B trans

The student will:
  - Understand nursing care related to blood product transfusion.
  - Understand complications associated with transfusion reactions.
  - Understand nursing care related to transfusion reactions.

Packed Red Blood Cells (PRBCs):
  - Volume: 225-360 ml
  - Increases hemoglobin (Hgb) by 1 gm/dL and hematocrit (HCT) by 3%.
  - Used for:
    - Symptomatic anemia
    - Chronic blood loss
Plasma (Fresh Frozen Plasma - FFPs):
  - Volume: 200-250 ml.
  - Indicated for decreased/deficient plasma coagulation factors.
  - Common scenarios: Trauma, disseminated intravascular coagulation (DIC), emergent reversal of PT/INR.
Platelets:
- Volume: 40-70 ml.
- Indicated for bleeding due to thrombocytopenia.
Albumin:
  - Volume varies.
  - Used for volume expansion.
  - Prepared from plasma; can influence platelet function.

Type and Screen:
- Conducted if a transfusion is anticipated but not yet definite.
Type and Cross:
- Performed when a transfusion is required.
- Results are valid for 72 hours.
ABO Compatibility:
- Ensures blood types are compatible.
Rhesus (Rh) Factor:
- Determines positive (+) or negative (-) status of blood.
Human Leukocyte Antigen (HLA):
- Proteins present on the surface of white blood cells (WBCs).

Blood Type Compatibility:
  - A: Can receive from A or O; can donate to A or AB
  - B: Can receive from B or O; can donate to B or AB
  - AB: Can receive from all types; can donate to AB only
  - O: Can receive from O only; universal donor
Rh Compatibility:
- Rh- can only receive Rh- blood.
- Rh+ can receive both Rh+ and Rh- blood.

Type and cross match.
Obtain informed consent from the patient.
Ensure appropriate IV access (18-20 gauge).
Use blood tubing (Y tubing).
Infuse with 0.9% Normal Saline (NS) only.
Use a dedicated line for infusion.
Change tubing with each unit transfused.
Transfusion must be started within 30 minutes of arrival on the floor.
Cannot run longer than 4 hours (typically lasts 1.5-2 hours).
- Monitor for risk of infection; blood products should be kept at room temperature.

Blood compatibility check:
- Check requires two licensed nurses and adherence to the 5 Rights framework.
- Confirm patient identity and blood product.
Monitor vital signs (VS) for baseline.
- Report if temperature is >100.5°F to the provider.
Perform respiratory assessment.
Prime the IV line with NS first.
After priming, prepare line with PRBCs and monitor lung sounds.
- Begin transfusion slowly.

Start the transfusion slowly.
Stay with the client for the first 15 minutes.
Monitor transfusion rate and duration.
Monitor vital signs: 15 minutes after starting, then hourly, at end of transfusion, and one hour post-transfusion.
Continually monitor and assess respiratory status.

Monitor the patient's response to transfusion.
Take vital signs (VS).
Complete a CBC (complete blood count).
Assess for increased blood pressure (BP), weight, heart rate, and oxygen saturation (TO2).

Cause: Sensitivity to donor plasma proteins.
Clinical Manifestations:
  - Itching and urticaria.
  - Flushing of the face.
  - Anxiety.
  - Shortness of breath (SOA).
Nursing Care:
  - Stop transfusion immediately.
  - Monitor vital signs and assess the patient's condition.
  - Notify the provider.
  - May consider restarting the transfusion at a slower rate with an order.
  - Administer antihistamines (e.g., diphenhydramine) based on baseline.

Transfusion-Associated Circulatory Overload (TACO):
Cause: Fluid infusion faster than the circulation can accommodate.
High Risk: Patients with cardiac or renal diseases.
Clinical Manifestations:
  - Shortness of breath (SOA).
  - Edema/jugular venous distention (JVD).
  - Increased BP.
  - Headache.
Nursing Care:
  - Stop transfusion.
  - Monitor vital signs and assess the condition.
  - Notify the provider.
  - Restart at a slower rate if applicable.
  - Consider diuretics, oxygen, and elevated head of bed (HOB).

Cause: Antibody reaction to white blood cells (WBCs) or platelets.
Clinical Manifestations:
  - Temperature increase of 2 degrees F.
  - Chills.
  - Headache.
  - Chest pain.
Nursing Care:
  - Stop transfusion.
  - Monitor vital signs and assess.
  - Notify the provider.
  - May restart at a slower rate with an order.
  - Administer antipyretics (e.g., acetaminophen).

Cause: ABO incompatibility.
Clinical Manifestations:
  - Fever and chills.
  - Flank pain.
  - Decreased BP.
  - Vascular collapse.
Nursing Care:
  - Stop transfusion and start Normal Saline (NS).
  - Monitor vital signs and assessment.
  - Notify provider immediately.
  - Keep blood bag for investigation.

Cause: Sensitivity to donor plasma proteins.
Clinical Manifestations:
  - Anxiety.
  - Abdominal pain.
  - Hives.
  - Dyspnea (difficulty breathing).
  - Wheezing progressing to bronchospasm.
  - Hypotension.
  - Possible cardiac arrest.
Nursing Care:
  - Stop transfusion and do not restart.
  - Monitor vital signs and patient assessment.
  - Notify provider.
  - Administer oxygen.
  - Be prepared to inject epinephrine and possibly use antihistamines, corticosteroids, and β2-adrenergic agonists.

Cause: Reaction between transfused anti-leukocyte antibodies and recipient leukocytes, causing pulmonary inflammation and capillary leak.
Clinical Manifestations:
  - Fever.
  - Chills.
  - Hypotension.
  - Tachypnea (increased respiratory rate).
  - Frothy sputum.
  - Dyspnea.
  - Hypoxemia (low oxygen levels).
  - Respiratory failure; can occur within 1-6 hours of transfusion.
Nursing Care:
  - Frequently monitor vital signs.
  - Provide oxygen and administer corticosteroids as ordered.
  - Start CPR if necessary and provide ventilatory and BP support.
  - Draw blood for arterial blood gases (ABG).
  - Obtain chest x-ray to assess condition.

The nurse is preparing to transfuse 2 units of PRBCs to a client. The patient has A+ blood type. The donor has A- blood type. Can the patient safely receive this blood?
- Yes.
- No.
A client is brought into the hospital requiring an emergent blood transfusion. What blood type can be used if the patient's blood type is not known?
- O- (universal donor).