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488 > Class 10: Blood products > Flashcards

Class 10: Blood products Flashcards

1
Q

Blood component

A

A therapeutic component of blood (RBCs, platelets) that can be prepared using a centrifugation, filtration or freezing

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2
Q

Blood product

A

Any therapeutic product derived from plasma and produced by a manufacturing process that pools multiple units (albumin, fibrinogen, factors Vlll and lX)

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3
Q

Donor blood is tested for…

A

ABO and RH type, RBC antibody screen, HIV, HTLV (human T-cell lymphotropic virus), Hep C, B, syphilis & West Nile Virus

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4
Q

Processing of blood

A

450-500ml taken from each donor and mixed with an anticoagulant and then is leukoreduced with a filter

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5
Q

Each donation derives

A

-One unit of RBCs (250 – 350 ml)
-One unit of platelets (50 – 70 mls)
-One unit of plasma (200 – 250 mls)

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6
Q

1 lot of albumin takes

A

10000 donors

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7
Q

1 lot of IVIG takes

A

2000-3000 donors

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8
Q

Indications for Packed red blood cell (PRBCs)

A

-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)

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9
Q

Inidications for washed red cells

A

Transfused for those with known sensitivity to blood and is the preferred choice for neonates requiring red blood cells

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10
Q

Indications for platelets

A

-Bleeding, decreased platelet production or functionally abnormal platelets. May be given prophylactically if platelet count falling

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11
Q

Dosing of platelets

A

-10 ml/kg, 300 ml max (1 unit ~ 50mls) in adults
-5-10 ml/kg in children. Transfused over 30-60 mins

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12
Q

Platelets

A

May be random donor (up to 5 units) or apheresis platelets (1 unit = 5 units from a random donor)

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13
Q

Indications for Rh immunoglobulin (WhinRho)

A

To prevent Rh sensitization in Rh- pts who receives Rh+ platelets (also used in pregnancy and to treat ITP)

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14
Q

Indications for albumin

A

-Low albumin, burns and hypotension during dialysis
-Available in 5% or 25%… It’s a plasma protein synthesized by the liver

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15
Q

Indications for IVIG

A

-Fractionated from plasma, contains immunoglobulins, >90% as IgG.
-Usually 250 – 400 mg/kg/dose

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16
Q

Indications for factor concentrates

A

-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

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17
Q

Limiting donor exposure

A

Decrease both the infectious and non-infectious risks of transfusions

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18
Q

Limiting donor exposure in neonates that require RBC

A

-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

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19
Q

Hemoglobin check

A

-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

20
Q

Coagulation check

A

-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

21
Q

Checking blood products

A

-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

22
Q

Administering blood products

A

-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

23
Q

Equipment needed for administration of blood

A

-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

24
Q

Returning blood components

A

-Blood components must be promptly returned to the transfusion medicine/lab if the infusion is not started within 30 minutes of delivery

25
Q

Blood components

A

RBC, plasma, platelets and cyroprecipitate

26
Q

Returning blood products

A

Returned to transfusion medicine/lab ASAP in the event that the patient no longer requires the blood product

27
Q

Transfusion reactions & complications

A

-Be aware of complications, if anticipated pre-medications may be ordered
-Most reactions occur during the first 15 minutes

28
Q

Allergic reactions to blood

A

-Onset is shortly after the start of the transfusion
-Cause is unclear

29
Q

Anaphylactic reactions to blood

A

-Onset is immediate or anytime during the transfusion
-Unknown cause

30
Q

S&S of a allergic/anaphylactic transfusion reaction

A

-Fever (rise in temperature of greater than 2 C (not always present), chills, rigors, N/V, hypotension

31
Q

Management of an allergic & anaphylactic transfusion

A

-Stop transfusion and notify physician
-Infuse N/S
-Take VS
-Recheck patient ID
-Transfusion may continue as ordered by NP or physician
-Administer medications as ordered (acetaminophen, benadryl)
-Report reaction to TM (may receive instructions for follow up testing)
-Return any unused portion of unit and tubing to TM only if directed

32
Q

Acute hemolytic transfusion reaction

A

-Onset is usually within the first 15 minutes
-Caused by ABO incompatibility and nearly always d/t an error in ID, specimen or unit

33
Q

Febrile non-hemolytic transfusion reaction

A

-Onset is shortly after the start of FFP, cryoprecipitate and RBC
-Caused by a reaction to antigens on the donor cells

34
Q

S&S of a hemolytic & febrile non-hemolytic reaction

A

Airway obstruction, chest tightness, feelings of impending doom, N/V, abdominal pain, urticaria, anxiety, hypotension and flushing

35
Q

Management of an acute hemolytic or febrile non-hemolytic reaction

A

-Discontinue transfusion and administer supportive care
-If patient is having airway difficulty, call code blue (depending on severity)
-Notify doc or NP
-Infuse NS
-Monitor VS
-Recheck patient identification to blood component/product
-Report reaction to TM (instructions may be given for follow up testing)
-Return unused portion of unit and tubing to TM

36
Q

Transfusion related acute lung injury (TRALI)

A

-Onset is within 6 hours but usually within 2
-Caused by donor white cells in the plasma usually occurring with RBC, platelets & plasma

37
Q

Bacterial contamination transfusion reaction

A

Caused by contaminated blood products

38
Q

Transfusion Related Acute Lung Injury

A

-A syndrome of acute respiratory distress with hypoxia and bilateral pulmonary edema, without evidence of CHF. Tends to resolve in 24-72 hours
-Donor must have been exposed to foreign white cells and have developed antibodies prior to donating (multiparous or multitransfused)

39
Q

S&S and diagnosis of TRALI

A

Dyspnea, hypotension, hypoxia, pulmonary edema, fever
-Chest X-ray will reveal interstitial and alveolar infiltrates

40
Q

Management of TRALI

A

-D/C transfusion and give supportive care
-Infuse NS
-Monitor VS
-Administer O2 as necessary
-If patient is experiencing airway difficulty, call code
-Notify doc or NP
-Administer medications as ordered
-Report reaction to TM (instructions may be given for follow up testing
-Return any unused portion of unit and tubing to TM

41
Q

Infectious disease transfusion reaction

A

Onset is days to years

42
Q

Circulatory overload transfusion reactions

A

-Onset is during or immediately following the infusion
-Caused by impaired cardiac function that have been administered too fast or in a greater amount than the circulatory system can hold

43
Q

Management of circulatory overload transfusion reaction

A

-Reaction medications at bedside with doses pre-calculated. NS reaction line
-Stop infusion, start reaction line
-Call for help & notify MD
-Take VS & O2 sat
-Administer supportive care
-Administer reaction meds with MD order
-Transfusion may need to be restarted

44
Q

In pediatrics, after 1-2 reactions…

A

The child usuallt requires pre-medication

45
Q

Normochromic

A

There is an appropriate concentration of hemoglobin in the cell but not enough

46
Q

Benadryl is…

A

Given between blood transfusions to minimize the risk of a reaction

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