T11: Blood Products & Transfusions Flashcards
Peripheral smear
morphology (SHAPE AND APPEARANCE) of blood cells
Pancytopenia
suppression of ALL (RBCs, WBCs, and platelets) blood cells
RBC count
3.8-5.7 X 10^6
Hemoglobin value (Hgb)
12-18 g/dL
Hematocrit value (Hct) determines
the percentage of RBCs compared to total blood volume
normal hematocrit levels
37-52%
what is the best indicator for anemia
hemoglobin and hematocrit
Erythrocyte sedimentation rate (ESR/Sed rate measures
sedimentation/settling of RBCs; tells us if inflammation is present
normal ESR
less than 20mm/hr
what WBC count is associated with infection
> 11,000/µL
normal WBC
5,000-10,000
Leukopenia is associated with WBC count of…
< 4000/µl
Differential count
% of each type of leukocyte
Absolute neutrophil count (ANC) is comprised of bands and segs ans tells us
there is an inflammatory response going on
Neutropenia is when the ANC is..
< 1000 cells/µL
Neutropenic precautions
(they have no immunity): ISOLATION, PPE, limiting visitors, no flower, no fresh fruit and veggies, when they go off the floor, put a mask on them when they are traveling, hand washing
Normal platelet count
150,000-400,000/µL
Thrombocytopenia
low platelet count; danger of spontaneous hemorrhage
Thrombocytosis
abnormally high platelet count; danger of excessive clotting
DIC is…
thrombocytopenia and thrombocytosis together; Bleeding and clotting at the same time
universal donor
O-
universal recipient
AB+
Chelation therapy
a procedure in which excess metals, such as IRON, are removed from the blood
what is used to treat anemias
Packed RBC/frozen
what is used to treat thrombocytopenia
platelets
Fresh frozen plasma is used for
o Bleeding-depleted clotting factors
o No platelets
albumin
keeps fluid in the vessels (used for hypovolemia and hypoalbuminemia)
Cryoprecipitate
o Clotting factors-Factor VIII, von Willebrand, fibrinogen
o Clotting factors for those with hemophilia (they have a hard time clotting)
once a blood transfusion is ordered, what is needed?
-patient consent
-labs
-2 IV access
why is 2 ive access needed
BLOOD NEEDS ITS OWN LINE
prep and start the line with
0.9% normal saline ONLY
TKO
to keep open (20-25mL of saline)
once blood product is received what is needed
-2 RN check ALWAYS at bedside
- VS before starting-spike/start within 30 minutes
start blood at
max of 2 mL/min (60-120mL/hr) for 15 minutes
during the first 15 minutes
STAY WITH THE PATIENT, THEN REASSESS VS AFTER 15 MINS
acute transfusion reactions usually occur
in the first 10-15 minutes or the first 50mL of blood
Acute Hemolytic
in the moment happening now, breaking down the RBCs
s/s of acute hemolytic
: fever, chills, low back pain, tachycardia, hypotension, hemoglobinuria, DARK URINE bleeding AKI, shock, DIC, death
what is important to assess with acute hemolytic reaction
o CHECK THEIR URINE: may be brown color if kidneys are blocked off by clot
Febrile Non-hemolytic
temp spike but it is not breaking down RBCs
s/s of Febrile Non-hemolytic
o S/S: fever, chills, anxiety, headache, tachycardia, tachypnea
intervention for Febrile Non-hemolytic
tylenol
Mild allergic reaction s/s
o itchy, hives, rash, facial flushing, wheezing
Mild allergic reaction intervention
o Antihistamine (Benadryl)
anaphylactic s/s
BROCHOCONSTRICTION, ANGIOEDEMA, increased BP
o itchy, hives, rash, facial flushing, wheezing
anaphylactic interventions
o Stop the transfusion
o Epinephrine, bronchodilators, steroids
TACO
Transfusion Associated Circulatory Overload (basically ADHF FAST!)
for TACO give
DIURETICS
sepsis
if blood is hanging for too long or if the blood becomes too warm, bacteria can grow in it and cause sepsis
TRALI
Transfusion Related Acute Lung Injury; Basically, their lungs are hemorrhaging (alveoli are filled with blood so no O2 and CO2 exchange ARDS)
TRALI interventions
Immediately stop transfusion
-Chest x ray: pulmonary infiltrates
-Need aggressive support of therapy: need to be treated aggressively cause it can progress and be fatal VENT WITH PEEP
INTERVENTION FOR REACTION
STOP TRANSFUSION AND OPEN UP THE FLUIDS
MANAGEMENT OF TRANSFUSION REACTION
- STOP TRANSFUSION
- MAINTAIN PATENT IV LINE WITH 0.9% SALINE
- NOTIFY THE BLOOD BANK AND THE HCP
- RECHECK IDENTIFICATION TAGS AND NUMBERS
- TREAT SYMPTOMS PER HCP ORDERS
- SAVE THE BLOOD BAG, TUBING AND SEND TO BLOOD BANK
- COLLECT REQUIRED BLOOD AND URINE SPECIMENS PER AGENCY POLICY
- DOCUMENT ON TRANSFUSION REACTION FORM AND HER
- THIS IS A SENTINAL EVENT: this could have killed them if we didn’t catch it
Autologous blood product
o Planned predonated and stored (10 years frozen); donate their own blood
