True or False
Any unexpected signs, symptom or change during or after admin of blood products should be assumed to be suspect for transfusion reactions
What are the signs of a transfusion reaction?
What are the types of transfusion reactions?
Acute Hemolytic Transfusion Rxn (AHTR)
Febrile Non-Hemolytic (FNHTR)
Transfusion Related Acute Lung Injury (TRALI)
Uriticarial (Mild allergic)
Bacterial contamination (septic)
Transfusion-assoc. circulatory overload (TACO)
What are the AHTR symptoms by system?
Systemic = chills/fever
Heart = incr. HR
Vascular= HYPOtension, uncontrolled bleeding
Vein = heat sensation
Chest = constricting pain
Lumbar = pain
Urinary = hemoglobinuria/hyperbilirubinemia
What are potential causes of AHTR?
antigen/antibody rxn d/t ABO incompatibility
80% d/t clerical errors in labeling
What pre-medication measures might we consider prior to transfusions?
antihistamine and/or acetaminophen
Ok, after stopping the tranfusion in a rxn, then what?
Call Response team
support pt sx's
notify blood bank
keep IV line open w/ 0.9% NS
*new tubing + bag
check pt. ID/unit ID
tx sx's per provider order
return blood bag w/ tubing + fluids
What is the solution we keep running in the IV after we stop the transfusion?
0.9% NS w/ new tubing + bag
True or False
The only antigens on RBC's are ABO
Tons of others but are universal and so antibodies don't react to them
If the pt.'s blood has been screened and no antibodies to the universal RBC antigens are found what kind of blood can they get?
What if the pt's blood is screened and unexpected antibodies are found?
pt. must have crossmatched blood
What kind of RBC antigens are present on people with type A? What antibodies?
A- RBC antigens
What can donor whole blood be broken down into?
RBC's - Platelet-rich plasma
Platelet-rich plasma = Plasma + Platelets
Plasma can be broken down to cryoprecipitate
What is the non-emergent RBC infusion rate?
1 unit / 1.5-2hrs
*Can infuse for up to 4hrs
what tests assures that the intended donor unit selected and tested with pt. sample to determine compatibility
Type and Crossmatch
(Type and screen and crossmatch)
Aside from the 2 pt. identifiers what other standard checks must we perform before administering blood products?
Check transfusion report to bag label
What is involved in verifying transfusion report to bag label?
Kind of component (RBC, PLT, etc.)
Expiration of unit
Expiration of crossmatch
What other admin. responsibilities does the Nurse have for admin. of blood prods?
Assure IC is signed
assure the transfusion is clinically indicated
RN is ready to monitor pt closely
We have the appropriate equip.
How often do we do VS and which ones do we do on our transfusion pts?
Baseline before transfusion
@ 15min into transfusion
*BP, HR, RR, SaO2, Temp.
How often do we do an assessment and what is included in the assessment?
Baseline before transfusion
min q 30min during transfusion
*Skin , Lung, Gen. Assess
What equipment do we need for a transfusion?
*bloodwarmer not necessary in routine transfusion
What is pheresing?
draw blood from single donor, take out the PLT, reinfuse the blood back into the donor
*yeilds 200-400mL platelets + plasma
What guage needles do we use for blood products?
19-guage or >
*18-guage or 16-guage are used for rapid infusions
PRBC's are prepared from __________ by ______________ process. One unit = ________mL's
sedimentation or centrifugation
Why are PRBC's preferred to RBC
Less danger of fluid overload
leukocyte depletion can be done to reduce hemolytic febrile rnxs
Frozen RBC's are prepared using __________________ and can be stored for ______yrs @ __________ temp.
glycerol and frozen
@ -188.6F / -87C
How soon must frozen RBC's be used once thawed? How do we get out the WBC's and plasma proteins?
Must use w/in 24hrs of thawing
successive washing w/ saline soln'
PLT come from ________ w/in _______hrs of collection, one unit of PLT = ______ mL of platelet concentrate?
fresh whole blood
w/in 4hrs of collection
What is the expected PLT rise after infusing one unit? If there isn't a rise what do we suspect?
