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Blood Component Therapy

created by Karen Friedberg


Objectives
1. Identify the types of Blood Transfusions and
their usage.

2. Prioritize nursing care during the initiation,


maintenance, and discontinuation of blood
product support.

3. Predict the various reactions associated with


blood component administration and related
nursing interventions.
What is blood made up of?
• Red Blood Cells
• White Blood Cells
• Platelets
• Plasma Proteins
• Clotting Factors

http://www.youtube.com/watch?v=ZuHdnTKBBKg
Terms
• Blood Types: A, B, O, AB
• Rh Factor
• HLA (Human Leukocyte Antigen)
• Recipient/Donor
• Typing/Cross-matching
• Antigen/Antibody
• Agglutinin
ABO Antigen System
• ABO antigens (cell-surface proteins) are
inherited & determine what blood type we
have.
• The Rh antigen(Rh+) can be present on the
RBC surface. It causes a transfusion
reaction when a person with an Rh- blood
type receives donor blood with an Rh+
surface antigen. **Remember this for OB!

• Our bodies form antibodies against blood


type antigens we do not possess & will
attack them during a transfusion.
RBC
• Whole Blood
• PRBC***
• Frozen PRBC
• Washed PRBC
• Irradiated PRBC

Expect 1 gram rise in Hg for each unit


of blood given.
PRBC and Standard Tubing
Administration
• PRBC is preferred
• ~250 ml in a unit
• Time frame is based on patient
condition
– Usually over 4 hours
– Can be quicker based on need
– Assess co-morbidities
– Must be given within 4 hours
after leaving blood bank
When to transfuse
• Based on how quickly one gets into
a problem
• H/H < 6 g/dL
• H/H 6-8 g/dL if there is the
following:
–Tissue hypoxia
–Symptoms present
Alternatives
• May try Biologic Response Modifier first:
– Types (Colony Stimulating Factors)
• epoetin alpha: Procrit® and Epogen®
• darbepoetin alpha: Aranesp®
• Nursing Care
– Monitor Blood Counts
– Side effects
• Thrombus formation
• Assess for complications of therapy (ITP; stroke)
– SQ injection**
– Heat sensitive!
• Call pharmacy right before you plan to give it.
• Instruct patient to keep in cold place
Platelets
Random Donor
(Pooled)
• Volume to be
infused is about
300mL
• Given over 15-30
minutes
• About 6 unit bags
(each form one
blood donation)
Random Donor Platelets
Single Donor Platelets (SDP)

• Volume to be
infused is 200 mL
given over 30
minutes.

• Indications for use:


Persons with a
former febrile or
allergic transfusion
reaction.
Single Donor Platelets
Platelet Apheresis
When to transfuse

• Low platelet count:


– >10,000 mm/dL

• Before invasive procedures if


platelets are low
• Considerations:
– How quickly the problem
occurred
– Presenting symptoms
Alternatives
• Use of Biologic Response Modifier: CSF
 oprelvekin- Neumega®

Nursing Care
• Monitor Blood Counts
• Side effect: anaphylaxis, CV, pneumonia
• SQ injection**
• Heat sensitive!
• Call pharmacy right before you plan to give it.
• Instruct patient to keep in cold place
WBC
• Never given: too many problems!

• May try Biologic Response Modifier:


– Types (Colony Stimulating Factors)
• filgrastim- Neupogen®
• pegfilgrastim- Neulasta®

• Nursing Care
– Monitor Blood Counts
– Side effect: anaphylaxis
– SQ injection**
– Heat sensitive!
• Call pharmacy right before you plan to give it.
• Instruct patient to keep in cold place
Plasma
Fresh frozen plasma (FFP)
– Albumin
– Clotting Factors

Cryoprecipitate
– Just the clotting factors
Plasma Products
Fresh Frozen Plasma (FFP)-(albumin
& clotting factors )
• Volume to be infused is 200 mL in
15-60 minutes
• Indications for use: Deficiency in
coagulation factors or PT/PTT time
is 1.5 x normal. Freezing
preserves the clotting piece.
Plasma Products
Cryoprecipitate (CP)- (clotting factors
only-VIII, XIII, von Willebrand’s factor &
fibrinogen)
• Infused amount is 10-20 mL/unit in
about 15- 30 minutes or IVP in 3
minutes.
• Indications for use: Hemophilia VIII,
VonWillebrand’s Disease or fibrinogen
levels < 100 mg/dL
FFP/CRYO
RBC Administration: Equipment
• Consent
• “Banding” (Type and Crossmatch)
• Y-tubing
• Filters (removes sediment from the stored
blood products)
• Blood Warmers
• Large Gauge Needle: 20 gauge or greater
• Isotonic IV solution: 0.9% Normal Saline only
NO Lactated Ringers/NO D5 solutions - both
cause clotting & hemolysis of blood cells
• Baseline Vital Signs
Blood Administration
• Review Policy & Procedure
• Check for Orders
• Blood specimen sent for type/cross match
• Administer early in the day/shift
• With another RN - Check blood bag label,
attached tag, requisition slip (ABO & Rh
types), expiration date, integrity of blood &
person’s blood bank ID number & person’s
name band
• No ID band? - Do Not Give
Blood Administration (continued)
• Blood must be administered within 30 minutes
of retrieval from the blood bank
• Explain procedure to person
• Obtain vital signs, including temperature
• Can place on the Alaris® pump
• Begin the transfusion slowly, observing for any
untoward reactions (chills, SOB, itching, hives
(severe reactions usually occur within the 1st
infused 50 mL)
• Remain with person for 1st 15-30 minutes,
assessing V/S every 15 minutes
Blood Administration (continued)

• If no reaction-↑ infusion rate to


transfuse 1 unit of blood as ordered.
• Might need to run slower rate for older
persons/♥ issues
• Sherman Hospital prepares a
Leukocyte-poor blood.
Other Reactions and Associated
Interventions

• Circulatory Overload
– Slow down fluids; ? Diuretic (after and/or
midway)
– Anticipate with underlying disorders

• TRALI: Transfusion-Related Acute Lung Injury


– Rare; R/T multiple transfusions
– 6 hours post transfusion
– High dose O2; IVF; ? Inotropes (ARDS
management); ? ventilator
Other Reactions and Associated
Interventions Continued

• Sepsis (not common)


– Importance of T

• Air embolism
– Assess; turn on left side with head lowered

• Electrolyte imbalances: Potassium and


Calcium
– Check for tetany! Check for arrhythmias!
Nursing Care
During Transfusion
• Assessments
• Frequency of Vital Signs
• Determination of how and when to give other
IV fluids
• DO NOT ADD TO or INFUSE OTHER DRUGS
BLOOD administration unless you have a
separate IV line.
• Time frames: start early in shift; how long?
• When to stop
• Documentation
• “empty bag”: send to lab
Objectives
1. Identify the types of Blood Transfusions and
their usage.

1. Prioritize nursing care during the initiation,


maintenance, and discontinuation of blood
product support.

2. Predict the various reactions associated with


blood component administration and related
nursing interventions.