AH3 Exam 1: Blood

1. Packed RBCs

2. Whole Blood

3. FFP

4. Platelets

5. Cryoprecipitate

6. Albumin

• Packed RBCs: replaces O2-carrying RBCs

• Whole Blood: massive hemorrhage

• Plasma (FFP): clotting factors

  • helps form blood clots

• Platelets: forms initial platelet plug (repairs injured blood vessels)

• Cryoprecipitate: fibrinogen (strengthens clots)

  • contains Factor VIII, Factor XIII

• Albumin: protein (increase blood viscosity)

How long can pts donate blood up to for autotransfusions?

And how often can they do this?

• donate up to 6 weeks b4 surgery!

• can donate weekly if H&H stay stable

What does 1:1:1:1 mean in Massive Transfusion Protocol?

1 PRBC: 1 Plasma 1: Platelet 1: Cryoprecipitate

• basically mimics whole blood

Considerations for massive transfusion protocol: (4)

• what lab do u want to monitor?

1. Emergency release (o+/o-)

• no time to type & cross

2. Tranexamic acid (aka TXA)

• antifibrinolytic med.

• preserves clot

3. Labs

• monitor low Calcium

• citrate in blood bag binds to Ca = ⬇Ca+

  • decreased Ca means ⬇CO, Hypotension

4. Hypothermia

• large amts of cold blood products ⬇body temp and worsen coagulopathy

What fluids to always give pt when giving blood?

0.9% NS and new tubing!!

What is FFP?

• considerations: (3)

Fresh plasma immediately frozen after donation

1. needs ABO compatibility

2. platelets are fragile = hung to gravity

• dont pressure infuse!!

3. VS taken 15 mins b4 infusion, q15mins for 1 hr, then on completion.

What causes an Acute Hemolytic Rx:

Findings specific to Acute Hemolytic Rx: (4)

→ ABO incompatibility (Rh factor or Blood type)

• as little as 10 mL… x_x

1. low back pain (kidneys → erythropoietin)

2. hemoglobinuria

3. chest tightness/pain

• tachypnea, tachycardia

• flushing, anxiety, nausea

3. impending doom

Why would a patient develop Febrile rx?

classic finding?

→ pt had multiple transfusions → anti-WBC antibodies

• ABO good, just has a fever

1. ⬆ > 1^oF (0.5^o C) from pretransfusion temp

Nursing actions to reduce Febrile reactions: (3)

1. use WBC filter for admin to catch WBCs

2. stop transfusion and give antipyretics

3. start 0.9 NS using new tubing

Mild allergic transfusion rx s/s(2) + treatment

Severe (4) allergic rx+ treatment (5)

Mild:

1. itching

2. urticaria (hives)

→ diphenhydramine

Severe: (4)

1. bronchospasms

2. laryngeal edema

3. hypotension

4. shock

→ EPI, corticosteroids, vasopressors, O2, CPR

What causes bacterial transfusion rx:

Findings: (2)

→ contaminated collected blood

• not common now

1. wheezing

2. dyspnea

Findings of Circulatory overload from a blood transfusion: (4)

• tx: (2)

→ blood given too quick or in HF pts

s/s: (4)

1. crackles

2. dyspnea

3. JVD

4. pulmonary edema

tx: (2)

1. position upright. legs below level of heart

2. diuretics

What is Transfusion-Related Acute Lung Injury (TRALI)

• 2 key findings:

• serious blood reaction where pt suddenly develops pulmonary edema w/ hypoxia (ARDS)

1. CXR: Bilateral infiltrates

• no evidence of pulmonary vascular overload

  • hypoxemia

  • hypotension

2. Progressive Refractory Hypoxemia:

• giving pt O2 but still de-sating