Nurs 201 Unit 3

What are the primary clinical indications for transfusing Packed Red Blood Cells (PRBCs)?

Severe symptomatic anemia (typically hemoglobin < 7 g/dL), active hemorrhage/blood loss, and tissue hypoxia.

What are the key clinical indications for administering Fresh Frozen Plasma (FFP)?

Active bleeding due to coagulation factor deficiencies, liver disease, massive hemorrhage, DIC, and urgent reversal of warfarin toxicity

what are the key clinical indications for administering platelets ?

Active bleeding due to thrombocytopenia, prevention of bleeding before procedures in patients with severe thrombocytopenia , bone marrow failure disorder

Why are platelet units at a higher risk for bacterial contamination compared to other blood products?

Platelets are stored at room temperature (~20–24°C), which supports bacterial proliferation more readily than cold or frozen storage.

What are the primary clinical indications for administering Cryoprecipitate?

Hemophilia A, von Willebrand disease, hypofibrinogenemia, and massive bleeding disorders.

What are the key clinical indicators for administering albumin ?

symptomatic hypotension , hypovolemia , hypoalbuminemia , severe burns

What specific equipment step is required when priming IV tubing for an Albumin infusion?

The vent on the IV tubing spike must be opened because Albumin is packaged in a sealed glass vial.

Under what condition is Whole Blood transfusion indicated instead of component therapy?

Acute, massive blood loss exceeding 25% of total circulating blood volume (e.g., severe trauma, massive hemorrhage).

What is an autologous blood transfusion, and what is its main advantage?

Collection and reinfusion of the patient's own pre-donated blood; it virtually eliminates the risk of viral disease transmission

How does intraoperative blood salvage (cell saver) function during major surgery

It suctions shed blood from the surgical field, washes and filters the red blood cells, and reinfuses them back to the patient in real-time.

What three key elements must be included in the initial medical order for a blood product transfusion?

1. Product type

2. Quantity (volume or number of units)

3. Clinical indication / rationale

Which blood type is designated as the universal red blood cell donor, and which is the universal recipient?

Universal donor: O-Negative (O-) Universal recipient: AB-Positive (AB+)

Why is 0.9% Normal Saline the ONLY IV fluid compatible with blood product transfusions?

Dextrose solutions cause hemolysis; Lactated Ringer's contains ionized calcium, which binds to citrate anti-coagulant and causes blood clotting in the tubing.

Within what time frame must a blood unit be initiated after being released from the blood bank?

Transfusion must be initiated within 30 minutes of removal from refrigeration/blood bank

What is the maximum allowable duration for a single unit of blood to be infused, and why?

4 hours max; infusing beyond 4 hours significantly increases the risk of bacterial growth and sepsis.

List the mandatory core nursing actions required IMMEDIATELY upon suspecting ANY blood transfusion reaction.

1. Stop transfusion immediately

2. Maintain IV patent access with Normal Saline (new tubing)

3. Notify provider

4. Assess/monitor vitals

5. Notify blood bank

6. Return blood bag & tubing to lab

7. Document reaction

What are the sx and interventions for Febrile, Nonhemolytic Reaction

Sx : chills , rigor , HA , malaise , muscle pain , anxiety , tachycardia , tachypnea , fever (1.8F ) above baseline

interventions : antipyretic , antihistamine

What are the sx and intervention for Acute Hemolytic Reaction

Sx: Flank pain , chest tightness , nausea , low BP , tachycardia , SOB , hematuria , oliguria

Interventions :ABCS , BP support , monitor for disseminated intravascular coagulation (DIC)

• caused by incompatibility

What are the sx and intervention for an mild allergic reaction to a blood transfusion

Sx : Urticaria (hives ) , maculopapular rash ( flat and raised red spots) , pruritus (itching) and skin flushing

Interventions : Antihistamine , corticosteriods , supplemental o2

what are the sx and interventions for transfusion associated circulatory overload (TACO)

Sx : hypertension , tachycardia , JVD , crackles , dyspnea

Interventions : elevate HOB , diuretics , antihypertensive , supplemental o2

What are the sx and interventions for a transfusion related acute lung injury ( TRALI)

sx : acute respiratory distress , pulmonary edema , fever , hypotension

interventions: Supplemental o2 , vasopressors ( hypotension) , mechanical ventilation

what are the interventions for a bacterial contamination reaction ?

IV fluid resuscitation, Broad spectrum IV antibiotics, blood cultures

what are the sx and interventions for Graft vs Host disease ?

sx :erythematous and maculopapular rash (flat red spots and small raised bumps.) diarrhea , fever , hepatomegaly

interventions : Pt education on identifying and reporting sx post transfusion , immunosuppressants

What is the primary assumed cause of iron deficiency anemia in older adults until proven otherwise?

Undetected or microscopic gastrointestinal bleeding.

Which dietary source provides the highest and most absorbable amount of iron?

• Red meats and organ meats such as liver

• Dark green leafy vegetables, beans, and lentils.

What specific physical sign appears on the fingernails of a patient with chronic iron deficiency anemia?

Spoon-shaped deformities of the fingernails (koilonychia).

What tongue and lip findings are characteristic of iron deficiency anemia?

