Transfusions

Question 1

What are the 5 types of transfusions

Answer 1

1. Homologous (Allogenic)
2. Autologous
3. Blood salvage
4. Directed donor
5. Artificial blood

Question 2

What is the 5 criteria for blood donation

Answer 2

1. healthy
2. older than 17
3. 110lbs and above
4. Hgb 12.5g/dl for women and 13.5 for men
5. <99.6 temp

Question 3

How long can red blood cell donations be stored and at what temp?

Answer 3

42 days at 4* celsius

Question 4

How long can platelet donations be stored and at what temp?

Answer 4

5 days at room temp

Question 5

How long can fresh frozen plasma be stored and at what temp?

Answer 5

1 year and frozen

Question 6

What is the normal lab values for hematocrit and hemoglobin including ratio?

Answer 6

HCT: 35-45% (males slightly higher)
HGB: 12-15 gm/dl (males slightly higher)

HCT : HGB = 3 : 1

Question 7

What is the normal lab values for platelets?

Answer 7

150,000 - 350,000

Question 8

What is the normal prothrombin time (PT) lab values?

Answer 8

9-11 seconds

Question 9

What is the normal international normalised ratio (INR) lab values?

Answer 9

1

Question 10

What is the normal partial thromboplastin time (PTT) lab value?

Answer 10

25-35 seconds

Question 11

What are the two therapeutic effects of pRBC transfusion?

Answer 11

Increases O2 carrying capacity of blood and replaces blood loss

Question 12

What are the indications (including lab values) of pRBC transfusion?

Answer 12

Active bleed
HCT <25% OR HGB <8 & symptomatic

Question 13

What is the therapeutic effect of platelet transfusion?

Answer 13

increased thrombocytes (controls bleeding by replacing platelets)

Question 14

What are the indications of platelet transfusion?

Answer 14

PLT < 50,000 and active bleed, or
PLT < 20,000

Question 15

What is the therapeutic effect of fresh frozen plasma transfusion?

Answer 15

increased clotting factors

Question 16

What are the indications for fresh frozen plasma transfusion?

Answer 16

INR >1.5 or PT>15 seconds or PTT>45 seconds

Question 17

What are the transfusion - disease contamination risks?

Answer 17

HIV, HCV etc e.g. zika virus?

Question 18

What are the 5reaction risk complications of transfusions?

Answer 18

Febrile: (temp increase >2deg)
Allergies: flushing, pruritis etc
Hemolytic: fever/chills, back pain, dark urine
Fluid overload
Sepsis

Question 19

What are the S/Sx of needing pRBC transfusion?

Answer 19

fatigue, weakness, tachycardia, pallor, low O2 sat, active bleed

Question 20

Explain type & cross procedure?

Answer 20

Type: blood type & Rh factor, expiration, client ID
Cross match: indirect coombs - want a negative

Question 21

How long is transfusion consent good for?

Answer 21

if outpatient - 1 year
if inpatient - duration of stay

Question 22

How may RN’s are required to sign out blood transfusion at bedside?

Answer 22

2

Question 23

What gauge IV is used for blood transfusion?

Answer 23

19 or 20 gauge is preferred

Question 24

What filtration is required for blood transfusion?

Answer 24

blood must be filtered using Y tubing with filter

Question 25

What is the timeframe for blood transfusion?

Answer 25

0-4 hours but generally is around 2 hours

Question 26

Explain key points for monitoring blood transfusion?

Answer 26

Start transfusion slow and stay for first 15 minutes Vitals: take baseline vitals and at end Temp: at 15 minutes (and ask about symptoms), then complete every hour

Question 27

What are the rules about blood transfusion delegation?

Question 28

What are the expected results for pRBC transfusion?

Answer 28

Increase of 3% HCT and 1gm HGB for each unit of blood

Question 29

When is blood drawn after blood transfusion to check results?

Answer 29

after 2-4 hours NOT earlier

Question 30

What happens if patient wants to go off unit during blood transfusion?

Question 31

What happens if blood transfusion pt only has one IV line but needs PCA and IV antibiotic?

Question 32

What happens if RN receives a call that blood transfusion pt needs MRI?

Question 33

How is a reaction to blood transfusion recognised?

Answer 33

fever: increase >2 deg (most reliable sign) itching, rash, flushed face/chest, chest pain, tachy, hypotension

Question 34

Nursing intervention for blood transfusion reaction?

Answer 34

1. STOP transfusion 2. take down blood & tubing and replace with NS and new tubing 3. blood sent back to blood bank 4. call MD 5. monitor VS 6. direct coombs test (checks for hemolytic reaction)

Question 35

What is the expected lab response to platelet transfusion?

Answer 35

Increase of 5000 to 10,000 per unit of platelets (normally multiple units are given)

Question 36

What is the expected lab response to plasma transfusion?

Answer 36

INR: decrease (move towards normal) PT: will decrease (clot quicker) PTT: will decrease (clot quicker)

Question 37

Nursing interventions to speed up a slow transfusion?

Answer 37

- hang blood higher - take blood down and gently agitate - flush IV and restart blood - use a pressure cuff

Question 38

Nursing interventions to minimise need for transfusion?

Answer 38

minimise bleeding risk: bedrest, bledsoe brace, no phlebotomy rebuild blood: iron/folate/B12, epoiten alpha