Blood Administration and Transfusion Reactions

A comprehensive vocabulary review of blood administration, covering component therapies, compatibility typing, acute and delayed transfusion reactions, massive transfusion management, and bedside nursing protocols.

Packed Red Blood Cells (PRBCs)

A concentrated blood product containing red blood cells separated from whole blood, transfused to restore oxygen-carrying capacity while minimizing fluid volume overload.

Fresh Frozen Plasma (FFP)

A liquid blood component separated from whole blood containing plasma proteins and clotting factors, used to manage coagulation deficiencies.

Platelets

A cellular blood component transfused to treat or prevent bleeding; carries the highest risk of bacterial contamination and transfusion-transmitted sepsis among blood products.

Albumin

A fractionated plasma protein derived from pooled human donor blood, prepared in concentrations such as $5\%$ to act as an intravenous colloidal volume expander.

ABO Blood Group System

The system classifying human blood into four major groups ($A$, $B$, $AB$, and $O$) based on specific antigens on the red blood cell surface and reciprocal antibodies in the plasma (except in type $AB$, which has no antibodies).

Rhesus (Rh) Factor

An erythrocyte surface antigen present in approximately $85\%$ of individuals ($Rh^+$); individuals without the antigen are $Rh^-$ and develop antibodies only upon exposure to $Rh^+$ blood.

RhoGam

An injectable Rh immune globulin given to an $Rh^-$ mother following exposure to $Rh^+$ fetal blood to destroy maternal Rh antibodies and prevent hemolytic disease in subsequent pregnancies.

Crossmatch

A pre-transfusion laboratory test that mixes recipient plasma with donor red cells to detect minor, atypical antibodies that could trigger an adverse hemolytic reaction.

Universal Donor

An individual with type $O^-$ blood whose red blood cells lack $A$, $B$, and Rh antigens, allowing their red cells to be transfused to any recipient in an emergency.

Universal Recipient

An individual with type $AB^+$ blood whose serum lacks $A$, $B$, and Rh antibodies, allowing them to safely receive red blood cells of any ABO/Rh blood type.

Two-Person Verification Process

A Joint Commission National Patient Safety Goal requirement where two qualified individuals, including the administering transfusionist, verify patient identity, order, donor blood ID, blood group, and expiration prior to transfusion.

Acute Hemolytic Reaction

A severe, life-threatening reaction caused by ABO or Rh incompatibility occurring within $5\text{ to }15\,\text{minutes}$ of transfusion initiation, causing rapid intravascular destruction of donor RBCs, shock, and acute renal failure.

Hemoglobinuria

The excretion of free hemoglobin into the urine, resulting in a distinct reddish or brown urine appearance caused by rapid intravascular hemolysis during an acute hemolytic reaction.

Delayed Hemolytic Reaction

A mild, self-limiting transfusion reaction occurring $2\text{ to }14\,\text{days}$ post-transfusion caused by the destruction of donor RBCs by undetected minor recipient antibodies, presenting with fever, mild jaundice, and decreased hematocrit.

Febrile Non-Hemolytic Reaction

The most common transfusion reaction, caused by recipient antibodies reacting to donor leukocytes and platelets; presents with sudden chills, flushed skin, headache, and a temperature of $\ge 100.4^\circ\text{F}\ (38^\circ\text{C})$.

Leukocyte Reduction Filter

A specialized inline microaggregate filter used during blood component administration to deplete white blood cells from donor blood, preventing febrile non-hemolytic reactions and leukocyte sensitization.

Washed Red Blood Cells

Red blood cells that have been cleaned with saline to remove virtually all plasma proteins and remaining leukocytes, indicated for patients who experience recurrent febrile or allergic reactions.

Mild Allergic Transfusion Reaction

A hypersensitivity response occurring during the first hour of transfusion due to recipient sensitivity to donor plasma proteins, characterized by flushing, urticaria (hives), and pruritus.