A smooth tongue and cracks at the corners of the mouth (cheilosis)

What clinical term describes the craving for non-food items like ice seen in iron deficiency anemia?

pica

Why does Total Iron-Binding Capacity (TIBC) increase in iron deficiency anemia?

The liver produces more transferrin to bind and capture any available iron.

What is the typical serum lab pattern for serum iron, ferritin, and TIBC in iron deficiency anemia?

Low serum iron, low serum ferritin, and elevated Total Iron-Binding Capacity (TIBC).

When should oral ferrous sulfate supplements ideally be taken for optimal absorption?

On an empty stomach, either 1 hour before or 2 hours after a meal.

Which vitamin or liquid should be administered alongside oral iron supplements to enhance GI absorption?

Vitamin C or citrus juice such as orange juice.

What expected change in stool appearance should a nurse warn a patient taking oral ferrous sulfate about?

The stool will turn dark black in color

What primary gastrointestinal side effect is associated with oral iron therapy?

constipation

What is the underlying cause of anemia in patients with chronic kidney disease?

Inadequate production of erythropoietin by the damaged kidneys.

What is the primary therapeutic indication for administering epoetin alfa (Epogen)

To stimulate bone marrow red blood cell production in chronic kidney disease or chemotherapy.

At what hard hemoglobin threshold must epoetin alfa therapy be held to avoid thromboembolic complications?

When the hemoglobin level reaches or exceeds 11 g/dL.

What is the most common cardiovascular adverse effect of epoetin alfa therapy?

HTN

What does Mean Corpuscular Volume (MCV) measure on a complete blood count?

The average volume or size of individual red blood cells

What MCV value defines a macrocytic anemia on a complete blood count panel?

An MCV greater than 100 fL.

Which neurological manifestations specifically distinguish Vitamin B12 deficiency from folate deficiency?

Symmetrical paresthesia in the lower extremities, loss of proprioception, and ataxia.

Why must Vitamin B12 deficiency be ruled out before starting high-dose folic acid therapy

Folic acid corrects blood counts but allows irreversible B12-induced nerve damage to progress unrecognized.

What classic physical sign appears on the tongue of a patient with pernicious anemia?

A smooth, sore, beefy-red tongue (glossitis).

What gastric defect causes pernicious anemia?

Absence of intrinsic factor produced by gastric parietal cells.

Why is oral Vitamin B12 ineffective for treating pernicious anemia?

The absence of intrinsic factor prevents Vitamin B12 absorption from the gastrointestinal tract.

Which long-term malignancy risk requires routine screening in patients with pernicious anemia?

Gastric cancer due to chronic parietal cell destruction.

Which long-term diabetes medication is known to impair Vitamin B12 absorption in the GI tract?

metformin

How do long-term proton pump inhibitors (PPIs) cause Vitamin B12 deficiency?

Decreased gastric acid prevents the cleavage and release of Vitamin B12 from food proteins

What severe, irreversible neurological condition can result from uncorrected thiamine deficiency in alcohol use disorder?

Wernicke-Korsakoff syndrome.

Which three clinical features characterize thiamine deficiency anemia?

Confusion, ataxia, and nystagmus

What complete blood count finding defines aplastic anemia?

Peripheral pancytopenia, characterized by reduced red cells, white cells, and platelets.

What is the standard average lifespan of a healthy circulating red blood cell?

approx. 120 days

What is the genetic inheritance pattern of sickle cell disease?

Autosomal recessive inheritance.

Why do infants with sickle cell disease remain asymptomatic for the first 4 to 6 months of life?

High levels of circulating fetal hemoglobin (HbF) prevent sickling.

What are the three core physical properties of sickled red blood cells that lead to vascular occlusion?

They are rigid, sticky, and poorly pliable (not flexible )

What is the primary clinical manifestation that brings patients with a vaso-occlusive sickle cell crisis to the hospital?

Severe, debilitating ischemic tissue pain.

What is the highest priority initial nursing intervention for a patient presenting in vaso-occlusive crisis?

Intravenous fluid hydration to expand vascular volume and reduce cell clumping.

What clinical features characterize Acute Chest Syndrome in a patient with sickle cell disease?

Fever, chest pain, dyspnea, hypoxia, and new pulmonary infiltrates on chest X-ray.

How does hydroxyurea benefit patients with sickle cell disease

It stimulates the production of fetal hemoglobin (HbF), reducing red cell sickling and painful episodes.

What prophylactic antibiotic is routinely prescribed for children with sickle cell disease starting at 2 months of age?

Daily oral prophylactic penicillin.

What morphologic appearance do red blood cells exhibit on a peripheral smear in thalassemia?

Hypochromic and microcytic (small and pale) red blood cells.

How many defective genes are required to cause Beta Thalassemia Major?

Two faulty or missing beta-globin genes.

How many missing alpha genes lead to the hydrops fetalis form of Alpha Thalassemia?

Four faulty or missing alpha-globin genes.

What causes the characteristic facial bone deformities seen in children with Beta Thalassemia Major?

Massive bone marrow expansion attempting to compensate for severe hemolysis.

What major organ-damaging complication occurs as a result of lifelong blood transfusions in thalassemia major?

Iron overload (hemosiderosis).