Receiving Blood Products

Question 1

Types of Blood Transfusions

Answer 1

• RBCs or PRBCs
• Platelets
• Plasma or Fresh Frozen Plasma (FFP)
• Granulocyte (White Blood Cells)

Question 2

Types of Transfusions - RBCs

Answer 2

• To replace lost blood or anemia
• Transplantation of tissues
  > compatibility is determined by 2 antigen systems
  > ABO and Rh
  > donor and recipient blood must be checked carefully for compatibility
• Infuse over 2-4 hours
• Use filtered pump tubing

Question 3

Types of Transfusions - Plasma

Answer 3

• To treat deficiency in plasma
  coagulation factors; elevated PT or PTT
• Must be ABO compatible
• Infuse over 15-30 mins immediately
  after thawing
  > so clotting factors are still active
• Use Y set tubing

Question 4

Types of Transfusions - Granulocyte (WBC)

Answer 4

• Used with sepsis or neutropenic
  infection
• Rare
• More at risk for transfusion reactions
  > WBC surfaces have many antigens
• Usually requires closer monitoring
• Infuse over 1 hour

Question 5

Types of Transfusions - Platelets

Answer 5

• To treat thrombocytopenia or active bleeding
  > platelets less than 10,000 mm3
• Platelets are pooled from multiple
  donors so do not have to have the same blood type
• Use specific tubing
  > longer tubing increases the chance that platelets will stick to lumen
• Infuse over 15-30 minutes immediately

Question 6

Pre Transfusion Of Blood

Answer 6

• Assess labs
• Verify order with another RN
• Ensure venous access
• Assess VS
• Obtain blood products from blood bank and adm as soon as possible
• Safety checks
  > must be done by 2 RNs
  > one of the RNs has to also be responsible for admining the blood product
  > verify patient’s identity with another RN
  > examine blood bag label, attached tag, & requisition slip for ABO & Rh compatibility with the patient w/ another RN
  > check expiration date w/ another RN
• Inspect blood for discoloration, gas bubbles, cloudiness
  > could indicate hemolysis or bacteria

Question 7

During Blood Transfusion

Answer 7

• Vital signs
  > immediately b4 starting infusion & again w/in the first 30 mins
• Use appropriate tubing, filters and fluids
  > never add or infuse anything w/ blood products
  > prime tubing w/ Normal Saline (0.9% NS)
• Begin transfusion slowly, stay w/ pt first 15 to 30 minutes
• Ask pt to report unusual sensations
  > chills, SOB, hives, itching
• Adm blood product per protocol
• Assess for hyperkalemia

Question 8

Complications - Blood Transfusions

Answer 8

• Febrile transfusion reaction
• Hemolytic transfusion reaction
• Allergic reaction
• Bacterial transfusion reaction
• Transfusion-Associated circulatory overload (TACO)
• Transfusion related graft v. host disease

Question 9

Febrile Transfusion Reaction

Answer 9

• Signs:
  > fever, chills, tachycardia, hypoten, & tachypnea
• Occurs when a pt has had multiple transfusions & develop WBC antibodies
• Prevention:
  > give leukocyte reduced blood or single donor blood
  > use of WBC filters when admining blood products

Question 10

Hemolytic Transfusion Reaction

Answer 10

• Signs:
  > fever, chills, apprehension, HA, chest pain, low back pain, tachycardia, tachypnea, hypoten, sense of impending doom
• Occurs when there is a blood type or Rh incompatibility
  > antigen-antibody complexes form & destroy cells & cause inflamm response
• Prevention:
  > ensure tht all blood products & types & cross matched
  > adhere to all safety checks prior to blood product admin

Question 11

Allergic (anaphylactic) Reaction

Answer 11

• Signs:
  > urticaria, itching, bronchospasm, anaphylaxis
• Usually seen in pts w/ other allergies
  > can occur immediately or w/in 24hrs
• Prevention:
  > give leukocyte reduced blood

Question 12

Bacterial Transfusion Reaction

Answer 12

• Signs:
  > tachycardia, hypoten, fever, chills
• Caused by contaminated blood & onset is rapid

Question 13

Transfusion-Associated Circulatory Overload (TACO)

Answer 13

• Signs:
  > HTN, bounding pulses, JVD, dyspnea, restlessness, & confusion
• Occurs when blood product is infused too quickly
• Prevention:
  > infuse blood products slowly
  > diuretics
  > monitor I&Os

Question 14

Transfusion Related Graft v. Host Disease

Answer 14

• Signs:
  > thrombocytopenia, anorexia, N/V, weight loss, infection
• Occurs in immunocompromised pts & occurs w/in 1-2 weeks
• Prevention:
  > admind irradiated blood products tht destroy T cells & cytokine

Question 15

Acute Pain Transfusion Reaction (APTR)

Answer 15

• Signs:
  > severe chest pain, back pain, joint pain, HTN, anxiety, & redness of head & neck
• Rare & occurs during or immediately after transfusion
• Treatment:
  > control symps

Question 16

Blood Products Complications - Interventions

Answer 16

• Stop infusion
  > don’t flush tubing & put anymore blood into pt
• Take down all blood tubing & save w/ all labels
• Oxygen
• Diphenhydramine (if allergic)
• IV fluids for shock
• Antibiotics (if bacterial)
• Antipyretics for fever
• Meperidine for rigors