Module 6: Blood Therapy Flashcards
Allogenic Blood
blood donated from someone else
Autologous Transfusion (autotransfusion)
a patient’s own blood is collected and reinfused for purpose of IV volume replacement
ABO system
Uses the presence or absence of specific antigens on
the surface of RBCs to identify blood groups.
* When the type A antigen is present, the blood group is type A.
* When the type B antigen is present, the blood group is type B.
* When both A and B antigens are present, the blood group is type AB.
* When neither A nor B antigens are present, the blood group is type O
Antibodies that react against the A and B antigens are naturally present in the plasma of people whose RBCs do not carry the antigen. These antibodies (agglutinins) react against the foreign antigens (agglutinogens). Incompatible RBCs agglutinate (clump together) and result in a life-threatening acute hemolytic transfusion reaction (AHTR).
People with type A blood have anti-B antibodies
People with type B blood have anti-A antibodies.
People with type AB blood have neither antibody and can receive all blood types.
People with type O blood have both A and B antibodies and can receive only type O blood.
Rh System
The Rh factor is considered when matching blood components for transfusion. The Rh factor is another antigen in RBC membranes. Although nearly 50 types of Rh antigen may be present on the surface of RBCs, the type D antigen is widely prevalent and is most likely to elicit an immune response. It is the presence or absence of the D antigen that determines a person’s Rh type. A person with the D antigen is Rh positive, and a person without the D antigen is Rh negative. Naturally
occurring antibodies to the Rh(D) antigen do not occur.
A person with Rh-negative blood must first be exposed to Rh-positive blood before any Rh antibodies are formed.
An Rh-negative mother previously exposed to Rh antigen can transfer Rh antibodies across the placenta to an Rh-positive fetus. This can result in severe fetal hemolysis. To prevent current or future fetal hemolysis, Rh(D) immunoglobulin (Rho-GAM) is given by intramuscular injection to the mother. Rho-
GAM can suppress or destroy the fetal Rh-positive blood cells that have passed from the fetal to the maternal circulation
Human leukocyte antigen system
Although most commonly linked to transplant rejection, HLAs are highly immunogenic antigens that can cause serious transfusion complications. HLA antibodies are located on the cell surface of leukocytes but can be found on all cells of the body.
HLA complications most commonly seen are as follows:
- Febrile nonhemolytic reaction
**Febrile Nonhemolytic Transfusion Reaction is one of the most common adverse reactions associated with blood transfusions. It is characterized by a rise in temperature (fever) during or shortly after a transfusion, without evidence of hemolysis (destruction of red blood cells). FNHTR is typically caused by antibodies in the recipient’s blood reacting against donor white blood cells, leading to the release of cytokines and subsequent fever. Symptoms may include chills, increased heart rate, and mild fever. FNHTR is generally not life-threatening and can be managed with antipyretics and by slowing or stopping the transfusion. - Immune-mediated platelet refractoriness
**(Immune-mediated Platelet Refractoriness refers to a condition where a patient becomes unresponsive to platelet transfusions, often due to the development of antibodies against human leukocyte antigens (HLA) or specific platelet antigens present in the transfused platelets. This immune response leads to the rapid destruction or clearance of the transfused platelets, making transfusions ineffective in raising the patient’s platelet count. Management may involve selecting HLA-matched or crossmatched platelets for transfusion to the patient) - Transfusion-related acute lung injury (TRALI)
**Transfusion-related Acute Lung Injury is a serious and potentially life-threatening complication of blood transfusion. It is characterized by acute respiratory distress and non-cardiogenic pulmonary edema (fluid accumulation in the lungs not caused by heart failure) occurring within 6 hours after a transfusion. TRALI is thought to be caused by antibodies in the donor blood reacting with the recipient’s leukocytes, leading to activation and damage to the lung endothelium. Symptoms include severe shortness of breath, hypoxemia, fever, and hypotension. Supportive care, including oxygen therapy and mechanical ventilation, may be required. - Transfusion-associated graft-versus-host disease (TA-
GVHD)
**Transfusion-associated Graft-versus-Host Disease is a rare but often fatal complication of blood transfusion, where transfused donor T lymphocytes engraft in the recipient and mount an immune response against the recipient’s tissues. TA-GVHD typically occurs in immunocompromised patients or when the donor and recipient share HLA haplotypes. Symptoms can include rash, fever, diarrhea, liver dysfunction, and pancytopenia (reduction in all types of blood cells). Preventative measures include irradiating blood products to deactivate lymphocytes before transfusion, especially for at-risk patients.
Pretransfusion requirements to decrease transfusion-
related errors include
The blood sample should identify the patient’s blood type and antibodies present in the plasma at the time transfusion will be administered. If the patient has been pregnant in the past 3 months, this specimen must be less than 3 days old.
