hematologic function and blood transfusion Flashcards
what makes blood stuff
bone marrow
name some blood componets
- whole blood (everything)
- platelets
- RBCs
- WBCs
- plasma
- albumin
plasma and albumin are liquidy parts
should you double check blood type and cross match (ABO compatibility)
yeppers
describe whole blood
- RBCs, plasma, WBCs, platelets
- volume of each unit is ~ 500ml
- whole blood requires T&C, ABO identification
- not preferred treatment bc of the amount of volume
describe platelets
- used to control or prevent bleeding associated with platelet deficiencies
- to treat thrombocytopenia
- transfused more commonly than any other blood component
- need to be ABO compatible
describe fresh frozen plasma (FFP)
liquid portion of blood and lymph used for:
- coagulation factor replacement (primary use)
- provides clotting factors
- reversal of warfarin (emergent)
needs to be ABO compatible
describe WBCs
- granulocytes administered for low or abnormal WBC count
- given cancer/chemotherapy patients
- mus be compatible
describe albumin
- used to resotre intravascular volume
- -maintains carduac output in patients with hypoproteinemia
- doesnt have to be compatible
describe packed red blood cells (PRBCs)
- improves oxygen carrying capacity
- provides the same oxygen carrying capacity as whole blood without the additional volume
- need to be ABO compatible
- volume 250-350ml
- 1 unit raises Hgb 1g and Hct 3-4%
describe admin of PRBCs
- infuse over 4hrs max
- standard blood admin set with blood filter
what are some nursing considerations for blood products
- physicians orders
- patient signed informed consent
- type and cross
- verification of type anc cross per licensed professionals
- obatin blood and verify in lab
- verify blood with pt and two licensed nurses
- only use 0.9% saline with blood products
- follow facility’s protocol for admin
infusion nurses society standard for blood admin: describe nurses responsibilities
- verify order
- blood product inspection
- pt identification
- expiration date
- confirmation of compatibiltiy: pt-donor
- confirmation of informed pt consent
- pt education
- monitoring during and after admin
what tubing is used for blood admin
Y
name some different transfusion reactions
- allergic
- febrile
- hemolytic
describe an allergic transfusion reaction
hives, itching, anaphylaxis
describe febrile transfusion reactions
fever, chills, HA
describe hemolytic transfusion reactions
immediate onset, flushing, fever, chills, back pain, shock
usually occurs if T&C was incorrect
what do you do if a transfusion reaction occurs
- stop transfusion, start normal saline
- notify MD
- follow agency protocols
you are preparing to hang 1 unit of PRBCs. what type of fluid should you gather?
normal saline
0.9% sodium chloride or normal saline are the only IV fluids that can be run with blood products
what is anemia
decrease in RBC count
whats the lifespan of RBCs
120 days
what do RBCs do
transport oxygen to cells
what organs remove RBCs
spleen and liver remove old RBCs
- most Hgb and iron is recycled
- some Hgb breaks down ro form bilirubin
95% of RBCs is…
Hgb
what does bone marrow need to make new RBCs
iron, B12, folate, B6 and protein
describe the signs and symtoms of anemia
symptoms may vary based on duration of anemia (acute vs chronic)
most common symptom = fatigue
- malaise/weakness
- pallor
- jaundice (megaloblastic/hemolytic anemia)
- tongue smooth and red (iron deficiency anemia)
- red sore tongue (megaloblastic anemia)
diagnostics
erythrocytes
4.5 - 5.3 (men)
4.1 - 5.1 (women)
diagnostics
hemoglobin
13 - 18 (men)
12 - 16 (women)
diagnostics
hematocrit
40% - 50% (men)
38% - 48% (women)
diagnostics
what is reticulocyte count
% immature RBCs in blood
diagnostics
what is mean corpuscle volume
average size of a RBC
serum b12 and folate are needed for…
hematopoiesis
describe iron studies
evaluate iron metabolism and storage
what are the different classifications of anemia
-hypoproliferative (not making enough or unhealthy shit)
-blood loss
-hemolytic (cells are destroyed)
name different types of hypoproliferative anemia
-iron deficiency anemia
-anemia of chronic disease (normocytic)
-aplastic anemia
-megaloblastic anemia
hypo-proliferative anemia
iron deficiency anemia
-iron intake inadequate for Hgb synthesis
-most common
-symptoms: smooth red tongue, brittle rdiged nails, cracks in mouth
-Dx: bone marrow aspiration, labs: ferritin, H&H, low iron, elevated transferrin
-treatment: high iron diet, iron supplements
describe taking iron supplements
-take on an empty stomach with vitamin C (OJ)
-do not take with dairy
-stools may be dark and stain
-liq can stain teeth
hypo-proliferative anemia
describe anemia of chronic disease (normocytic)
-caused by: chronic inflammation, chronic infection, malignancy
-symptoms: few (chronic) Hgb rarely >9
-treatment: treat underlying disease, supplements not beneficial
hypo-proliferative anemia
describe aplastic anemia
-rare
-causes damage to stem cells and bone marrow, causing decreased RBC production
-treatment: stem cell transplant, immunosupression
hypo-proliferative anemia
describe megaloblastic anemia
abnormally large RBCs due to lack of B12 or folate
what are the symptoms of megaloblastic anemia
- pancytopenia, abnormally shaped cells
- low B12 may cause confusion, weakness, N/V, balance issues
what are some risk factors of megaloblastic anemia
pregnancy, ETOH abuse, pernicious anemia
what is the treatment for megaloblastic anemia
folate or B12 replacement, diet changes
what is blood loss anemia caused by
caused by sudden loss of large volume of blood
(trauma, surgery, bleeding disorders)
what is the treatment of blood loss anemia
-treat underlying condition
-transfuse PRBCs
what is hemolytic anemia
-red blood cells have a shortened lifespan
what are soe symptoms of hemolytic anemia
decreased O2 -> hypoxia -> stimulates erythropoietin -> release premature RBCs (reticulocytes) -> increased bilirubin -> jaundice
name a type of hemolytic anemia
sickle cell anemia
what is sickle cell anemia
severe anemia from an inherited sickle cell hemoglobin gene that causes abnormal shape to cell
what are the symptoms of sickle cell anemia
- RBC lifespan of 4-10 days
- jaundice
- tachycardia, murmurs, cardiomegaly, heart failure
- pain
- hypoxic damage
what are some complications of sickle cell anemia
- life expectancy - 50s
- clots, CVA
- sickle cell crisis
what is the treatment for sickle cell anemia
- stem cell transfusion
- hydroxyurea (chemo drug)
- blood transfusions
- symptom management: hydration, oxygen, pain medication
what are the complications of anemia
- heart failure
- chest pain
- paresthesia
- confusion
- falls
- activity intolerance
most complications come as a result of stress on the heart
describe nursing care for anemia
- manage fatigue
- maintain nutrition
- maintain perfusion
- pt education
- monitor for complications
your patient comes to the urgent care complaining of fatigue and a red smooth tongue. what lab value would be important to check?
iron
fatigue and smooth red tongue are symptoms of iron deficiency anemia
