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MS3 Exam 1 > Blood Products > Flashcards

Blood Products Flashcards

(44 cards)

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1
Q

Blood Administration: Typing

A

Blood is grouped according to the presence or absence of specific antigen

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2
Q

Blood Administration: Typing

A

•Type A: A antigen only on RBC’s
(B antibody in plasma)

•Type B: B antigen only on RBC’s
(A antibody in plasma)

•Type AB: Both A and B antigens on RBC’s
(neither A or B antibody in plasma)

•Type O: Neither A or B antigens on RBC’s
(Both A and B antibody in plasma)

  • O negative is the Universal Donor
  • AB+ is the Universal Recipient
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3
Q

Rh (Rhesus) Factor

A
  • The presence or absence of the Rh antigen, “D” on the surface of the RBC’s determine the classification of Rh-positive (85%) or negative
  • If a person is Rh negative they can only receive negative blood
  • If a person is Rh positive they can receive Rh positive or negative blood
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4
Q

Rh Immune Globulin

A
  • For Rh neg. women delivering Rh pos. infant
  • Rh partial “D” positive women who deliver Rh pos. infant
  • RH neg. women never sensitized at 28-32 weeks gestation, abortion, amniocentesis or other indicated procedures
  • Vial (300 mcg)/15 mL per Rh pos. cell exposure
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5
Q

Blood Crossmatching

A
  • Done to decrease the potential for reaction

* Mixing the recipient’s serum with the donor’s RBC followed by the addition of a Direct Coomb’s Test

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6
Q

Blood Administration

•Five types of transfusable blood products:

A 
–Whole blood
–Red Blood Cells (RBC’s)
–Platelets (PLT’s)
–Plasma (FFP)
–Cryoprecipitate (CRYO)
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7
Q

Blood Administration

•Use of donated blood products post-collection:

A

–RBC’s – within 42 days
–PLT’s – within five (5) days
–FFP & Cryo – stored frozen and may be used up to one year

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8
Q

Blood Administration

•Whole blood

A
  • Replenishes both volume and oxygen carrying capacity
  • Emergency and acute trauma
  • 500mL of volume per unit
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9
Q

Blood Administration

•PRBC’s

A
  • Prevents circulatory overload
  • 80% of the plasma has been removed
  • Hemoglobin <10g/dl (<7%) (parameter)
  • Hematocrit <10 g/dl (<21%) (parameter)
  • Each unit should increase the hematocrit about 3%
  • Each unit 250-300 mL/unit
  • One unit over 2-4 hours [NO longer than 4 hours max]

•Post-Op common

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10
Q

Blood Administration

•Platelets

A

Given when platelets are less the 20,000 or with active bleeding

30-50mL ~60 units

rotated/agitated to prevent clumping

Irradiated platelets removes WBC that may cause reactions

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11
Q

Blood Administration

•FFP

[fresh frozen plasma]

A

Contains a lot of clotting factors & provides volume (220mL/unit) for INR > 1.7 and any coagulation deficiencies

often given with blood

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12
Q

Blood Administration

•Albumin

A

100 mL acts like 500 mL of plasma in providing volume into intravascular space

hypertonic
volume expander

(shock, burns)

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13
Q

Blood Administration

•Cryoprecipitate

A

Given when Fibrinogen level < 100 milligrams/dl

can increase fibrinogen by 50mg

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14
Q

Bacterial Contamination of Platelets

A

•Becoming one of the greatest transfusion infectious risk:
–Transfusion transmitted sepsis
•Confirmed in 1/100,000 recipients
•Actual risk higher due to under-reporting
•Immediate fatal outcomes are 1/500,000

  • Critical to investigate febrile transfusion reactions, especially when transfusing platelets
  • Sepsis risk
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15
Q

Special Attributes

A
  • Leuko-reduced – Cytomegalovirus (CMV) reduced risk (transplant patients)
  • Washed – removal of plasma proteins that may cause reactions
  • Pathogen Reduced Platelet Product – reduces risk of bacterial contamination and emerging pathogens
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16
Q

Blood Administration

•Autologous Blood

A
  • Safest way to receive a transfusion
  • Pre-operative donation
  • Donation at least 3 days prior to surgery (7-3 days before sx)
  • Can not donate if hemoglobin is <11g/dl
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17
Q

