Blood Products

Colloids

Increase oncotic pressure, move fluid from interstitial compartment to plasma compartment

Colloids indication

Shock, severe hypovolemia

Colloids MOA

Increases oncotic pressure by replacing large proteins in the blood stream

Colloids contraindications

Fluid overload

Colloids adverse effects

Have no clotting factors or oxygen-carrying capacity, more expensive than crystalloids but need less to increase blood volume

Colloids nursing implications

Monitor for therapeutic/adverse effects, administer colloids, monitor for fluid overload and possible heart failure

Fresh-frozen plasma (FFP)

Includes all factors in soluble coagulation system, indicated with multiple factor deficiencies, bleeding, reversal of anticoagulation

Cryoprecipitate

Concentrated subset of ffp, indicated for bleeding disorders (i.e. von willebrand disease)

Packed red blood cells (PRBCs)

Increase oxygen-carrying capacity in patients, 1 unit will raise the hematocrit of a patient by ~3%, replace when hct < 7 or symptomatic

Whole blood

More beneficial than prbcs in extreme (greater than 25%) blood loss because it contains plasma, contains plasma proteins and clotting factors, which help draw fluid back into blood vessels from surrounding tissues

Platelets

Indicated to prevent hemorrhage, thrombocytopenia, or platelet function defects, replace when <50,000

Blood products MOA

Replacement of deficient blood product (depends on patient condition)

Blood products contraindications

Religion may not allow blood product replacement

Blood products adverse effects

Hemolytic reactions (acute or delayed) (non-immune or immune mediated), transfusion reaction, TRALI

Blood products nursing implications

Monitor for therapeutic effect/adverse effects, stay in patient’s room for at least the first 15 minutes of transfusion, vital signs q15 minutes for the first hour of transfusion

Immune acute hemolytic reactions

Within 24 hours of transfusion, intravascular or extravascular, cross-match testing/type and screen (educes incidence, usually done every 3 days)

Intravascular acute hemolytic reactions

Severe due to ABO antibodies

Extravascular acute hemolytic reactions

More common (hemolysis by spleen or liver)

Non-immune mediated acute hemolytic reactions

Caused by bacterial overgrowth (expires: 4 hours), improper storing, infusing with incompatible medications, hypotonic solutions or through small-bore IV tubing

Transfusion related acute lung injury (TRALI)

Noncardiogenic pulmonary edema; causes acute hypoxemia, occurs within 6 hours of a transfusion, patients with TRALI have no other risk factors

Transfusion related acute lung injury (TRALI) presentation

Rapid onset dyspnea or tachypnea, pulmonary crackles; maybe fever, cyanosis, hypotension