Blood Products and Transfusion Reactions - Adult Nursing Care II

A PREPLANNED process where an individual donates their own blood for their own future use, usually for a scheduled procedure like surgery?

Autologous blood donation

The process of collecting and reinfusing a patient's own blood lost during surgery or trauma collected (up to 4 hours)?

Auto transfusion

Blood donated by a specific individual (usually a family member or friend) for a specific patient in need

Donor (directed) specific blood

Blood donated by someone else and stored for later use by a recipient who is not the donor?

Bank blood (AKA allogenic blood)

Blood can ONLY be administered with what type of IV fluid?

0.9% sodium chloride other fluids can cause RBC hemolysis or clot formation due to incompatibility

Refers to the complete, unseparated collection of blood from the body, including all of its components like red blood cells, white blood cells, platelets, and plasma?

Whole blood

A blood product used to increase a patient's oxygen-carrying capacity, especially when they have lost a significant amount of blood or have anemia?

Packed red blood cells (PRBC's)

A component of blood that are crucial for blood clotting?

Platelets

A blood product derived from the liquid portion of whole blood that has been rapidly frozen to preserve its CLOTTING factors and other proteins?

Fresh frozen plasma (FFP)

A blood product derived from frozen plasma that's rich in clotting factors, particularly fibrinogen, Factor VIII, von Willebrand factor, and Factor XIII?

Cryoprecipitate

True or false blood products are typed and screened prior to infusion?

True

What type of blood product is this?

- Contains RBCs and plasma components

- Restores total volume, plasma proteins, and oxygen carrying capacity

- INCREASED risk for fluid overload

Whole blood product

What type of blood product is this?

- Primarily RBCs

- Given to increase Hgb/Hct and O2 carrying capacity in anemic patients

- Preferred method to replace acute blood loss (trauma, surgery)

- Requires ABO, Rh compatibility and cross match

Packed RBCs

In this blood product leukocytes are depleted thus decreasing the risk of febrile or mild allergic reaction?

Packed RBCs

1 unit of packed RBCs contains how many mLs?

250-300 mLs

1 unit or 250-300 mLs of packed RBCs must be given over how many hours?

2-4 hours

Why must an infusion of packed RBCs be completed within 4 hours?

Reduces risk of bacterial growth and hemolysis, which can occur if blood is left at room temperature for too long

What is the Hct:Hgb ratio?

Hct 3: 1 Hgb, meaning the hematocrit value is roughly three times the hemoglobin level

RBC cell types are categorized according to ____________ on RBCs?

Antigens on RBCs

Type A blood has what type of antigens?

A antigens

Type B blood has what type of antigens?

B antigens

Type AB blood has what type of antigens?

A and B antigens

Type O blood has what type of antigens?

No antigens

An inherited PROTEIN found on the surface of RBCs?

Rh factor

If Rh "D" factor is present patient is considered RH positive or negative?

RH positive

If Rh "D" factor absent, patient is considered RH positive or negative?

Rh negative

Who is considered the universal donor?

Type O negative (O−) blood

Who is the universal receiver?

AB positive (AB⁺) blood

What type of blood product is this?

- Plasma separated from RBCs and platelets; contains coagulation factors and complement

- Treats bleeding caused by reduction or loss of clotting factors

- May be used to treat bleeding d/t destruction of platelets

Fresh frozen plasma

What blood product has reverse effects of Warfarin?

Fresh frozen plasma

Fresh frozen plasma may be given to expand plasma volume though is used less frequently for this. What other product is used more for this?

Albumin

True or false fresh frozen plasma requires ABO compatibility because it contains plasma with antibodies that can react with the recipient's red blood cells if not matched correctly?

True

What part of the blood contains ABO antibodies?

Plasma

Fresh frozen plasma contains generally how many mLs?

200-250 mLs

How fast can fresh frozen plasma of 200-250 mL's be infused?

Infused quickly usually over 15-45 minutes

Fresh frozen plasma must be given within how many hours after being thawed?

Within 24 hours

A tranfusion of fresh frozen plasma must be completed within how main hours?