Blood Administration

•Type & Crossmatch

A 
–Time-out verification form must be completed for every blood bank crossmatch
–Completed at bedside
–Two licensed personnel verification signature
–Band completed by both individuals
       –Includes:
•Patients full name
•MR #
•Date/time of collection
•Blood band ID #
•Signature of both individuals
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18
Q

Blood Administration

•To provide an additional safety layer to blood typing who has never been ABO/Rh tested

Study These Flashcards
A

–A second blood sample is completed

–Cross checking these two separate and independently drawn specimens provides a secondary protection

19
Q

Crossmatch Sample Validity

Study These Flashcards
A
  • A crossmatch specimen is valid for three (3) days for all patient over four (4) months of age
  • Neonatal specimens are valid for four (4) months
  • After the neonate reaches four (4) months, a new specimen must be obtained every three (3) days
20
Q

Blood Administration Steps

before actually starting infusion

Study These Flashcards
A
  • Check the orders & consent [only physician explains, nurse ONLY ever witnesses - be in room to verify what was said]
  • “No Blood” Status
  • Check labs
  • Blood bank administration band
  • Assess Vitals: Temp
  • Patient Teaching – S&S - most reactions occur within first 5 minutes, but some take 14 days to appear
  • Check your IV site condition & patency
  • IV tubing set up NS only
  • Bedside check with a licensed personnel (product to patient check) – CANNOT be LPN
  • Start blood infusion within 30 minutes of receiving it

•Recorded as Input on I’s&O’s

21
Q

IV Site

Study These Flashcards
A
  • Check the gauge of the catheter (no smaller than a 22 gauge) 20-18 ideal
  • What the site looks like
  • Flush
  • If a new central line make sure that it has been cleared by x-ray [any lumen but dedicated line req’d]
  • Nothing can run with the blood, only normal saline
22
Q

Pre-Medication

Study These Flashcards
A

History of an allergic reaction may be ordered to receive:

  • Tylenol
  • Benadryl
23
Q

Checking Label

Study These Flashcards
A
  • Patients full name
  • Medical Record number
  • Blood bank armband number
  • Unit number
  • Blood component type
  • ABO/ Rh type compatibility
  • Expiration date
  • Signature by two licensed
24
Q

Blood Administration

to begin, and once begun

Study These Flashcards
A
  • Put on protective gear
  • Blood tubing with filter and NS [tubing only good for 2 units or 6 hours]
  • Flush line with Saline
  • No medication in line
  • Start infusion no faster than 50ml over 15 minutes
  • Document HR, BP, RR and temp. 15 minutes into transfusion
  • Remain with the patient over the 1st 5 minutes [then another coworker of any license can take over for next 10 minutes]
  • Administer one unit over 2-4 hours
  • Check Vitals and observe patient per protocol
  • Blood bags & tubing go into red bag trash

