-
Describe these blood sources of transfusion
1. Homologous
2. Designated
3. Autologous and the two types
- 1. Homologous: donated by someone other than recipient
- 2. Designated: Donated from friends or relatives of recipient
- 3. Autologous: reinfusion of recipient's own blood
- - Intraoperative: blood going out from body, cleaned/filtered, and reentering
- - Postoperative: seen on orthounits, and from the surgery site, blood goes into special canister and back into patient
-
Describe what whole blood consists of, considerations, and indications
- Consists of: RBCs, plasma, WBCs, and platelets
- Considerations: can be separated into 3 components (patient won't always need everything), less risky this way for exposure
- Indications: acute massive blood loss with s/s such as (hypotension, dyspnea, tachycardia, pallor)
-
Describe characteristics of RBCs (PRBCs)
What interventions can be tried first before going to PRBCs?
List indications
- A unit of RBCs prepared by removing plasma (70-80%) leaving original volume of RBCs, and some leukocytes and platelets (known as PRBCs)
- It has less citrate, K, and ammonia during transfusion
- 1 unit of PRBCs should increase hemoglobin by roughly 1g/dL, and Hct by 3%
- It can be stored for 42 days refrigerated
Interventions before PRBCs: Iron, Vit B12, folic acid, or erythropoietin
- Indications: increase red cell mass w/o increasing volume
- - Improve O2 carrying capacity
- - Symptomatic anemia
- - acute blood loss with symptoms
-
List indications for Leukocyte reduced RBCs
- Known hx of reaction caused by donor WBCs
- Reduces risk of rash and anaphylactic reactions
- Prevent transmission of cytomegalovirus
- Immune suppressed patients
-
What is done in Irradiated blood products and List indications for it.
- This is when cellular blood components can be irradiated by using gamma irradiators or ultraviolet-A irradiation.
- Indications include: prevention of GVHD
- - pts. with acute leukemia and lymphoma
- - bone marrow or stem cell transplant recipients
- - patients with immunodeficiency disorders
- - neonates and low-birth-weight infants
-
1. What is normal platelet count?
2. How much can 1 platelet concentrate unit bag raise the platelet count by?
3. List the platelet levels for each illness that indicates the need for platelets:
- Acute thrombocytopenia
- Chronic thrombocytopenia
- fever/recent hemorrhage
4. Fill in: Platelets must be continuously agited during storage for up to ___ days, and ____ if not agitated.
5. Is ABO matching required when giving platelets?
- 1. Normal level: 150,000-300k
- 2. 1 platelet concentrate unit bag raises count 5k-10k
- 3. Indications:
- - Acute thrombo: <10k
- - Chronic thrombo: <5k
- - Fever/recent hemorrhage: <10k
- Other indication: coagulopathy
- 4. 7 days agitated, 24 hours if not.
- 5. Not required but preferred.
-
List characteristics of FFP.
How long can they be stored for?
List indications
- FFP is the liquid portion of blood that carries nutrients and clotting factors (called serum with no clotting factors)
- Once plasma is separated from whole blood, it can be frozen up to 1 year.
- Indications: increase/replace volume
- - active bleeding with coagulation factor deficiencies
- - reversal of warfarin anti-coagulation action (if vitamin K isn't sufficient)
- - DIC
-
List the main use for cryoprecipitate.
Is crossmatch required?
- It is the only concentrated source of fibrinogen and in today's practice is used for its fibrinogen content in acquired coagulopathies: DIC and massive hemorrhage.
- - may also be used for hemophilia A (factor viii deficiency) and vWF dz
- Crossmatch is not required.
-
List indications for albumin
Is cross matching required?
- Plasma volume expander and prevents leaking of fluids into tissues
- Treats hypovelmic shock
- supports BP during hypotensive episodes
- Induces diuresis in fluid overload
Cross matching not required
-
How does AHTR (acute hemolytic transfusion reaction) occur? What are s/s?
What can show in the urine as a sudden indicator?
List interventions when suspecting an AHTR reaction
- Occurs when donor red cells are not compatible with patient's
- s/s: fever, tachycardia, abdominal / chest / back pain, hypotension, dyspnea, shock
- Bloody urine
- Interventions:
- 1. STOP INFUSION
- 2. D/C tubing and start NS
- 3. Notify MD and lab
- 4. Monitor VS
- 5. maintain BP and treat for shock
-
How much of a temp change during a transfusion to be considered a nonhemolytic febrile rxn?
What are s/s?
List interventions
What can be done in the future if pt has repeated febrile reactions?
- = or > 2 deg F
- s/s: fever, chills, HA, vomiting
- Interventions:
- 1. STOP transfusion
- 2. D/C tubing and start NS
- 3. Notify MD and lab
- 4. Monitor VS
- 5. admin antifever as ordered
- If there is repeat febrile reactions, pt. may need Leukocyte-reduced transfusions
-
List interventions during a allergic rxn to a transfusion
- 1. STOP transfusion
- 2. d/c tubing and start NS
- 3. Notify md and lab
- 4. Monitor VS
- 5. administer antihistamines as ordered
-
What is TRALI?
s/s?
List interventions
- Leading cause of fatal transfusion rxn, it is a sudden onset pulmonary edema of unkown reason within 1-6 hours of transfusion.
- s/s: progressive severe hypoxia, hypotension, bilateral diffuse pulmonary infiltrates
- Inteventions:
- 1. STOP TRANSFUSION
- 2. d/c tubing and start NS (TKO only UNLESS bp starts to go down)
- 3. Notify MD and lab
- 4. VS
- 5. O2 therapy and possibly mechanical vent
- 6. Support BP by giving vasoconstrictor meds
-
What is TACO?
What may the MD order in anticipation?
s/s?
Interventions?
- TACO is transfusion administered faster than patient can tolerate, higher risk with CHF patients.
- MD may order laxis and instruct to infuses more slowly than normal
- s/s: SOB, cyanosis, tachycardia, JVD
- Interventions:
- 1. STOP transfusion
- 2. Maintain TKO
- 3. Notify MD and lab
- 4. vs
- 5. keep in sitting position
- 6. o2 therapy
- 7. diuretics
-
What is the max duration can you infuse blood products? What can occur if you go over this?
- >4 hours
- Sepsis: gives more time for bacteria to grow otherwise
-
List pre-transfusion procedures
what size gauge is preferred for transfusions?
What kind of tubing?
- Pre-transfusion:
- - Lab testing
- - ID wristband on patient
- - labels/ID on blood components
- Vascular access: 18 gauge preferred (20 will work)
- Tubing: Y tubing
-
What is the max starting rate of transfusions?
How long do you initially wait when starting a transfusion before increasing the rate?
How often will you check VS during a transfusion?
- Max: 2ml/min
- Wait 15 before increasing the rate to check for reactions
- VS:
- - before transfusion (5-15 mins)
- - 15 min after transfusion started
- - 30 min after start
- - At least q1hr afterwards
- - After completion
|
|
