indications, contraindications, risks, and benefits of blood transfusion
· Increase circulating volume· Blood loss from surgery· Trauma· Hemorrhage· Increase number of RBC· Maintain hemoglobin levels in anemia· Replace certain cell components - clotting factors
assessments required of a patient receiving a transfusion of blood or blood products
Everyone must have a type and screen test doneBlood is tested for antigens present, blood type, Rh + or Rh -Blood type and screen is valid for 96 hours (4days) from time of collectionCan do a cross match - check for reactions - mix donors blood with recipients' bloodMust know blood type and Rh factor before giving bloodMust have a hemoglobin level 70 or less
Common transfusions
· Blood· Plasma· Platelets
Whole Blood
Contains:· RBC· WBC· Platelets· Plasma· Cryoprecipitate - fibrinogen
Red Blood Cells (RBC)
Indications for administration:To replace blood loss due to hemorrhage, surgery, traumaKey Points:One unit will increase hemoglobin by approximately 10g/dLDo not often transfuse unless Hgb <70Shelf life is up to 42 days after collectionBegin transfusion within 30 minutes of receipt of blood - if cannot start infusion within 30 mins must send blood back to blood bankTransfuse in <4 hoursKept in fridgeChange IV tubing every 8 hours or after 2 units of blood
Platelets
blood componentIndications for administration:For bleeding due to decreased plateletproduction or abnormal plateletsProphylactically for invasive procedures when platelet levels are lowKey Pointshave a shelf life of only five daysmust be used within 4 hours of hangingstored at room temperature - NEVER put in fridgePlatelet type is the same as blood typeAny type of platelets can work if nothing else is available - ideally receive same blood type
Plasma (FFP - fresh frozen plasma)
Indication for administration:Replace clotting factorsReverses the effects of warfarin & heparinFor patient who is bleeding due to coagulopathy - impaired clotting of the bloodHelps regulate BP & TempBlood expanderHelps with circulation of hormonesKey points:Referred to as FFP/FPShelf life of 1 yearMust be thawed by the blood bank- Takes 20-30 minutesSize of unit varies and is based on how collected from the donor - 250 ml or 500 mlInfuse within 4 hours
Plasma expanders - colloid
Composed of large molecules which draw or hold fluid in the bloodstreamNaturalMade from blood productsSterile - NO RISK of viral transmissionExamples - Dextran, Albumin (protein made in the liver- helps draw fluid in)SyntheticContain no human antigensExamples - Pentaspan, Voluven** Be mindful when giving this to patients with HF or CHF. Already have a large circulating volume and your increasing the volume with the plasma expander.
Massive TransfusionMassive Transfusion
Greater than 10 units in 24 hours> patient's entire blood volume in 24hours> 10 units of RBC'sEffects are:Dilutional coagulopathy (↑INR, ↓platelets)HypothermiaHypocalcemia/Hypomagnesemia (citrate tox.)HyperkalemiaMetabolic Acidosis
Blood Type A+
Can give to: A+ AB+Can receive from A+, A-, O+, O-
Blood type O+
Can give to: O+, A+, B+ AB+Can receive from: O+, O-
Blood Type B+
Can give to: B+, AB+Can receive from: B+,B-, o+, O-
Blood Type AB+
Can Give to: AB+ Can receive from: Everyone
Blood Type A-
Can give to: A+, A-, AB+, AB- Can receive from: A-, O -
Blood Typer O-
Can give to: Everyone Can receive from: O-
Blood Type B-
Can give to: B+, B-, AB+, AB-Can receive from: B-, O-
Blood Type AB -
Can give to: AB+, AB- Can receive from: AB-, A-, B-, O-
Alberta Health Services Policy and Procedures for initiation of blood products
LPN can start IV, set up for transfusion, administer blood, spike bag etc. CANNOT give adverse reaction medications, RN must give.
