Week 3: Blood Transfusions

Purposes 4

1. increase volume

2. correct RBC and improve oxygen carrying caacity

3. maintain clotting ability

4. provide blood components

whole blood transfusions

when major blood loss has occured

packed red blood cells

imrpove o2 capacity'

volume expander

anemia

platelets

resposbible for clotting

for less than 10-20 000

Blood products (albumin)

albumin, IV imunoglobin, Rh immune globulin, prothrombin, complex concentrate

fresh frozen plasma

active bleeding , replacement of plasma

Pretransfusion ~ neuro

confusion, decreased energy, LOC

Pretransfusion~ resp

increases RR and effort, cyanosis, SOB

pretransfusion ~ cardiac

low BP, increased HR for compensation

Pretransfusion~ active bleeding

trauma, surgery

Pretransfusions ~ current treatments

chemo alters RBCs, WBC, platelets

pretransfusion ~ factor deficiencies

I, II, V, VII, VIII, X, XI, XIII, vit K

pretransfusion ~ lab values

CBC, RBC, Hgb

preparing blood tranfsuons

1. consent

2. call blood bank for sample

3. hospital protocol

4. 18-22 g needle

at the bedside, 2 nurses check ID on

1. transfusion record

2. label on blood product

3. clients ID

Before starting transfusion

1. take baseline vitals

2. check pt ID

3. start slowly

4. monitor VS

5. observe for hives, fever, rigours, dysnpea

6. blood must be started 30 mins and infused in 4 hours

why some clients have a reaction 6

1. incompatible blood

2. donor WBC

3. antibodies

4. bacterial contamination

5. allergens

6. donor viruses

Blood group O

Antibodies: anti A and B

Comptaibal RBC: O

Compatible Plasma: O, A, B, AB

A

Antibodies: anti B

Comptaibal RBC:A O

Compatible Plasma: A, AB

B

Antibodies: A

Comptaibal RBC: B O

Compatible Plasma: B AB

AB

Antibodies: neither

Comptaibal RBC: AB, A, B, O

Compatible Plasma: AB

Immediate reactiosn 4

1. mild allergic

2. anaphylaxis

3. febrile (non-hemolytic)

4. febrile hemolytic

Mild Allergic

MA ~ s/s 3

1. itching, flushing, hives

ma ~ intervention 5

1. stop transfusion

2. call HCP

3. anticipate antihistamine

4. continue w caustion

5. do not restar with fever, pulmonary or hypotension

Anaphylaxis

Ana~ s/s

1. Uirticaria

2. Erythema 

3. Anxiety 

4. Respiratory distress

5. Hypotension 

6. Edena

7. Bronchospasm 

8. N?V

9. Cyanosis

10. Tachycardia

11. Substernal pain 

12. LOC

13. Cardiac arrhythmia and arrest

Ana ~ Interventions 7

1. stop

2. assess

3. ask assisannce

4. do not leave client alone

5. notify HCP

6. expect epi, corticosteroid, antihistamines, vasopressors

7. o2 and VS check

Febfrile non hemolytic

FNH ~ s/s 4

1. Sudden shaking chills (rigours)

2. Fever with no breakdown in red cells 

3. Temperature increases more than 0.5 from pretransfusion 

4. Headache, flushing, anxiety, muscle pain

FNH ~ interventions

1. Stop transfusion 

2. Consult with physician 

3. Anticipate antipyretics, avoid aspirin in thrombocytopenic patients

Febrile Hemolytic

FH ~ s/s

1. Chills

2. Fever

3. Low back pain 

4. Flushing 

5. Tacycardia

6. Tachypnea

7. Hypotension 

8. Hemogloburia

9. Sudden oliguria

10. Circulatory shock 

11. Cardiac arrest

FH ~ interventions

1. Stop and replace the IV line 

2. Run normal saline in new tubing

3. Draw blood samples and send urine to the lab 

4. Assess client 

5. Ask for assist 

6. Do not leave the client alone 

7. Monitor for hypotension 

8. Notify MD 

9. Give diuretics 

10. Insert foley catheter

advantagous of autologus 3

1. No contamination 

2. Decrease complications 

3. No allergic reaction

types of autologus blood 4

1. Preoperative 

2. Intraoperative hemodiultion 

3. Intraoperative blood salvage (cell saver)

4. Post-operative blood salvage

anemia 4

1. iron

2. folic acid

3. b12

4. erythropoetin

pharm agents for bleeding 3

1. ddavp for clotting disorders

2. antifibronoltic

3. vitamin K