Compatibility testing is performed on plasma, with blood drawn into a tube containing ethylenediaminetetraacetic acid (EDTA).
Serum from a clotted sample can be used, but plasma is
preferred.
Use proper labeling of the sample immediately on collection. To avoid transfusion errors, laboratories and transfusion departments usually require two separate specimens for blood type verification.
Safety Guidelines for Transfusion
Two nurses should verify correct unit and correct
patient at the patient’s bedside before
administration.
Despite precautions, transfusion therapy carries
risks.
Compatibility of the patient and donor is essential.
Human-related errors can occur in every step of the
process.
Disease transmission is also a possibility.
Comprehensive screening and testing reduce these
occurrences considerably
Nurse responsibilities include:
* Understanding which components are appropriate in different situations
* Ensuring that a blood sample for typing and compatibility screening has been collected and sent to the laboratory within 72 hours
Unexpected outcomes and related interventions
Patient displays signs and symptoms of transfusion
reaction such as chills, flushing, itching, dyspnea, or
rash.
* Stop transfusion immediately.
Maintain IV Access: While stopping the blood product infusion, it’s important to maintain intravenous access with normal saline to ensure that a line is available for medications or fluids that may be needed to treat the reaction.
Monitor the Patient: Close monitoring of vital signs and symptoms is essential to assess the severity of the reaction and guide further treatment.
Notify the Physician: The healthcare provider should be informed immediately about the reaction to determine the necessary interventions.
Treat Symptoms: Based on the symptoms and the physician’s orders, treatment may include antihistamines for itching, antipyretics for fever, and corticosteroids for more severe reactions.
Send Blood Products and Samples for Testing: The remaining blood product and a fresh blood sample from the patient should be sent to the laboratory to check for possible causes of the reaction, such as blood type incompatibility or the presence of antibodies.
Document the Event: Documenting all details of the reaction and the steps taken in response is crucial for patient safety and for investigating the cause of the reaction.
Supportive Care: Depending on the symptoms and their severity, additional supportive care may be necessary, including oxygen for dyspnea or intravenous fluids for hypotension.
Patient develops infiltration or phlebitis at
venipuncture site.
* Transfusion should be stopped at first sign of infiltration, and IV line removed.
* Insert new VAD in area above previous location or opposite arm.
* Restart product if remainder can be infused within 4 hours of initiation of transfusion.
* Institute nursing measures to reduce discomfort at infiltrated or phlebitic area.
Fluid volume overload occurs, and/or patient exhibits
difficulty breathing or has crackles on auscultation of
lungs.
* Slow or stop transfusion, elevate head of bed, and inform health care provider of physical findings.
* Administer diuretics, morphine, and/or oxygen as ordered by health care provider.
* Continue frequent assessments and closely monitor vital signs and intake and output
Adverse Reactions
Adverse transfusion reactions may occur at any
time during a transfusion of blood products.
Life-threatening reactions usually occur within the first
15 minutes of transfusion.
Remain with a patient during this time to monitor
physiological responses.
Symptoms that indicate an adverse reaction range
from fever, chills, and skin rash to hypotension and
cardiac arrest.
Some patients also experience a delayed transfusion
reaction days or weeks after the transfusion.
- Acute Hemolytic Reaction
Interventions: Immediate cessation of transfusion, maintenance of renal perfusion with IV fluids, monitoring and managing acute kidney injury, and possibly administering diuretics to maintain urine output. Blood samples should be rechecked for compatibility, and the incident should be reported according to hospital policy.
- Febrile Non-Hemolytic Transfusion Reaction (FNHTR)
Interventions: Stopping the transfusion, administering antipyretics like acetaminophen for fever, and monitoring the patient. Leukocyte-reduced blood products may be used in the future to prevent recurrence.
- Allergic Reactions
Interventions: For mild cases, stopping or slowing the transfusion and administering antihistamines may be sufficient. For more severe reactions, including anaphylaxis, epinephrine, corticosteroids, and airway support may be necessary.
- Transfusion-Related Acute Lung Injury (TRALI)
Interventions: Immediate cessation of the transfusion, supportive care with oxygen or mechanical ventilation for respiratory distress, and corticosteroids may be considered, although their use is controversial.
- Transfusion-Associated Circulatory Overload (TACO)
Interventions: Slowing or stopping the transfusion, sitting the patient upright, administering diuretics to manage fluid overload, and providing supplemental oxygen or respiratory support as needed.
- Transfusion-Associated Sepsis
Interventions: Stopping the transfusion, broad-spectrum antibiotics, supportive care for septic shock if present, and sending the blood product and patient samples for culture.
