Care of Patients Receiving Blood Products

Question 1

Red Blood Cells (RBC) or Packed Red Blood Cells (PRBC)
Platelets
Plasma or Fresh Frozen Plasma (FFP)

Answer 1

Types of transfusions

Question 2

Typ packed - concentrated
To replace lost blood or anemia
Transplantation of tissues
Compatibility is determined by 2 antigen systems - ESSENTIAL
ABO and Rh
**Donor and recipient blood must be checked carefully for compatibility
Infuse over 2-4 hours
Use filtered pump tubing

Answer 2

Red Blood Cells

Question 3

To treat thrombocytopenia or active bleeding
Platelets < 10,000 mm3
Platelets are pooled from multiple donors so do not have to have the same blood type
Use specific tubing
Longer tubing increases the chance that platelets will stick to lumen
Infuse over 15-30 minutes immediately

Answer 3

Platelets

Question 4

To treat deficiency in plasma coagulation factors; elevated PT or PTT
Must be ABO compatible
Infuse over 15-30 minutes immediately after thawing
So clotting factors are still active
Use Y set tubing

Answer 4

Plasma

Question 5

Used with sepsis or neutropenic infection
Rare
More at risk for transfusion reactions
WBC surfaces have many antigens
Usually requires closer monitoring
Infuse over 1 hour

Answer 5

Granulocyte (WBC)

Question 6

Assess labs and ensure need transfusion
Verify order with another RN
Ensure adequate venous access
Assess vital signs before get bloood
Obtain blood products from blood bank and administer as soon as possible
Safety checks - biggest priority
Inspect blood for discoloration, gas bubbles, cloudiness
Could indicate hemolysis or bacteria

Answer 6

Pretransfusion

Question 7

Must be done by 2 RNs
One of the RNs has to also be responsible for administering the blood product
Verify patient’s identity with another RN
Examine blood bag label, attached tag, and requisition slip for ABO and Rh compatibility with the patient with another RN
Check expiration date with another RN

Answer 7

Safety checks - biggest priority

Question 8

Vital signs
immediately before starting infusion and again within the first 15-30 minutes
Use appropriate tubing, filters and fluids
Never add or infuse anything with blood products
Prime tubing with Normal Saline (0.9% NS)
Begin transfusion slowly, stay with patient first 15 to 30 minutes
Ask patient to report unusual sensations
chills, shortness of breath, hives, itching
Administer blood product per protocol
Assess for hyperkalemia

Answer 8

During transfusion

Question 9

Acute
Signs:
Fever, chills, tachycardia, hypotension and tachypnea - check VS
Occurs when a patient has had multiple transfusions and develop WBC antibodies
Prevention:
Give leukocyte reduced blood or single donor blood
Use of WBC filters when administering blood products to filter out WBC

Answer 9

Febrile Transfusion Reaction - Complications

Question 10

Acute
Signs:
Fever, chills apprehension, HA, chest pain, low back pain, tachycardia, tachypnea, hypotension, sense of impending doom - VS
Occurs when there is a blood type or Rh incompatibility
Antigen-antibody complexes form and destroy cells and cause inflammatory response
Prevention:
Ensure that all blood products and typed and crossmatched
Adhere to all safety checks prior to blood product administration

Answer 10

Hemolytic Transfusion Reaction - Complications

Question 11

Acute
Signs:
Urticaria, itching, bronchospasm, anaphylaxis - stop blood if receiving it
Usually seen in patients with other allergies
Can occur immediately or within 24 hours
Prevention:
Give leukocyte reduced blood

Answer 11

Allergic (anaphylactic) Reaction - Complications

Question 12

Acute
Signs:
Tachycardia, hypotension, fever, chills
Caused by contaminated blood and onset is rapid

Answer 12

Bacterial Transfusion Reaction - Complications

Question 13

Acute
Signs:
Hypertension, bounding pulses, JVD, dyspnea, restlessness and confusion
Occurs when blood product is infused too quickly
Fluid overload
Prevention:
Infuse blood products slowly esp if high risk
Diuretics if dire enough and acute resp distress
Monitor I&O

Answer 13

Transfusion-Associated Circulatory Overload (TACO) - Complications

Question 14

Not acute; happens later
Bone marrow transplant pats
Signs:
Thrombocytopenia, anorexia, N&V, weight loss, infection
Occurs in immunocompromised patients and occurs within 1-2 weeks - reacting to foreign tissue
Serious if not treated
Prevention:
Administered irradiated blood products that destroy T cells and cytokine

Answer 14

Transfusion related Graft v. Host disease - Complications

Question 15

Acute
Signs:
Severe chest pain, back pain, joint pain, hypertension, anxiety and redness of head and neck
Rare and occurs during or immediately after transfusion
Treatment:
Control symptoms
Rigors - pain meds

Answer 15

Acute Pain Transfusion Reaction (APTR) - Complications

Question 16

Get VS and notify provider
Stop the infusion - first!!!!!
Don’t flush tubing and put anymore blood into the patient
Take down all blood tubing and save with all labels - put in bag because investigation occurs
Oxygen - distress
Diphenhydramine (if allergic)
IV Fluids for severe shock
Antibiotics (if bacterial transfusion rxn if blood contaminated)
Antipyretics for fever - comfort
Meperidine for rigors

Answer 16

Nursing Interventions - Complications