Class 10: Blood products Flashcards
Blood component
A therapeutic component of blood (RBCs, platelets) that can be prepared using a centrifugation, filtration or freezing
Blood product
Any therapeutic product derived from plasma and produced by a manufacturing process that pools multiple units (albumin, fibrinogen, factors Vlll and lX)
Donor blood is tested for…
ABO and RH type, RBC antibody screen, HIV, HTLV (human T-cell lymphotropic virus), Hep C, B, syphilis & West Nile Virus
Processing of blood
450-500ml taken from each donor and mixed with an anticoagulant and then is leukoreduced with a filter
Each donation derives
-One unit of RBCs (250 – 350 ml)
-One unit of platelets (50 – 70 mls)
-One unit of plasma (200 – 250 mls)
1 lot of albumin takes
10000 donors
1 lot of IVIG takes
2000-3000 donors
Indications for Packed red blood cell (PRBCs)
-Increase the oxygen-carrying capacity of the blood, acute blood loss and in some neonatal and autologous transfusions
-Dosing in units or mls: 10 – 15 cc/kg over 3-4 hours (1 unit ~ 300mls)
Inidications for washed red cells
Transfused for those with known sensitivity to blood and is the preferred choice for neonates requiring red blood cells
Indications for platelets
-Bleeding, decreased platelet production or functionally abnormal platelets. May be given prophylactically if platelet count falling
Dosing of platelets
-10 ml/kg, 300 ml max (1 unit ~ 50mls) in adults
-5-10 ml/kg in children. Transfused over 30-60 mins
Platelets
May be random donor (up to 5 units) or apheresis platelets (1 unit = 5 units from a random donor)
Indications for Rh immunoglobulin (WhinRho)
To prevent Rh sensitization in Rh- pts who receives Rh+ platelets (also used in pregnancy and to treat ITP)
Indications for albumin
-Low albumin, burns and hypotension during dialysis
-Available in 5% or 25%… It’s a plasma protein synthesized by the liver
Indications for IVIG
-Fractionated from plasma, contains immunoglobulins, >90% as IgG.
-Usually 250 – 400 mg/kg/dose
Indications for factor concentrates
-Should be ordered by hematologist or physician
-Used to replace a deficiency of factors in the clotting cascade (usually factor VIII or IX)
-Most are genetically engineered
Limiting donor exposure
Decrease both the infectious and non-infectious risks of transfusions
Limiting donor exposure in neonates that require RBC
-Use a dedicated donor unit with multiple satellite packs or with a sterile docking device
-Require small amounts of blood from each transfusion, repeated transfusions may be given to the same patient from a single unit
Hemoglobin check
-During the first 3 months of life, all infants have a normal or “physiological” decrease in their hemoglobin down to approximately 115 g/L (larger decrease in pre-term infants)
-By age 12 it is the same as adults
Coagulation check
-Birth-6 months of age concentrations of vitamin K-dependent factors (factors II, VII, IX, X) and vitamin K-dependent inhibitors of coagulation are lower than adult levels
-Same as adults by 6 months of age
Checking blood products
-Physician/NP get consent
-2 nurses check order to blood label, then blood label to bag
-Check ABO compatibility chart
-Crossmatch must be drawn prior to administration of blood
-2 nurses check blood bag to patient’s armband and crossmatch band
Administering blood products
-Nurse must remain at bedside for entire infusion of platelets or first 15 min for most other blood products/components
-V/S q15min x 1 hour, q30min x 2 hour, q hourly for the remainder of the infusion
-Restart process for a new bag, blood filters are good for 4 units of blood
Equipment needed for administration of blood
-170-260 micron for blood, platelets & vented unfiltered infusion set for bottled products
-Y-piece, NS reaction line, VS machine, frequent VS sheet & reaction medications with doses pre-calculated
Returning blood components
-Blood components must be promptly returned to the transfusion medicine/lab if the infusion is not started within 30 minutes of delivery
