Administration of Blood and Blood Products (LO4) Flashcards
Blood serves the following functions:
Supplies oxygen and nutrients for energy production and for tissue maintenance, growth, and repair
Transports cellular waste, including carbon dioxide, to the organs for elimination
Provides a defense against infection by transporting antibodies
Regulates and equalizes body temperature
Helps to maintain the acid-base balance
Regulates fluid and electrolyte balance
Blood is made up of 2 basic components:
Cellular or formed elements
Plasma
Plasma
is a sticky straw-coloured fluid
approximately 90% water.
Dissolved within the plasma are over 100 different solutes including proteins, nutrients, electrolytes, and respiratory gases.
Plasma makes up about 55% of the volume of blood.
Erythrocytes
(red blood cells)
constitute approximately 45% of the blood’s volume
have a dedicated role in the transportation of respiratory gases.
Leukocytes
white blood cells
make up less than 1% of the entire blood volume
play a major role in defense against infection and disease.
Platelets
(also less than 1% of blood volume)
are necessary for the clotting process and circulate in the vasculature, inactive until a blood vessel ruptures or is damaged
Blood is group classified based
on the types of antigens present or absent on the surfaces of the red blood cell
Pre-transfusion testing includes the following
Blood typing
Antibody detection (and antibody identification if antibody screen is positive)
Crossmatching
ABO Group
- A
- B
- AB
- O
- name antigen and the frequency in population
-A
40%
-B
11%
-A and B
4%
-None
45%
A patient’s antibodies will do what to red blood cells that have corresponding antigen on their surface
A patient’s antibodies will hemolyze (break down or destroy red blood cells) transfused red blood cells that have the corresponding antigen on their surface.
Historically, patients whose blood group was unknown and who required an urgent transfusion were provided with
Group O Rh negative red blood cells (RBC) until the patient’s blood group was determined
In situations where the blood group is unknown:
The Transfusion Medicine Laboratory (TML) will usually issue O Rh negative RBC’s for females of child bearing potential (less than 45 years of age) until the patient’s blood group is confirmed.
All males and females past child bearing potential, can receive O Rh positive RBC’s until the patient’s blood group is confirmed
Crossmatching
is the process of determining the compatibility of blood from a donor with that of the recipient before transfusion
Whole blood
contains all components of blood
the clotting factors and platelets quickly lose their function during storage
A unit contains approximately 450 mL of whole blood plus 63 mL of anticoagulant
Indications of whole blood
indicated in blood loss
not commonly available from blood banks, and therefore red blood cells are more commonly used for treatment of anemia and acute blood loss
One unit of whole blood can increase the patient’s hemoglobin by approximately 10g/L
Infusion Rate of whole blood
The initial transfusion should be slow (5 mL/min for 15 minutes) while assessing the patient for adverse reactions
In the absence of any reactions, the product can be infused as quickly as the patient can tolerate it.
The transfusion must be completed with the 4-hour window
whole blood Compatibility
Normal saline
whole blood Special Considerations
Whole blood must be ABO-identical to the recipient’s blood group. (Group O is not universal donor for whole blood.)
whole blood Administration Set
The administration set must be a blood tubing set that has a 170–260 micron blood filter.
whole blood Storage and Shelf Life
Whole blood cannot be left at room temperature for longer than 4 hours.
As soon as collection from the donor is complete, whole blood must be stored at 1–6° C
the red blood cells will retain their function for up to 21–35 days
Whole Blood – Overview
- major uses
- storage and shelf life
- administration
Major Uses
- To replace:
- Fibrinogen: in patients actively bleeding who have a low fibrinogen level
Storage and Expiration
- Frozen
- Shelf life: 1 year
- Once thawed, expires after 4 hours stored at 20–24°C
Administration
- Blood tubing required
- Transfuse as rapidly as tolerated
Red Blood Cells
along with normal saline are more commonly used than whole blood for acute blood loss
A unit of red blood cells is 240–340 mL and will be more viscous than whole blood
most red blood cell components today have an additive solution mixed with the red blood cells (e.g., AS-3).
With an additive solution, red blood cells will have the same flow rate as whole blood
Red blood cells have minimal amounts of plasma (and ABO antibodies) so you can give ABO-compatible blood rather than only ABO identical
Red Blood Cells indications
Red blood cells units are administered to patients requiring increased oxygen-carrying capacity by increasing the circulating red blood cell mass.
Infusion Rate
The initial infusion should be slow for the first 15 minutes to assess for adverse reactions, then administered as quickly as the patient tolerates
A slower rate should be considered for patients at risk for overload.
A unit of red blood cells must be administered within 4 hours.
red blood cells Compatibility
Normal Saline
red blood cells special considerations
In massive transfusions, if possible warm blood with approved blood warmer prior to transfusion to prevent hypothermia.
cAdministration Set
The administration set must be a blood tubing set that has a 170–260 micron blood filter.
If administering at a fast rate, 16–18 gauge cathlon is required
in small vein patients a 20–22 gauge may be used.
red blood cells shelf life
Depending on the anticoagulant and additive solution used, red blood cell units have a shelf life of 21–42 days.
red blood cells Storage
Red blood cells must be stored at 2–6° C. During inter-facility transfers, the blood should be stored in a Canadian Blood Services styrofoam box with ice packs.
Red Blood Cells – Overview
Major Uses
- Bleeding or anemic non-bleeding patients with signs and symptoms of impaired tissue oxygen delivery:
- -Tachycardia
- -Shortness of breath
- -Dizziness
Storage and Expiration
-2–6° C in approved refrigerator only
-Shelf life: Maximum 42 days
Administration
- Blood tubing required
- Initiate transfusion slowly for first 15 minutes unless massive blood loss
- Transfuse over no more than 4 hours
- Typically over 1½–2 hours with slower rates for patients at risk for circulatory overload
Fresh Frozen Plasma
- Fresh frozen plasma (FFP) is separated from whole blood by centrifugation or sedimentation and must be frozen within 8 hours of collection
- A unit of fresh frozen plasma (FFP) contains approximately 250 mL (minimum 100 mL) of anticoagulated plasma.
Fresh Frozen Plasma Indications
Fresh frozen plasma (FFP) is separated from whole blood by centrifugation or sedimentation and must be frozen within 8 hours of collection
A unit of fresh frozen plasma (FFP) contains approximately 250 mL (minimum 100 mL) of anticoagulated plasma.
Fresh frozen plasma is indicated for patients requiring plasma coagulation factors, patients on Coumadin requiring emergency invasive procedures before Vitamin K can reverse its effects, or patients with plasma protein deficiencies.
Infusion Rate Fresh Frozen Plasma
Recommended infusion time is 30 minutes to 120 minutes but must be infused within 4 hours.
