Care of Patients Receiving Blood Products

Question 1

Red Blood Cells (RBC) or Packed Red Blood Cells (PRBC)
Platelets
Plasma or Fresh Frozen Plasma (FFP)
Granulocyte (White Blood Cells)

Answer 1

Types of transfusions

Question 2

Typ packed - concentrated
To replace lost blood or anemia
Transplantation of tissues
Infuse over 2-4 hours
Use filtered pump tubing

Answer 2

Red Blood Cells

Question 3

Compatibility is determined by 2 antigen systems - ESSENTIAL
ABO and Rh
**Donor and recipient blood must be checked carefully for compatibility

Answer 3

Transplantation of tissues

Question 4

To treat thrombocytopenia or active bleeding: Platelets < 10,000 mm3
Platelets are pooled from multiple donors so do not have to have the same blood type
Use specific tubing: Longer tubing increases the chance that platelets will stick to lumen
Infuse over 15-30 minutes immediately

Answer 4

Platelets

Question 5

To treat deficiency in plasma coagulation factors; elevated PT or PTT
Must be ABO compatible
Infuse over 15-30 minutes immediately after thawing:
So clotting factors are still active
Use Y set tubing

Answer 5

Plasma

Question 6

Used with sepsis or neutropenic infection
Rare
More at risk for transfusion reactions: WBC surfaces have many antigens
Usually requires closer monitoring
Infuse over 1 hour

Answer 6

Granulocyte (WBC)

Question 7

Assess labs and ensure need transfusion
Verify order with another RN
Ensure adequate venous access
Assess vital signs before get bloood
Obtain blood products from blood bank and administer as soon as possible
Safety checks - biggest priority
Inspect blood for discoloration, gas bubbles, cloudiness

Answer 7

Pretransfusion

Question 8

Must be done by 2 RNs
One of the RNs has to also be responsible for administering the blood product
Verify patient’s identity with another RN
Examine blood bag label, attached tag, and requisition slip for ABO and Rh compatibility with the patient with another RN
Check expiration date with another RN

Answer 8

Safety checks - biggest priority

Question 9

Could indicate hemolysis or bacteria

Answer 9

Inspect blood for discoloration, gas bubbles, cloudiness

Question 10

Vital signs
Use appropriate tubing, filters and fluids
Begin transfusion slowly, stay with patient first 15 to 30 minutes
Ask patient to report unusual sensations
Administer blood product per protocol
Assess for hyperkalemia

Answer 10

During transfusion

Question 11

immediately before starting infusion and again within the first 15-30 minutes

Answer 11

Vital signs

Question 12

Never add or infuse anything with blood products
Prime tubing with Normal Saline (0.9% NS)

Answer 12

Use appropriate tubing, filters and fluids

Question 13

chills, shortness of breath, hives, itching

Answer 13

Ask patient to report unusual sensations

Question 14

Febrile Transfusion Reaction
Hemolytic Transfusion Reaction
Allergic (anaphylactic) Reaction
Bacterial Transfusion Reaction
Transfusion-Associated Circulatory Overload (TACO)
Transfusion related Graft v. Host disease
Acute Pain Transfusion Reaction (APTR)
Nursing Interventions

Answer 14

Complications

Question 15

Acute
Signs:
Occurs when a patient has had multiple transfusions and develop WBC antibodies
Prevention:

Answer 15

Febrile Transfusion Reaction

Question 16

Fever, chills, tachycardia, hypotension and tachypnea - check VS

Answer 16

Signs: - Febrile Transfusion Reaction

Question 17

Give leukocyte reduced blood or single donor blood
Use of WBC filters when administering blood products to filter out WBC

Answer 17

Prevention: - Febrile Transfusion Reaction

Question 18

Acute
Signs:
Occurs when there is a blood type or Rh incompatibility
Prevention:

Answer 18

Hemolytic Transfusion Reaction

Question 19

Fever, chills apprehension, HA, chest pain, low back pain, tachycardia, tachypnea, hypotension, sense of impending doom - VS

Answer 19

Signs: - Hemolytic Transfusion Reaction

Question 20

Antigen-antibody complexes form and destroy cells and cause inflammatory response

Answer 20

Occurs when there is a blood type or Rh incompatibility - Hemolytic Transfusion Reaction

Question 21

Ensure that all blood products and typed and crossmatched
Adhere to all safety checks prior to blood product administration

Answer 21

Prevention: - Hemolytic Transfusion Reaction

Question 22

Acute
Signs:
Usually seen in patients with other allergies
Prevention:

Answer 22

Allergic (anaphylactic) Reaction

Question 23

Urticaria, itching, bronchospasm, anaphylaxis - stop blood if receiving it

Answer 23

Signs: - Allergic (anaphylactic) Reaction

Question 24

Can occur immediately or within 24 hours

Answer 24

Usually seen in patients with other allergies - Allergic (anaphylactic) Reaction

Question 25

Give leukocyte reduced blood

Answer 25

Prevention: - Allergic (anaphylactic) Reaction

Question 26

Acute Signs: Caused by contaminated blood and onset is rapid

Answer 26

Bacterial Transfusion Reaction

Question 27

Tachycardia, hypotension, fever, chills

Answer 27

Signs: - Bacterial Transfusion Reaction

Question 28

Acute Signs: Occurs when blood product is infused too quickly Fluid overload Prevention:

Answer 28

Transfusion-Associated Circulatory Overload (TACO)

Question 29

Hypertension, bounding pulses, JVD, dyspnea, restlessness and confusion

Answer 29

Signs: - Transfusion-Associated Circulatory Overload (TACO)

Question 30

Infuse blood products slowly esp if high risk Diuretics if dire enough and acute resp distress Monitor I&O

Answer 30

Prevention: - Transfusion-Associated Circulatory Overload (TACO)

Question 31

Not acute; happens later Bone marrow transplant pats Signs: Occurs in immunocompromised patients and occurs within 1-2 weeks - reacting to foreign tissue Serious if not treated Prevention:

Answer 31

Transfusion related Graft v. Host disease

Question 32

Thrombocytopenia, anorexia, N&V, weight loss, infection

Answer 32

Signs: - Transfusion related Graft v. Host disease

Question 33

Administered irradiated blood products that destroy T cells and cytokine

Answer 33

Prevention: - Transfusion related Graft v. Host disease

Question 34

Acute Signs: Rare and occurs during or immediately after transfusion Treatment:

Answer 34

Acute Pain Transfusion Reaction (APTR)

Question 35

Severe chest pain, back pain, joint pain, hypertension, anxiety and redness of head and neck

Answer 35

Signs: - Acute Pain Transfusion Reaction (APTR)

Question 36

Control symptoms Rigors - pain meds

Answer 36

Treatment: - Acute Pain Transfusion Reaction (APTR)

Question 37

Get VS and notify provider Stop the infusion - first!!!!! Take down all blood tubing and save with all labels - put in bag because investigation occurs Oxygen - distress Diphenhydramine (if allergic) IV Fluids for severe shock Antibiotics (if bacterial transfusion rxn if blood contaminated) Antipyretics for fever - comfort Meperidine for rigors

Answer 37

Nursing Interventions

Question 38

Don’t flush tubing and put anymore blood into the patient

Answer 38

Stop the infusion - first!!!!!