Week 9: Treas pg 1490-1492, Replacement of Blood + Blood Products Flashcards
What does not restore oxygen-carrying capacity or replace clotting factors?
IV fluids
When are Blood products infused?
infused when the patient has experienced significant blood loss, diminished oxygen-carrying capacity., or a deficiency in one of the blood components
How is donated blood separated?
each unit of donated blood is separated into multiple components, such as RBCs, plasma, platelets, and clotting factors
-thus, one unit of donated blood may be used in the care of 4 patients
What you need to be eligible to donate blood?
a person must be in good health, at least 16 years old, and weigh at least 110 lbs
-each potential donor is screened for travel to certain countries and for a variety of disorders (HIV, hepatitis, or “mad cow’s” disease)
Blood Groups: 4 main groups
A, B, AB, O
based on the presence or absence of certain antigens and antibodies
Antigen
proteins that illicit immune response
Antibody
protects the body from “invaders”
-tells the blood/body what to destroy
Why do you not want to have the same antigen and antibody?
because it will attack itself
- AB= no antibodies, A + B antigens
- A= B antibodies, A antigens
- B= A antibodies, B antigens
- O= A+B antibodies, no antigens
AB blood type is considered what?
universal recipient
-because of the absence of plasma antibodies
O blood type is considered what?
universal donor
-because of the absence of antigens
Rh Factors
an additional antigen that is important in blood typing
-if the antigen is present you are Rh-positive (Rh+)
-if the antigen is absent you are Rh-negative (Rh-)
>8 groups: ARh+, Arh-, BRh+, BRh-, ABRh+, ABRh-, ORh+, ORh-
>people who are Rh+ may receive blood with or without Rh factor
>people who are Rh- ay receive only Rh- blood
Sequence of what happens once blood is donated
several tests are performed on the sample
-first, the sample is tested for ABO group (blood type) and RH type (+ or -) as well as any unexpected RBC antibodies that may cause problems in a recipient
-Screening Tests–> assess for evidence of donor infection with hepatitis B and C viruses, HIV, human T-lymphotropic viruses, West Nile virus, and syphillis
>if all disease screenings are negative, the blood is acceptable for transfusion and is placed in the pool of available products
When a potential donor is identified what process if performed?
crossmatching
Crossmatching
identifies possible minor antigens that will affect the compatibility of the donor blood in the recipient
Process of Crossmatching
RBCs from the donor blood are mixed with plasma from the potential recipient
-a reagent is added, and the sample is observed for clumping or agglutination; if no clumping is observed, the risk of transfusion reaction is low, and it is safe to transfuse the sample of blood
Autologous
(self-donated)
- when possible, self donated units of blood are given instead of blood from a donor
- this negates the risk of a mismatch or exposure to undetected disease
Process of Autologous donation
the patients blood is usually collected in the pre-operative weeks for possible transfusion during elective surgery
- autologous donation is most often done with orthopedic, cardiac, and vascular surgeries
- the process of donating autologous blood stimulates the bone marrow to produce new blood cells
- given adequate time for recovery, the collected cells may be wholly or partially replaced prior to surgery
Blood Products: Several Blood products are available for transfusion
- Whole Blood
- RBC
- Platelets
- Plasma
- WBC
- Plasma Derivatives
Blood Products: Whole Blood
contains RBCs, WBCs, and platelets suspended in plasma
Blood Products: RBC
prepared from whole blood by removing the plasma
- RBCs can raise the clients hematocrit and hemoglobin levels while minimizing an increase in volume
- RBCs are available for transfusion as packed RBCs (PRBC)
Blood Products: Platelets
help the clotting process by sticking to the lining of blood vessels
- units of platelets are prepared by using a centrifuge to separate the platelet-rich plasma from the donated unit of whole blood;
- the platelet rich plasma is then centrifuged again to further concentrate the platelets
- platelets are used to treat clients who have a shortage of platelets or have abnormal platelet function
Blood Products: Plasma
is the liquid portion of the blood
- it is 90% water and makes up about 55% of blood volume
- plasma may be transfused whole or may be separated into specific products such as albumin, clotting factor concentrates, and immune globulins
Blood Products: WBC
specifically granulocytes (neutrophils, eosinophils, or basophils) can be collected by centrifugation of whole blood -they are transfused within 24 hours after collection and are used for infections that are unresponsive to antibiotic therapy
Blood Products: Plasma Derivatives
are concentrates of specific plasma proteins prepared from many units of plasma
-plasma derivatives include a variety of clotting factors, immune globulins, and albumin
What to do before beginning a transfusion?
verify the written prescription for the blood product
-it is critical to identify the patient and the blood product when transfusing blood
What to do when initiating a transfusion?
- obtain a set of vital signs 5 to 15 minutes before initiating a transfusion
- inspect the IV site to be sure it is patent before hanging the blood product
Rationale for: Obtain a set of vital signs 5 to 15 minutes before initiating a transfusion
if a patients temperature is elevated, inform the primary care provider before hanging the transfusion
- most patients experience a minor elevation in temperature after a transfusion is given
- a preexisting elevated temperature may exacerbate this response; as a result, premedication may be prescribed
Rationale for: Inspect the IV site to be sure it is patient before hanging the blood product
nurses commonly use a 20-gauge catheter to infuse blood- and a larger size for rapid flow rates
-for elderly or smaller children you will need a smaller 22 or 24 gauge catheter
Transfusion Reactions
- Allergic
- Bacterial
- Febrile
- Hemolytic Reactions
- Circulatory Overload
Transfusion Reactions: Allergic
allergy to blood being transfused
Transfusion Reactions: Allergic: S+S
flushing, itching, wheezing, urticaria (hives); anaphylaxis if severe
Transfusion Reactions: Allergic: Nursing Responsibilities
- stop the transfusion
- replace with a saline infusion
- notify the provider immediately
- administer prescribed antihistamine
Transfusion Reactions: Bacterial
contamination of the blood
Transfusion Reaction: Bacterial: S+S
fever, chills, vomiting, diarrhea, hypertension
Transfusion Reaction: Bacterial: Nursing Responsibilities
- stop the transfusion reaction
- replace with a saline infusion
- notify the provider
- administer antibiotics as ordered
- treat symptoms
Transfusion Reactions: Febrile
temperature elevation due to sensitivity to WBC, plasma proteins, or platelets
Transfusion Reactions: Febrile: S+S
fever, chills, warm, flushed skin, aches
Transfusion Reaction: Febrile: Nursing Responsibilities
- stop the transfusion
- replace with saline infusion
- notify provider
- treat symptoms
Transfusion Reaction: Hemolytic Reactions
destruction of RBCs as a result of infusing incompatible blood; occurs in 1 in 600,000 transfusions
Transfusion Reactions: Hemolytic Reactions: S+S
fever, chills, dyspnea, chest pain, tachycardia, hypotension; can be fatal
Transfusion Reactions: Hemolytic Reactions: Nursing responsibilities
- stop transfusion immediately
- replace with saline infusion
- notify provider immediately
- send remaining blood, including tubing and filter; a sample of venous blood, and the first voided urine to the lab for analysis
- treat shock
Transfusion Reactions: Circulatory Overload
administering too great a volume or too rapidly
Transfusion Reactions: Circulatory Overload: S+S
persistent cough, crackles, hypertension, distended neck veins
Transfusion Reactions: Circulatory Overload: Nursing Responsibilities
-slow or stop the transfusion
-monitor vital signs
-place client upright
-notify the provider
(do not replace with saline infusion because they are in fluid overload)