Within 4 hours once infusion has started

A patients blood type is O. What type of antigens do they have?

No antigens

A patients blood type is O. What type of blood can they receive?

O

A patients blood type is O. What type of antibodies do they have in their plasma?

A and B antibodies

A patients blood type is O. What type of plasma can they receive?

All types (A, B, AB, and O)- has no antigens therefore the antibodies can't attack

A patients blood type is A. What type of antigens do they have?

A

A patients blood type is A. What type of blood can they receive?

A and O

A patients blood type is A. What type of antibodies do they have in their plasma?

B antibodies

A patients blood type is A. What type of plasma can they receive?

A and AB

A patients blood type is B. What type of antigens do they have?

B

A patients blood type is B. What type of blood can they receive?

B and O

A patients blood type is B. What type of antibodies do they have in their plasma?

A antibodies

A patients blood type is B. What type of plasma can they recieve?

B and AB

A patients blood type is AB. What type of antigens do they have?

A and B

A patients blood type is AB. What type of blood can they receive?

All types (A, B, AB, O)

A patients blood type is AB. What type of antibodies do they have in their plasma?

No antibodies

A patients blood type is AB. What type of plasma can they recieve?

AB

True or false with PRBCs a Rh+ client may receive Rh+ or Rh-?

True

True or false a Rh- client may only receive Rh-?

True

With PRBC transfusions, we worry about our ____________ attacking the _____________

We worry about our antibodies attacking the donor blood

With plasma transfusions, we worry about donor _____________ attacking our ____________

We worry about donor antibodies attacking our blood

What type of blood product is this?

- Prevent or control bleeding from some forms of thrombocytopenia or impaired platelet function; may be used during cancer treatment

Platelets

With this type of blood product ABO/RH compatibility typically NOT REQUIRED though some facilities prefer it?

Platelets

What type of blood products require ABO compatibility?

PRBCs and FFP

With this blood product Rh- should be given to Rh- females of childbearing age to prevent a reaction?

Platelets

A typical platelet transfusion contains how many mLs per unit?

Per unit 35-50 mLs

How many units of platelets can be transfused at a time?

Up to 10 units

With a platelet transfusion you can expect a platelet increased of how much per unit?

5,000-10,000 per unit

True or false platelets can be infused rapidly?

True

With a platelet transfusion they must be completed within how many hours?

Within 4 hours

Album typically can a concentration of what percentage?

Albumin 5% and 25%

What type of blood product is this?

- Treats hypoalbuminemia and is used for volume expansion in hypovolemic shock, large burns, massive hemorrhage, liver failure (fail to produce albumin, may require paracentesis), and BP support in dialysis, plasmapheresis

Albumin

This type of blood product replaces INSOLUBLE clotting?

Cryoprecipitate

What type of blood product is this?

- Used to treat specific clotting deficiencies (i.e.: hemophilia A - Factor VIII deficiency) and control bleeding d/t fibrinogen deficiency (i.e.: DIC).

Cryoprecipitate

Cryoprecipitate replaces what 4 clotting factors?

1) Factors VIII (anti-hemophilic factor)

2) XIII (fibrin stabilizing factor)

3) Von Willebrand factor

4) Fibrinogen (Factor I)

Cryoprecipitate contains how many mLs per unit?

10-20 mLs per unit- can infuse multiple units at once

Cryoprecipitate must be infused within how many hours?

Within 4 hours

Who's at risk for fluid overload in blood transfusions?

1) Heart failure

2) HTN

3) Elderly patients

4) Kidney disease

5) Edema

What lab(s) or assessments should be done prior to those who are at risk of fluid overload?

1)B-type Natriuretic Peptide)

2) Creatinine & BUN

3) Electrolytes (especially sodium)

4) CBC

5) BP

6) Lung sounds

7) Weights

If someone has a history of a transfusion reaction what medication would be given prior to prevent allergic symptoms by blocking histamine release?

Diphenhydramine

If someone has a history of a transfusion reaction what medication would be given prior to help prevent or reduce fever as part of a premedication protocol?