•Fatty blood ok

25
Blood Administration
* Warmer-Hypothermia * Blood filters good for up to 2 units or 6 hours * New IV pumps won’t crush RBC in blood
26
Complications
* Circulatory overload [PE, arrhythmias - Lasix may be ordered between units] * Hypothermia [bradycardia] * Citrate toxicity [high # of transfusions - preservative for blood] * Hypocalcemia [binds with citrate - tremors, EKG changes, calcium gluconate is antidote] * Hyperkalemia [calcium leaks from stored RBSs - monitor for arrhythmia] * Infections * Lung Injury * Iron Overload
27
Transfusion Reaction: Allergic (define)
* Mild to severe [life threatening] * Transfusion recipient has an Immunglobulin E (IgE) antibody directed against an antigen in donor plasma activating release of histamine * more common in those with other allergies
28
Transfusion Reaction: Allergic (S&S)
* Flushing * Itching * Rash * Wheezing/Stridor * Hives * Laryngeal edema •Anaphylaxis * Tachycardia * Dysrhythmias * Cyanosis •Cardia arrest secondary to respiratory arrest
29
Allergic Reaction | Treatments
* Stabilize respiratory status * Treat hypotension (position, fluids) * Administer Diphenhydramine(Benadryl), Epi and/or other steroids * Initiate transfusion reaction work-up * Treat with Diphenhydramine, steroid and/or Epi prior to future transfusions * may require ICU
30
Transfusion Reaction: Febrile (S&S)
* Chills * Fever [↑ 1℃ or ⋝38℃] * Headache * Palpitations * Cough * Chest Tightness [not cardiac related] * Tachycardia * Muscle pain •within 4 hours of transfusion
31
Febrile Reaction Treatment
•Administer non-aspirin antipyretic (Acetaminophen) •Meperidine IV may be considered in patients with rigors •Initiate transfusion reaction work-up •Future transfusions –Use leukocyte-reduced products –Pre-medications
32
Transfusion Reaction: Hemolytic (define)
* Incompatible blood administration resulting in an antigen/antibody response with activation of complement and subsequent intravascular hemolysis * Most common transfusion error r/t not following all steps of transfusion administration * Can lead to death!
33
Transfusion Reaction: Hemolytic (S&S)
Sentinel event [must be reported] * Chills / Fever (> 1° C) * Rigors [uncontrolled shaking caused by pyrogens] * Chest Pain * Hypo/hypertension * Diaphoresis * Tachycardia * Flank Pain [indicated renal failure] * Hemoglobinuria * Unexplained bleeding**May occur up to 14 days post infusion
34
Hemolytic Reaction Treatments
* Stabilize respiratory status * Maintain CV support with vasopressors * Invasive cardiac monitoring * Fluids to maintain renal perfusion and U/O * Treat for S/S of DIC (disseminated intravascular coagulation
35
Transfusion Reaction: Sepsis (define)
* Transfusion of bacterially contaminated blood components * Bacteria usually originates from the blood donor * May also result from donor unit processing * More likely to occur in blood components (platelets) stored at room temp rather than refrigerated •most common with plts and ffp
36
Transfusion Reaction: Sepsis (S&S)
* Sudden onset Chills * Very High Fevers * Unexplained bleeding * Abdominal cramping * Diarrhea * Rigors * Hypotension * Shock * Signs of renal failure
37
Sepsis Reaction Treatments
* Maintain respiratory status * Maintain CV support with vasopressors * Initiate transfusion reaction work-up * Culture and gram stain indicated blood component * Draw blood cultures [2 separate sites] * Prompt initiation of IV antibiotics
38
Transfusion Associated Circulatory Overload (TACO) | define
* An increase in pulmonary blood volume and hydrostatic pressure resulting in pulmonary edema * Occurs due to -rapid- transfusion of large volumes of blood [during or within 1st 6 hours] * 2nd most common cause of transfusion-associated death
39
Transfusion Associated Circulatory Overload (TACO) | S&S
* Occurs during or within 6 hours of transfusion * Acute respiratory distress * Evidence of positive fluid balance * X-ray evidence of pulmonary edema * Elevated CVP * Elevated Brain Natriuretic Peptide (BNP)
40
TACO Treatment
* Stop transfusion ASAP * Place patient in high fowlers position * Give supplemental oxygen * Administer diuretics as ordered * Initiate transfusion work-up [monitor potassium] •Prevention: –Closely monitor patients receiving transfusions and transfuse smaller amount of blood at a slower rate
41
Transfusion Related Acute Lung Injury (TRALI)
* Infusion of donor antibodies directed against recipient antigens or neutrophil antigens causing capillary leakage and pulmonary damage * Occurs more commonly with products containing large volumes of donor plasma – FFP and platelets •results in partial lung tissue damage, some may be permanent
42
TRALI Presentation
* Acute respiratory distress/failure within 6 hours of transfusion * Dramatic onset WITHOUT fluid overload * Dyspnea * Cyanosis * Bilateral infiltrates on x-ray * Hypoxemia SpO2 < 90% on room air * Tachycardia
43
TRALI Treatment
* Stabilize respiratory and cardiac status * Diuretics and steroids as indicated * Initiate transfusion work-up * mortality ~10% * starts reversing in 2-3 days * diuretics used to dry out further * steroids used to decrease inflammation
44
Transfusion Reaction
•STOP INFUSION!!!! * Take Vitals q15 minute [note s&s] * NS at KVO [first aspirate all blood back out of line] * Notify MD * Notify Blood Bank * Collect Blood and urine samples * Follow MD instructions and facility protocols * Place on strict I&O * Do not discard blood or tubing * Documentation [incident report and nursing note]

MS3 Exam 1 (6 decks)

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