Severe Allergic (Anaphylactic) Transfusion Reaction

A life-threatening systemic hypersensitivity response manifesting with chest tightness, bronchospasm, laryngeal edema, stridor, decreased $O_2$ saturation, and shock.

Transfusion-Related Sepsis

A systemic bacterial infection caused by the infusion of contaminated blood (most frequently platelets), presenting with rapid onset of chills, high fever, vomiting, diarrhea, hypotension, and shock.

Transfusion-Associated Circulatory Overload (TACO)

A hypervolemic complication resulting from transfusing blood too rapidly or in excessive volume, characterized by dyspnea, orthopnea, crackles, jugular vein distention, hypertension, tachycardia, and bounding pulses.

Unit Splitting

The practice of dividing a $300\,\text{mL}$ unit of blood into two separate $150\,\text{mL}$ bags to allow each half to be transfused over $3\text{ to }4\,\text{hours}$, preventing circulatory overload in susceptible patients.

Hypothermia in Massive Transfusion

A core body temperature reduction caused by the rapid administration of cold, refrigerated donor blood products, which is prevented by using an in-line blood warmer or rapid infuser.

Citrate-Induced Hypocalcemia

A massive transfusion complication where the citrate anticoagulant preservative in stored blood binds to circulating serum calcium; managed by administering calcium gluconate after every $2\,\text{units}$ of blood.

Hyperkalemia in Massive Transfusion

An electrolyte complication resulting from the progressive deterioration of stored red blood cells and release of potassium into the plasma; managed by giving $1\,\text{unit}$ of fresh blood after every $5\text{ to }6\,\text{units}$ of stored blood.

Therapeutic Apheresis

A procedure utilizing a specialized machine that separates and removes specific pathogenic components (e.g., platelets, plasma, RBCs, autoantibodies) via centrifugation and filtration, returning the remainder to the donor.

Therapeutic Phlebotomy

The controlled withdrawal of a prescribed volume of whole blood under clinical conditions to reduce total circulating blood volume and lower elevated hematocrit levels, as in polycythemia.

Type and Crossmatch Validity Window

The maximum duration of $72\,\text{hours}$ that pre-transfusion blood typing and antibody crossmatch testing remain valid before a new recipient sample must be drawn and tested.

Pre-Transfusion Temperature Threshold

A baseline patient body temperature of $\ge 100^\circ\text{F}\ (37.8^\circ\text{C})$ that must be reported to the prescribing physician prior to initiating blood component administration.

Minimum IV Catheter Gauge for Blood Transfusion

A vascular access cannula size of $20\,\text{gauge}$ or larger, required to allow unobstructed infusion and prevent mechanical lysis of donor red blood cells.

Keep Vein Open (KVO) Rate

An initial normal saline infusion rate of $25\,\text{mL/hr}$ (or $4\,\text{gtt/min}$ with a $10\,\text{gtt/mL}$ drip factor) utilized to maintain vascular access patency while preparing blood products.

Blood Administration Y-Tubing

A specialized administration set containing an in-line blood filter, drip chamber, and two upper spiked arms with roller clamps dedicated exclusively to normal saline ($0.9\%\,\text{NaCl}$) and the blood product.

Blood Transfusion Initiation Window

The strict $30\text{-minute}$ timeframe within which a blood product transfusion must be started following its release from the blood bank to maintain storage temperature and prevent bacterial growth.

Initial Transfusion Infusion Rate

The cautious starting rate of $75\,\text{mL/hr}$ (or $13\,\text{gtt/min}$) maintained during the first $15\,\text{minutes}$ of transfusion while the nurse remains bedside to monitor for immediate adverse reactions.

Maintenance Transfusion Infusion Rate

The target infusion rate adjusted to $125\text{ to }150\,\text{mL/hr}$ (or $21\text{ to }25\,\text{gtt/min}$) after the initial 15-minute observation period, tailored to the patient's cardiovascular and renal tolerance.

Maximum Transfusion Duration

The maximum allowable infusion duration of $4\,\text{hours}$ per unit of blood to minimize the risk of ambient temperature warming and bacterial proliferation.