Acetaminophen

If someone has a history of a transfusion reaction what medication would be given prior to suppress the immune response and reduce the risk of allergic or inflammatory reactions?

Hydrocortisone

If someone has a history of a transfusion reaction what 3 medications would be given prior to the infusion?

1) Diphenhydramine

2) Acetaminophen

3) Hydrocortisone

True or false those at risk for fluid overload in blood transfusion may be unable to tolerate rapid transfusion and may better tolerate half-unit blood transfusion?

True

For patients who are at risk for fluid overload with a blood transfusion the MD may order what medication between blood transfusion units?

IV furosemide (Lasix)

A serious complication of blood transfusions where the body cannot handle the volume of fluid being transfused, leading to fluid accumulation in the lungs and other tissues?

Transfusion-associated circulatory overload (TACO)

With transfusion-associated circulatory overload (TACO) you want to watch out for circulatory overload in patients with cardiac, renal, or _________ disease

Liver disease

All of these are clinical manifestations of what blood transfusion reaction?

- Dyspnea

- Tachypnea

- HTN

- Distended neck veins

- Moist lung sounds (crackles)

- Tachycardia

- Headache

- Delayed hand vein emptying when hand raised

Transfusion-associated circulatory overload (TACO)

What is the first thing you should do if you notice your patient has circulatory overload when receiving a blood transfusion?

STOP the transfusion!

With circulatory overload with a blood transfusion you want to maintain the IV with what type of solution?

Maintain IV with normal saline solution

After stopping the transfusion with circulatory overload you want to assess your patient which includes what 3 things?

1) Get VS

2) Administer oxygen

3) Elevated head of bead

After you have assessed your patient who was experiencing circulatory overload what is the next thing you want to do?

Notify provider and blood bank!

After you have notified the provider blood bank of your patient experiencing circulatory overload what may you administer and obtain due to the providers order?

Administer diuretic and obtain chest x-ray

If your patient experienced circulatory overload what do you want to monitor for?

Monitor urine output

How can circulatory overload be prevented?

1) Adjust volume and rate based on patient size and status

2) See if blood bank can divide units into smaller volumes

A life-threatening reaction to a blood transfusion that occurs within 24 hours, often within minutes, of starting the transfusion. It is caused by the destruction of donor red blood cells by the recipient's antibodies, typically due to ABO blood group incompatibility.

Acute Hemolytic Transfusion Reaction (AHTR)

ABO-incompatible blood transfused to recipient is considered what type of hypersensitivity?

Type 2

A acute Hemolytic Transfusion Reaction (AHTR) usually occurs within how minutes of the transfusion being started?

Within 15 minutes

In an Acute Hemolytic Transfusion Reaction (AHTR) IgG and/or IgM antibodies coat foreign (transfused) RBCs. What 3 steps are involved in this process?

1) Agglutination- the process where particles in a liquid clump together due to the binding of antibodies to antigens on the surface of the particles

2) Depletion of clotting factors

3) Complement activation

When the complement system is activated hemolysis occurs causing what to be released?

Free hemoglobin gets released in the plasma

When the complement system is activated hemolysis occurs causing a decrease in _____________ function and _______________?

Decrease in renal function and vasoconstriction

What are some clinical manifestations of an Acute Hemolytic Transfusion Reaction (AHTR)?

1) Onset typically acute

2) Complaint of anxiety

3) Flank/low back, abdominal and/or chest pain

4) Dyspnea or tachypnea

5) Tachycardia

6) Hypotension

7) Fever and/or chills

8) N/V

9) Bleeding (possible DIC)

10) Jaundice

11) Prerenal AKI

12) Dark urine

13) Can progress to vascular collapse (shock) and death if not treated

If a patient is experiencing a Acute Hemolytic Transfusion Reaction (AHTR) what is the first thing you do?

STOP the transfusion

After stopping the transfusion with a AHTR you want to assess your patient, which includes?

Assess ABCs leading to treatment if needed and monitor VS