Flashcards in Blood transfusions Deck (61)
What are indicators for blood transfusions?
c. Bone marrow suppression
d. Disseminated intravascular coagulation
f. Hemophilia--> Deficient in a specific body clotting protein (A or B). These are normally synthesized in liver or epithelial cells
What makes up whole blood?
What is plasma made up of?
1. fresh frozen plasma
2. fractionated products
What are RBC's
the oxygen carrying component of the blood
When is a blood transfusion indicated for platelets?
severe thrombocytopenia --> 20,000
Less than 50,000 platelet count posses a risk for what?
risk for bleeding
How long can platelets be stored in a blood blank?
What makes up 55% of your total blood volume?
What is in the plasma?
proteins (albumin especially), clotting factors, hormones, glucose, electrolytes
When is plasma indicated?
chronic liver disease, DIC, too much of their Coumadin or warfarin (INR is high).
How long can fresh frozen plasma be stored? How long does it take to freeze it?
36 months; 8 hours
How long is the 1/2 life for clotting factors in FFP?
What do you want to check with FFP?
1. clotting factors
What is cryoprecipitate?
product that is made when FFP is thawed and further centrifuged down.
Why might someone receive cryoprecipitate?
fibrinogen deficiency associated with trauma situations
What are fractionated plasma products?
manufactured products that are made without the use of a donor. It is contained in the plasma that can be broken down to be given to patients.
What are fractionated products broken down into?
3. immune globulin
What are factors?
recombinant factors that are made in a lab
What do factors reduce
the amount of blood borne pathogens that can be given to a patient
When is albumin given?
given to patients with a protein deficiency.
What is albumin indicated for?
when a patient needs volume expansion or to raise oncotic pressure. Given to patients who have LIVER DISEASE
What is immune globulin?
different antibodies that are given to patient to help boost their immune system
Can granulocytes be transfused?
No; but they are still a component of the blood
What does the O allele code for?
codes for a protein that is not functional and does not produce surface molecules. Universal donor.
What can Rh- give to?
Rh- and Rh+
What can Rh- receive?
What are 8 very important pieces of information to get before a transfusion?
1. History of blood transfusion reactions
3. Religious preference about getting one or not getting one
4. Medical history
6. pre-medication PRN
7. type and cross
What are 3 pt/ instances where medical history would be super important?
a. Congestive heart failure
--> Increase risk for fluid overload
--> Rapid transfusion
c. Oncology patient
--> Suppressed immune system with a history of very frequent blood transfusions
--> May need to be more conservative because they are more at risk for fluid overload if they are getting a lot of transfusions.
What are vital signs so important before a transfusion?
FEVER! avoid giving if the patient is febrile
When would you give premedication?
If they have a history of a transfusion reaction
Does giving a transfusion require a second nurse?
After doing your safety check, what do you want to do?
After baseline VS, what do you want to check? and why?
IV access; you want > or equal to 20 gauge needle
What is the spiking process like?
1. 2 different sides to spike.
2. Roller clamp both sides and the bottom
3. Take one cap off and spike your bag of NS
a. Unclamp NS spike, allow the tubing to prime with NS. Once it is primed you are going to roller clamp.
b. This stays clamped the entire time.
4. Uncap other end and undo the roller clamp and spike your blood.
a. Blood can fill middle chamber.
How long do you want to monitor?
Monitor for reaction within first 15 minutes - slow infusion rate for the first 15 minutes. If there is no reaction you can speed it up.
How long should an infusion take?
under 4 hours; 1. Even if they have a condition that could possibly cause congestive heart failure.
What are the possible reactions?
3. febrile, non-hemolytic
4. Acute hemolytic
5. circulatory overload
Why does an allergic reaction happen with blood?
sensitivity to antigens in the blood component, not the blood itself.
What are possible signs of an allergic reaction?
What happens if the patient has an anaphylactic reaction to blood?
stop infusion and call the doctor
What are symptoms of an anaphylactic reaction?
--> Elevated heart rate, decreased blood pressure
What are 3 interventions of an anaphylactic reaction?
What are febrile, non-hemolytic reactions more associated with?
more with platelets, not as much RBC transfusion because of a run to donor antigens in the blood product.
- more blood they receive, worse chance
What are symptoms of an febrile, non-hemolytic reaction?
