2/2/2011. Blood Components and Transfusions. Why Blood Transfusion?

Transcription

1 Blood Components and Transfusions Describe blood components Identify nursing responsibilities r/t blood transfusion Discuss factors r/t blood transfusion including blood typing, Rh factor, and cross matching Recognize and discuss the various transfusion reactions Why Blood Transfusion? To restore blood volume after severe hemorrhage Reason??? To replace loss due to disease Name disease??? 1

2 Complete blood count WBC RBC Hgb Hct Plt Source of Blood Autologous transfusion pre-operative peri-operative post-operative Allogenic transfusion Blood Typing and Cross matching Blood needs to be typed and cross-matched prior to a transfusion Plasma does not need to be cross-matched 2

3 Blood Types Recepient Type O Type A Type B Type AB Donor Type O X Type A X X Type B X X Type AB X X X X Rh Factor If Rh factor absent patient is considered Rh negative If Rh factor is present patient is considered Rh positive Whole Blood Blood has not been separated into its components Rarely used 3

4 Blood components PRBC Platelets FFP Cryoprecipitate Packed Red Blood Cells (PRBCs) 80% of plasma has been removed Given when H/H is decreased Should be given over 2-4 hours Platelets Given for decreased platelet count Should be cross typed Typical unit is 35-50ml Given over minutes 4

5 Plasma Referred to as fresh frozen plasma (FFP) Used as volume expander needed when??? Many coagulation factors Must be kept frozen until ready to use Cryoprecipitate Derived from thawing a unit FFP and recovering the precipitate Contains multiple coagulation factors (VIII, XIII, fibrinogen, VII=vWF) Albumin Fractionated portion of plasma Used as volume expander Maintain oncotic pressure Concentrations are: 5% - most commonly used 25% 5

6 Administrating Blood Obtain order Explain procedure to pt Verify consent IV should be gauge Always use correct blood administration tubing Always transfuse with NS Discard tubing after 2 units Administrating Blood Needs to be picked up in blood bank Two licensed nurses will check blood and patient Administration needs to start within 30 min after it leaves BB Administrating Blood Obtain baseline vital signs Start infusion slowly Stay with patient for first 15+ min why??? 6

7 Febrile reactions Allergic reactions Acute hemolytic reactions Anaphylactic reaction Circulatory overload Sepsis Acute lung injury (TRALI) Febrile: Caused by antibodies to donor white blood cells Signs and symptoms Chills Fever Increase in body temperature of 1 degree Fahrenheit within 2 hours after initiation of transfusion Allergic Cause Foreign protein sensitivity Incidence 1% of transfusions Symptoms Urticaria Flushing 7

8 Acute hemolytic: Life-threatening blood incompatibility Antibodies react with antigens on donor erythrocytes Causes massive hemolysis Can occur after only as little as 10 ml of blood Anaphalactic Cause Infusion of immune globulin A (IgA) proteins to IgA recipient with anti-iga antibodies Incidence One in 150,000 transfusions or 2% of all reactions Signs Anxiety Urticaria Wheezing Circulatory overload Volume overload Impaired cardiac function Signs and symptoms???? Treatment??? 8

9 Sepsis Cause Bacterial contamination of blood product Signs and symptoms Chills High fever Vomiting Diarrhea Hypotension progressing to shock Transfusion Related Acute Lung Injury (TRALI) Account for the largest number of transfusion reactions Signs: resp distress, pulmonary edema, infiltrates on CXR Transfusion Related Acute Lung Injury (TRALI) This is what pulmonary edema looks like 9

10 Stop the transfusion. Keep intravenous line open with a different normal saline bag and tubing. Take VS Notify healthcare provider. Take blood and urine sample. Send blood back to blood bank Return blood unit and tubing, with documentation, to blood bank. Transfusion Reaction Procedures Document using blood transfusion reaction report. Remain with and treat patient per healthcare provider orders. Monitor for signs and symptoms of shock. Obtain blood and urine tests as ordered. Monitor coagulation studies if hemolytic reaction is suspected. Monitor renal function. NLCEX The nurse should monitor a client with a blood type O- who received a transfusion from a type A+ donor for which of the following? A febrile reaction because the blood is mismatched An expected rise in hemoglobin and hematocrit A conversion from Rh negative to Rh positive because of the mismatched bloodtype Fluid overload symptoms 10

11 Nursing Student Overload No known cure Sorry! 11