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
Blood components
RBC, plasma, platelets and cyroprecipitate
Returning blood products
Returned to transfusion medicine/lab ASAP in the event that the patient no longer requires the blood product
Transfusion reactions & complications
-Be aware of complications, if anticipated pre-medications may be ordered
-Most reactions occur during the first 15 minutes
Allergic reactions to blood
-Onset is shortly after the start of the transfusion
-Cause is unclear
Anaphylactic reactions to blood
-Onset is immediate or anytime during the transfusion
-Unknown cause
S&S of a allergic/anaphylactic transfusion reaction
-Fever (rise in temperature of greater than 2 C (not always present), chills, rigors, N/V, hypotension
Management of an allergic & anaphylactic transfusion
-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
Acute hemolytic transfusion reaction
-Onset is usually within the first 15 minutes
-Caused by ABO incompatibility and nearly always d/t an error in ID, specimen or unit
Febrile non-hemolytic transfusion reaction
-Onset is shortly after the start of FFP, cryoprecipitate and RBC
-Caused by a reaction to antigens on the donor cells
S&S of a hemolytic & febrile non-hemolytic reaction
Airway obstruction, chest tightness, feelings of impending doom, N/V, abdominal pain, urticaria, anxiety, hypotension and flushing
Management of an acute hemolytic or febrile non-hemolytic reaction
-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
Transfusion related acute lung injury (TRALI)
-Onset is within 6 hours but usually within 2
-Caused by donor white cells in the plasma usually occurring with RBC, platelets & plasma
Bacterial contamination transfusion reaction
Caused by contaminated blood products
Transfusion Related Acute Lung Injury
-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)
S&S and diagnosis of TRALI
Dyspnea, hypotension, hypoxia, pulmonary edema, fever
-Chest X-ray will reveal interstitial and alveolar infiltrates
Management of TRALI
-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
Infectious disease transfusion reaction
Onset is days to years
Circulatory overload transfusion reactions
-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
Management of circulatory overload transfusion reaction
-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
In pediatrics, after 1-2 reactions…
The child usuallt requires pre-medication
Normochromic
There is an appropriate concentration of hemoglobin in the cell but not enough
Benadryl is…
Given between blood transfusions to minimize the risk of a reaction