1. Fever +/- pulmonary symptoms
2. Sudden chills and fever (1 degree Celsius, or 1.8 degree Fahrenheit change in their temperature)
When does an acute hemolytic reaction occur?
incompatible blood being transfused. Immune system is attacking those transfused.
What are symptoms of an acute hemolytic reaction?
3. Low back pain
--> Cells are not circulating through blood properly
--> Kidneys are not doing well as lysed cells are traveling through the blood stream/
7. Low blood pressure
Why does a circulatory overload occur?
happens when given to a patient that is already fluid overloaded, too fast, congestive heart failure and given too fast or without Lasix (diuretic)
What are symptoms of circulatory overload?
2. SOB with course crackles
3. Increased HR
4. Increased BP
5. Neck vein distension
Why does septicemia occur?
where there is bacterial contamination of the transfused product. Patient is septic right on transfusion.
Symptoms of septicemia?
1. Chills (rapid onset)
2. High fever
4. Marked low BP
What is a transfusion-related lung injury?
antibody mediated reaction. No signs of circulatory overload (i.e. neck vein distention).
What reaction is associated with the highest mortality rate?
transfusion-related lung injury
Symptoms of a transfusion-related lung injury?
1. Acute onset fever
3. Progressive respiratory distress
4. Cardiac symptoms
What happens if someone has a blood transfusion reaction?
i. Stop transfusion
ii. Start normal saline
1. Do not start the NS that is connected to the blood product.
2. Hook up a whole new set of saline.
iii. Disconnect transfusion set
iv. Notify MD/initiate appropriate orders
v. Notify blood bank
1. Suspected blood transfusion reaction
vi. Send transfusion work-up
1. RBC transfusion reaction and draw some of the patient’s blood and send it to the blood bank.
a. Everything goes – tubing and blood
2. Tell them why you suspected
a. What symptoms
You also want to what with blood transfusions eactions?
1. What happened
2. What you did to help the patient
3. Results of the intervention
1). The patient with comorbid liver failure emergently needs to be sent to surgery for a bowel obstruction. The bedside nurse can anticipate what type of order from the physician?
A. Ensure the patient is NPO for 8 hours prior to the procedure
B. Ensure Lovenox injection is given prior to sending patient off floor
C. Transfuse 3 units FFP and recheck INR STATcheck
D. Place the patient on bedrest at all times
Answer: C; The patient with liver failure will not produce enough clotting factors, FFP can provide these clotting factors prior to surgery. A stat INR will let the nurse know if the clotting time is within a safe range for a surgical procedure.
1). The patient with liver failure will not produce enough clotting factors, FFP can provide these clotting factors prior to surgery. A stat INR will let the nurse know if the clotting time is within a safe range for a surgical procedure.
A. Tranfuse PRBCs check
B. Transfuse Granulocytes
C. Transfuse platelets check
D. Transfuse FFP
Answer: A & C; The nurse could anticipate giving both platelets and PRBCs, both platelets and red blood cells are made in the bone marrow. White blood cells (granulocytes) would not be infused into a patient as this would cause an immune reaction. FFP would replace clotting factors, which are primary made in the liver.
3). A patient with CHF is receiving 1 unit of PRBCs for a Hgb of 6.6 he begins to experience dyspnea, SpO2 91%, course crackles, BP 145/89, and JVD. The nurse could expect which of the following orders from the LIP:
A. Stop the transfusion and recheck CBC
B. Continue the transfusion, the patient's overall condition is stable
C. Stop the transfusion, send transfusion reaction workupclose
D. Slow the transfusion, administer 20mg IV lasixcheck
Answer: D; The patient is experiencing fluid/circulatory overload. The patient needs the blood to be run slower, the lasix will help to remove some of the excess fluid.
4). A patient must sign a new consent for each type of blood product they will receive? True or false
Answer: false; A signed blood consent form is good for administration of all types of blood products.
5). A nurse is completing a transfusion of PRBCs with a patient on a medical-surgical floor. Upon entering the room to take the blood down the nurse finds the following assessment data: Temp 38.3, HR114, BP 78/50, SpO2 93%, pt c/o feeling cold and is having abdominal cramping. The nurse can anticipate which of the following orders from the LIP?
A. Administer 1L NS bolus
B. Administer scheduled metoprolol
C. Draw blood cultures and administer IV cefepime
D. Send empty blood bag and tubing to blood bank
E. Recheck CBC
Answer: A, C, D