Erythrocytes RBCs Leukocytes WBCs Thrombocytes platelets Plasma 90 water 10 solutes Proteins clotting factors 1 What can we give Whole blood Packed RBC PRBC Platelets Fresh Frozen Plasma FFP ID: 1038689
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1. Components of BloodFormed elements-Cells Erythrocytes (RBCs)Leukocytes (WBCs)Thrombocytes (platelets)Plasma90% water10% solutesProteins, clotting factors1
2. What can we give?Whole bloodPacked RBC (PRBC)PlateletsFresh Frozen Plasma (FFP)Granulocytes CryoprecipitateFactor VIIIAlbuminWhat are expected outcomes?2
3. AntigensDefinition: a substance capable of stimulating the production of an antibody and then reacting with that antibody in a specific wayInheritedFound on red cellsABO, Rh (D antigen)3
4. AntibodiesDefinition: protein produced by the immune system that destroys or inactivates a particular antigenProduced as a result of antigenic reactionsFound in plasma4
5. AgglutinationCaused by reaction between antigens and antibodiesType & screenType & cross5
6. Giving and ReceivingBlood GroupAntigens on cellAntibodies in serumCan give blood to:Can Receive blood from:ABA & BNoneABAB, AB, 0AAAnti-BA & ABA & OBBAnti-AB & ABB & OONoneanti-A & anti-BAB, AB,0O6
7. Ways to Give & ReceiveAutologousIntraoperative PostoperativeHomologous VolunteerDesignated donation7
8. Blood Components (Phillips, ch. 11)Key pointsAll blood MUST be infused within 4 hoursCatheter size: 22- to 14-gauge with 20- to 18-gauge appropriate for general populationsMust use filter specific for bloodAdministration set changed with every unit8
9. Blood Components: Whole bloodvolume — 500 cc (approx.) Rarely usedMust be ABO compatibleAcute massive blood loss >25%Raises Hgb by 1 g/dLRaises Hct by 3%9
10. Blood Components (Packed Red Cells)must be ABO compatibleVolume — 250 – 300 mL (approx.) Use for chronic symptomatic anemiaNOT used for volume expansionRaises Hgb 1 g/dL and Hct 3%Use only 0.9% sodium chloride as primerUse 170 micron filterAdminister over4 hours (usually 2 hours)10
11. Leukocyte Reduced RBCsFilter: leukocyte filter Need physician’s orderFilter 99% of WBCs that cause febrile reactions11
12. Blood Components: plateletsUse: control bleeding in platelet deficiencyUse in thrombocytopeniaAdministration: 1 unit (30 – 50 mL) over 5 – 10 min.ABO compatibility not required but preferred.1 unit raises platelet count 5 – 10,000 Administer 6-8 units/time Apheresis = single donor12
13. Plasma Derivatives: FFPPlasmaLiquid portion of blood; does not contain RBCsFresh frozen plasmaPrepared from whole blood separating and freezing plasma within 8 hours of collectionFFP may be stored up to 1 yearDoes not provide plateletsTypical volume is 200 – 250 mLUse: procoagulant deficiencies, DIC, massive transfusions in trauma13
14. Plasma Derivatives: Albuminplasma protein that supplies 80% of plasma’s osmotic activityDoes not transmit viral disease because of extended heating processAvailable as 5% or 25% solutionGlass bottle: administration set w/air vent.14
15. Alternatives to Blood TransfusionsAugmentation of volume with colloid solutionsAutologous cell salvageRBC substitutesModified hemoglobin or hemoglobin-based oxygen carriersPerfluorocarbons (PFCs)Erythropoietic stimulating agents (ESAs)White cell growth factorsHematinics15
16. Administration of Blood ComponentsKey pointsAssessmentPreparing for transfusionObtaining blood from labChecking unit with another nurseInitiation of transfusionMonitoringDisposal16
17. Assessment of Patient Prior to Initiation of Blood TransfusionCheck hospital P&PConsent in chartReview any parameters set by physicianVital sign base lineAssessment of lungs and kidneysLaboratory valuesPatient history of transfusions17
18. Preparation for TransfusionInitiate IV with appropriate catheter; in most situations, 20- to 18-gaugeIf IV infusing, check patency and cannula sizeSaline lock: flush to check patencyStart primer of 0.9% sodium chloride with Y administration setY set has 170 micron filter18
19. Obtain Blood Component from LabPick up only one unit from lab at a time!Clerical errors most common transfusion complicationSign for blood – checking Name, identification number of patientTransfusion donor numberExpiration date of componentABO and Rh compatibility19
20. Preparation for AdministrationCheck with another licensed person compatibility informationName, identification number of patient“paper to armband” then “paper to blood bag”Transfusion donor numberExpiration date of componentABO and Rh compatibilityObtain set of vitals prior to initiation20
21. AdministrationWear gloves to hang bloodSpike bag and hangTurn off sodium chlorideslowly begin infusionStay with patient a minimum of 15 minutes21
22. Rate of InfusionDr. order?Age of patientPurpose of infusionOther medical conditions (CHF)Current IV rate“slow” rate for 1st 15 min.Craven: 10 gtts/min (60 ml/hr)Phillips: 2 ml/min (120 ml/hr)Berman et al Skills book: 20 gtts/min (120 mL/hr)Must be infused w/in 4 hours22
23. Monitoring of TransfusionCheck vitals per hospital P&PReflected on blood transfusion slipAssess kidneys and lungs throughoutObserve for signs and symptoms of transfusion reactions23
24. Transfusion reactionsImmuneAcute hemolyticDelayed hemolyticNonhemolytic febrileAllergicNon-ImmuneCirculatory overloadHyperkalemia HypothermiaCitrate toxicityBacterial contaminationCoagulation imbalancesTransmission of infectious disease24
25. Transfusion ReactionsImmediateHemolytic transfusion reactionsNon-hemolytic transfusion reactionsFebrileAllergic25
26. Hemolytic transfusion reactionsWrong blood to wrong patientOccurs within 5 – 15 min. of initiation of transfusionDeathDICCMsFever (w/ or w/out chillsHypotensionPain: lumbar, flank, chestTachycardiaTachypneaHemoglobinuriaSee Table 11-826
27. Suspected Hemolytic Reaction?Stop transfusionDo NOT flush w/NS flush bagDisconnect blood tubing, then flush.Prepare to treat shockFollow hospital guidelines:Notify MDSave blood bagCall labBlood sampleUrine sample27
28. Febrile reactionsCause: reaction to antibodies in blood in reaction to leukocytesSigns and symptoms : fever, chills, HATreatment: stop blood, notify RN, notify physician Treat with antipyretic medicationUse leukocyte filter28
29. Allergic reactionsCause: antibody formation against plasma proteinsSigns and symptoms are varied : hives, itching, respiratory distressTreatment: stop blood, notify RN, notify physicianTreatment: antihistamines29