Fever, sepsis, splenomegaly or DIC
When are PLT contraindicated except in life-threatening emergency?
thrombotic thrombocytopenic purpura
Fresh frozen plasma is processed by _____________, one unit plasma = ________mL, it can be stored for ______ and must be used _______ after thawing
separated from whole blood and frozen
one unit = 200-250mL
use w/in 2hrs of thawing
Who gets plasma?
bleeding d/t clotting factor deficiency:
Vit K deficiency
Albumin is prepared from __________, it can be stored for _______ and comes in what two solutions?
albumin prepared from plasma
stored for 5yrs
available in 5% and 25% soln'
How does albumin work?
hyperosmolar soln' acts by moving water from extravascualr to intravascula space
cryoprecipitates and commercial concentrates are prepared from ______, yielding about ______ mL/bag, it can be stored for ____, once thawed need to use _________
fresh frozen plasma
1 bag = 10-20mL
stored for 1yr
must be used immediately after thawing
Who gets cryoprecipitates?
replacement of: clotting factors esp. factor VIII and fibrinogen
If you do a baseline assessment and the pt. has a fever or any other abnormal VS what do you do?
Call provider to clarify whether you should still give the blood product
The blood should be given to the pt ___________, how long can it be stored on the unit?
give to pt. as soon as brought to pt.
DO NOT REFRIGERATE ON UNIT
If not used w/in 30min send it back to the bank
Why don't we infuse for over 4 hours?
increased risk of bacterial growth once it is out of refrigeration
What do we check in addition to the VS previously listed in a transfusion reaction?
BP, HR, RR, SaO2 + URINE OUTPUT
What is the etiology of an acute hemolytic rxn?
antibodies in pt. react w/ antigens in donor RBC - > agglutination - > obstruct capillaries - > hemolysis of RBCs releases Hgb into plasma -> Hgb overloads/blocks kidneys = ARF, DIC, DEATH
febrile rxn are d/t
leukocyte incompatibility; people who get 5+ transfusions can devlop antibodies to WBC in donor blood, can use addl' filters in tubing, filtered, washed or frozen products can also be used to reduce febrile rxn
How can we do to reduce febrile rxns in pts who get frq transfusions?
pre-med w/ acetaminophen and diphenhyramine 30 min before transfusion
allergic rxn result from the pts sensitivity to ______ in the donor blood and are more common in pts w/ a hx of ____________
____________ may be used to prevent allergic rxn and ___________ are used to tx severe allergic rxns
epi or corticosteriods
AHR is caused by __________, has the sx's of __________________
low back pain
acute kidney injury
Tx shock and DIC
draw blood samples*
mtn BP w/ IV colloid soln'
What to do about AHR
*draw slowly to avoid hemolysis
*diruetics to mtn urine flow
*catheter to measure output
Sudden chills and fever = rise in temp >1C
Febrile non-hemolytic rxn
*sensitization of WBCs, platelets or plasma proteins
DO NOT RESTART INFUSION UNLESS ORDERED TO
Tx for Febrile non-hemolytic rxn
*avoid aspirin in thrombocytopenic pts
if sx's are mild/transient transfusion may be restarted slowly*
What to do about mild allergic rxn
*DO NOT RESTART if fever or pulmonary sx's are present
possible cardiac arrest
distended neck veins
fluid overload rxn
*fluid admin too fast
place pt upright w/ feet dependent
admin diuretics, O2, morphine
*phlebotomy may be indicated
what to do about fluid overload rxn
rapid onset of chills
*from bacterially infx blood prods
Obtain culture of pts blood an send bag w/ reaming blood and tubing to bank
give antibiotics, IV fluids, vasopressors
treatment for sepsis rxn
rxn btwn transfused antileukoctye antibodies and pts leukocytes which causes pulmonary inflammation and capillary leak
transfusion-related acute lung injury
send bag + tube + blood to bank
draw blood for ABG's
initiate CPR if necessary
provide ventilatory and BP support if necessary
tx for TRALI
*diruetics don't work on TRALI
impaired thyroid/gonadal fx
tx w/ chelating agents
occurs in people receving >100units of blood for chronic anemia: sickle cell, B-thallassemia
What agent chelates Fe out of the blood and and removes it via the kidneys, is given IV or SQ
True or False
Women can donate PLASMA aphoresis?
*Only males can do PLASMA aphoresis b/c females could have HLA's as a result of pregnancy