obtaining consent for administration of blood and blood products
Consent is assumed until told otherwiseSeparate consent form or with surgery paperwork
ethical, legal, cultural, and religious considerations related to the administration of blood and blood products
Not every religion and culture agree to blood transfusions - Jehovah witnesses do not receive blood transfusionsMust gain consent
obtains blood or blood product from the blood bank
Obtained from blood bankMust start administration within 30 mins of gaining unit of bloodMust be transfused in less than 4 hours
set up an infusion set for the administration of blood or blood products
Gather equipmentGet blood administration set - 170-260-micron filterInfusion pump - must use500 mL NSPrime a separate NS infusion - separate pumpMust have emergency meds on unit MUST HAVE ALL 3 ON UNIT- Epinephrine- Diphenhydramine (Benadryl)- Hydocortisol - reduces swelling in lungsAll must be in IV form
initiate blood transfusion
Must be double checked by a professional who can also give blood products3 steps to verify - 2 nurses involvedID band - Blood ID # on transfusion - Blood
calculates the rate of infusion/ IV pump
1-2 mL/min start rate until 15 mins and no reactionsMust run within 4 hours
monitors the administration of blood or blood product
Must remain in room for 5 minutesAssessment at 10-minute markAssessment at 15-minute markMost likely to have a reaction within 15 minutes of administeringAssessment at 1 hour then every hour followingMUST have 02 & suction available
Infectious reaction to blood transfusions
Disease transmitted by infected blood donors who areasymptomaticEg. HIV, Hep C, Hep B, bacterial sepsis
Non-infectious reaction to blood transfusions
Allergic reactions, hemolytic transfusion reactions (RBC breakdown), ABO reactions
Febrile (fever)/ Non hemolytic reaction to blood transfusions
Most commonAntibodies against donor WBC'sSigns and Symptoms:- Sudden chills- Fever (>1degree Celsius)- Headache- Flushing- Muscle pain- Treatment:- STOP infusion, DO NOT FLUSH, notify MD- Antipyretics as ordered
Mild Allergic Reaction reaction to blood transfusions
Antibodies against donor plasmaSigns and Symptoms:- Flushing, itching, hivesTreatment:- Stop transfusion, notify MD- Antihistamines as ordered
Anaphylactic reaction to blood transfusions
Antibodies to donor plasma,especially anti-IgASigns and Symptoms:- Anxiety, Urticaria, Wheezing,- Severe Hypotension, Shock,- Cardiac Arrest- Treatment- Stop transfusion, notify MDAnticipate administration of epinephrine (0.4ml of 1:1000)BP support and possible CPR
Acute Hemolytic Transfusion Reaction (AHTR)
Most serious reactionResults from blood type incompatibility - can happen with as little as 10 mLOccurs in first 15minsAntibodies in recipients' plasma attach to antigens o transfused RBC destroying themDelayed reactions 24hrs later up to 1 month laterProgresses to:- Vascular collapse- Bleeding- Acute renal failure- Shock- Cardiac arrest- Ultimately, deathTreatment:- Stop transfusion- Treat shock if present- Blood samples- Urine specimen- Maintain BP- Diuretics prn- Insert catheter
Sepsis
Bacterial contamination oftransfused blood productsSigns and Symptoms:- High fever- Rapid onset chills- Marked hypotension- ShockTreatment:- Obtain blood culture- Return bag to blood bank- Treat septicemia- Antibiotics- IV fluids- Vasopressor- Steroids
Circulatory Overload
Fluid administered faster thancirculation can accommodateSigns and Symptoms: Cough, Dyspnea, Pulmonarycongestion, Headache, Hypertension,Tachycardia, Distended neck veinsTreatment:- Sit upright- Administer prescribed- Diuretics- Morphine- OxygenRisk factors:- Rapid transfusion- Elderly- Underlying heart disease (heart failure)
WHAT TO DO FOR ANY TRANSFUSION REACTION
Stop the transfusion immediatelyProvide emergency care for ABC'sDO NOT flush the IV lineChange IV set and start normal salineNotify physician:Provide medications as orderedBlood work drawn & urine collected as orderedReport to transfusion medicine, return unused blood & tubingDocument reaction and event
DOCUMENTATION
Date & time transfusion (start & end)Type of component used product numberVital signs and timeID of person administering and the ID of second person verifying the blood component or productAdverse events & treatments givenVolume administered - I&O recordPatient /Family EducationPatient outcomes
Patient education for blood transfusions
Inform them to report immediately:- Fever, hot, diaphoresis- Shortness of breath- Itching- Chills- Feeling very unwell