T11: Blood Products & Transfusions

Question 1

Peripheral smear

Answer 1

morphology (SHAPE AND APPEARANCE) of blood cells

Question 2

Pancytopenia

Answer 2

suppression of ALL (RBCs, WBCs, and platelets) blood cells

Question 3

RBC count

Answer 3

3.8-5.7 X 10^6

Question 4

Hemoglobin value (Hgb)

Answer 4

12-18 g/dL

Question 5

Hematocrit value (Hct) determines

Answer 5

the percentage of RBCs compared to total blood volume

Question 6

normal hematocrit levels

Answer 6

37-52%

Question 7

what is the best indicator for anemia

Answer 7

hemoglobin and hematocrit

Question 8

Erythrocyte sedimentation rate (ESR/Sed rate measures

Answer 8

sedimentation/settling of RBCs; tells us if inflammation is present

Question 9

normal ESR

Answer 9

less than 20mm/hr

Question 10

what WBC count is associated with infection

Answer 10

> 11,000/µL

Question 11

normal WBC

Answer 11

5,000-10,000

Question 12

Leukopenia is associated with WBC count of…

Answer 12

< 4000/µl

Question 13

Differential count

Answer 13

% of each type of leukocyte

Question 14

Absolute neutrophil count (ANC) is comprised of bands and segs ans tells us

Answer 14

there is an inflammatory response going on

Question 15

Neutropenia is when the ANC is..

Answer 15

< 1000 cells/µL

Question 16

Neutropenic precautions

Answer 16

(they have no immunity): ISOLATION, PPE, limiting visitors, no flower, no fresh fruit and veggies, when they go off the floor, put a mask on them when they are traveling, hand washing

Question 17

Normal platelet count

Answer 17

150,000-400,000/µL

Question 18

Thrombocytopenia

Answer 18

low platelet count; danger of spontaneous hemorrhage

Question 19

Thrombocytosis

Answer 19

abnormally high platelet count; danger of excessive clotting

Question 20

DIC is…

Answer 20

thrombocytopenia and thrombocytosis together; Bleeding and clotting at the same time

Question 21

universal donor

Answer 21

O-

Question 22

universal recipient

Answer 22

AB+

Question 23

Chelation therapy

Answer 23

a procedure in which excess metals, such as IRON, are removed from the blood

Question 24

what is used to treat anemias

Answer 24

Packed RBC/frozen

Question 25

what is used to treat thrombocytopenia

Answer 25

platelets

Question 26

Fresh frozen plasma is used for

Answer 26

o Bleeding-depleted clotting factors o No platelets

Question 27

albumin

Answer 27

keeps fluid in the vessels (used for hypovolemia and hypoalbuminemia)

Question 28

Cryoprecipitate

Answer 28

o Clotting factors-Factor VIII, von Willebrand, fibrinogen o Clotting factors for those with hemophilia (they have a hard time clotting)

Question 29

once a blood transfusion is ordered, what is needed?

Answer 29

-patient consent -labs -2 IV access

Question 30

why is 2 ive access needed

Answer 30

BLOOD NEEDS ITS OWN LINE

Question 31

prep and start the line with

Answer 31

0.9% normal saline ONLY

Question 32

TKO

Answer 32

to keep open (20-25mL of saline)

Question 33

once blood product is received what is needed

Answer 33

-2 RN check ALWAYS at bedside - VS before starting-spike/start within 30 minutes

Question 34

start blood at

Answer 34

max of 2 mL/min (60-120mL/hr) for 15 minutes

Question 35

during the first 15 minutes

Answer 35

STAY WITH THE PATIENT, THEN REASSESS VS AFTER 15 MINS

Question 36

acute transfusion reactions usually occur

Answer 36

in the first 10-15 minutes or the first 50mL of blood

Question 37

Acute Hemolytic

Answer 37

in the moment happening now, breaking down the RBCs

Question 38

s/s of acute hemolytic

Answer 38

: fever, chills, low back pain, tachycardia, hypotension, hemoglobinuria, DARK URINE bleeding AKI, shock, DIC, death

Question 39

what is important to assess with acute hemolytic reaction

Answer 39

o CHECK THEIR URINE: may be brown color if kidneys are blocked off by clot

Question 40

Febrile Non-hemolytic

Answer 40

temp spike but it is not breaking down RBCs

Question 41

s/s of Febrile Non-hemolytic

Answer 41

o S/S: fever, chills, anxiety, headache, tachycardia, tachypnea

Question 42

intervention for Febrile Non-hemolytic

Answer 42

tylenol

Question 43

Mild allergic reaction s/s

Answer 43

o itchy, hives, rash, facial flushing, wheezing

Question 44

Mild allergic reaction intervention

Answer 44

o Antihistamine (Benadryl)

Question 45

anaphylactic s/s

Answer 45

BROCHOCONSTRICTION, ANGIOEDEMA, increased BP o itchy, hives, rash, facial flushing, wheezing

Question 46

anaphylactic interventions

Answer 46

o Stop the transfusion o Epinephrine, bronchodilators, steroids

Question 47

TACO

Answer 47

Transfusion Associated Circulatory Overload (basically ADHF FAST!)

Question 48

for TACO give

Answer 48

DIURETICS

Question 49

sepsis

Answer 49

if blood is hanging for too long or if the blood becomes too warm, bacteria can grow in it and cause sepsis

Question 50

TRALI

Answer 50

Transfusion Related Acute Lung Injury; Basically, their lungs are hemorrhaging (alveoli are filled with blood so no O2 and CO2 exchange ARDS)

Question 51

TRALI interventions

Answer 51

Immediately stop transfusion -Chest x ray: pulmonary infiltrates -Need aggressive support of therapy: need to be treated aggressively cause it can progress and be fatal VENT WITH PEEP

Question 52

INTERVENTION FOR REACTION

Answer 52

STOP TRANSFUSION AND OPEN UP THE FLUIDS

Question 53

MANAGEMENT OF TRANSFUSION REACTION

Answer 53

- STOP TRANSFUSION - MAINTAIN PATENT IV LINE WITH 0.9% SALINE - NOTIFY THE BLOOD BANK AND THE HCP - RECHECK IDENTIFICATION TAGS AND NUMBERS - TREAT SYMPTOMS PER HCP ORDERS - SAVE THE BLOOD BAG, TUBING AND SEND TO BLOOD BANK - COLLECT REQUIRED BLOOD AND URINE SPECIMENS PER AGENCY POLICY - DOCUMENT ON TRANSFUSION REACTION FORM AND HER - THIS IS A SENTINAL EVENT: this could have killed them if we didn't catch it

Question 54

Autologous blood product

Answer 54

o Planned predonated and stored (10 years frozen); donate their own blood