydramine = benedryl)
if severe - benedryl and epinephrine given and closely monitored; maintain intravascular volume
Circulatory overload transfusion reaction:
Who is at risk?
How can it be prevented?
Should you stop the infusion?
Can you continue the infusion?
Medication post-transfusion?
CHF/heart problems, kidney failure
Prevent - do a good assessment beforehand
Depending on vitals:
- if laboured breathing - stop, give diuretic, then continue
if they have a lot of fluid - will ask physician for diuretic (Lasix/furosemide)
Describe TRALI.
WBCs form and occlude the microvasculature of the lungs.
Most common transfusion realted cause of death.
TRALI
TRALI is most common with what transfusions?
TRALI can occur within __ ____ of transfusion
plasma
2 hours
TRALI treatment?
oxygen, intubation, diuretics and fluid support by IV
How is TRALI diagnosed?
Chest X-ray - will see bilateral pulmonary infiltrates
Where physiological homeostasis is challenged by injuries or disease process, causing hypoxia & impaired exchange of nutrients at the cellular level
shock
Which types of transfusion reactions could lead to shock?
Acute hemolytic, anphylactic
What are the nurses responsibilites post-transfusion? (4)
1 - Document
2 - Dispose of equipment in biohazard receptacles
3 - Ongoing monitoring of client throughout rest of shift to ensure no delayed reactions
4 - Flush with saline (Once blood tubing removed, new continuous tubing flushed with normal saline and attached to previous IV
- if no IV line before, flush IV tubing with saline, or run a bag of saline if already in place)
