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injection/administration of blood or blood products into the blood stream
an antigen that is a component of the RH blood groups and is made up of numerous complex antigens.
indicates person has Rh factor on surface of RBCs
Rh+ person may be transfused with either Rh- Rh+ blood
indicates person does not have Rh factor on surface of RBCs
person may only be transfused with Rh- blood to prevent formation of antibodies to Rh+ blood.
blood test that determines blood type
blood test that indicates compatibility between blood of donor and recipient.
Packed RBCs are supplied in _____mL bags
a concentrated source of RBCs and are the most common component given to RBC-deficient patients.
Packed RBCs are used for pts who
patients who have a hemoglobin level less than 8 g/dL or who are hypoxemic.
Compatibility is determined by two different antigen systems (cell surface proteins):
the ABO system antigens and the Rh antigen, present on the membranes of RBCs.
- are given to patients with platelet counts below 10,000 mm3
- to patients with thrombocytopenia who are actively bleeding
- or are scheduled for an invasive procedure.
Single donor platelets
- taken from just one donor and decrease the amount of antigen exposure to the recipient, helping prevent the formation of platelet antibodies.
- The chances of allergic reactions to future platelet transfusions are thus reduced.
For patients who are going to receive a hematopoietic stem cell transplant (HSCT) or who need multiple platelet transfusions,
single-donor platelets may be prescribed.
Platelet infusion bags usually contain
300 mL for pooled platelets and 200 mL for single-donor platelets
Platelets are fragile and must be infused immediately after being brought to the patient's room, usually over a
15- to 30-minute period
For a platelet transfusion take vital signs
- before the infusion,
- 15 minutes after the infusion starts,
- and at its completion.
What is given to reduce the chances of a reaction in a platelet transfusion
diphenhydramine (Benadryl) and acetaminophen (Tylenol)
A pt can have febrile and have rigors (severe chills) during transfusion, but these symptoms
are not a true transfusion reaction.
may be given fresh to replace blood volume
Fresh Frozen Plasma (FFP)
plasma is frozen immediately after donation
Freezing preserves the clotting factors, and the plasma can then be used for patients with clotting disorders
immediately after thawing while the clotting factors are still active.
Who are candidate for FFP??
Patients who are actively bleeding with a prothrombin time (PT) or partial thromboplastin time (PTT) greater than 1.5 times normal
ABO compatibility is
required for transfusion of plasma products.
Plasma infusion bag contains
Infuse FFP as
rapidly as the patient can tolerate, generally over a 30- to 60-minute period, through a regular Y set or straight-filtered tubing.
a product derived from plasma.
Clotting factors VIII and XIII, von Willebrand's factor, and fibrinogen are precipitated from pooled plasma to produce cryoprecipitate.
who are candidates for cryoprecipitate
Patients with a fibrinogen level of less than 100 mg/dL
cryoprecipitate can be infused, but it is usually given by
IV push within 3 minutes. Dosages are individualized, and it is best if the cryoprecipitate is ABO compatible.
Febrile transfusion reactions
occur most often in the patient with anti-WBC antibodies, a situation that can develop after multiple transfusions.
develops chills, tachycardia, fever, hypotension, and tachypnea
How can you reduce a Febrile transfusion reaction
- Giving leukocytereduced blood or single-donor HLA-matched platelets reduces the risk for this type of reaction.
- WBC filters may be used to trap WBCs and prevent their infusion into the patient.
Hemolytic transfusion reactions
- caused by blood type or Rh incompatibility.
- When blood containing antigens different from the patient's own antigens is infused, antigen-antibody complexes are formed in his or her blood.
Hemolytic transfusion actual reactions to the body
- The reaction may be mild, with fever and chills, or life threatening, with disseminated intravascular coagulation (DIC) and circulatory collapse. Other manifestations include:
- •Chest pain
- •Low back pain
- •A sense of impending doom
The onset of a hemolytic reaction may be
immediate or may not occur until subsequent units have been transfused.
Allergic transfusion reactions
- are most often seen in patients with a history of allergy.
- They may have urticaria, itching, bronchospasm, or anaphylaxis.
The onset of an Allergic reaction
usually occurs during or up to 24 hours after the transfusion
Patients with a history of allergy can be given
- leukocytereduced or washed RBCs in which the WBCs and plasma have been removed.
- This procedure reduces the possibility of an allergic reaction.
Bacterial transfusion reactions
Bacterial transfusion reactions
Symptoms of Bacterial transfusion reactions are
include tachycardia, hypotension, fever, chills, and shock
The onset of a Bacterial transfusion reaction is
can occur when a blood product is infused too quickly.
This complication is most common with whole-blood transfusions or when the patient receives multiple transfusions.
Older adults are more at risk
- Increase HOB, stop transfusion, IV NSS to
- KVO, notify MD,
Circulatory overload Symptoms include
- •Bounding pulse
- •Distended jugular veins
How can you manage and prevent circulatory overload
monitoring intake and output, infusing blood products more slowly, and giving diuretics
Transfusion-associated graft-versus-host disease (TA-GVHD)
a rare but life-threatening problem that can occur in both immunosuppressed and immunocompetent patients.
Its cause in immunosuppressed patients is similar to that of GVHD that occurs with allogeneic stem cell transplantation, in which donor T-cell lymphocytes attack host tissues.
Due to contaminated blood components and when blood sits around too long
Fever, chills, possible shock
Stop blood, NSS to KVO, notify MD, blood bag and tubing sent back to lab
Most dangerous – blood is usually incompatible
Chills, back pain, chest tightness leading to shock, renal failure, vascular collapse and cardiac arrest
Can occur after only 10 ml of blood
- Discontinue blood – emergency
- fluids/drugs/dialysis to maintain renal and blood pressure
Red urine appears on next void – collect urine
Collect blood specimen
Delayed Hemolytic Reaction
Occurs days to weeks after infusion – usually less severe
Fever, malaise, gradual decrease in H/H
No red urine
Important to monitor because may be a precursor to a more severe reaction in further transfusions
Prolonged storage of blood, cell destruction, improper handling
blood cells get destroyed
Preservative used to store blood binds with calcium to cause a deficiency.
Diseases transmitted by blood transfusions
The nurse is administering PRBCs. The pt is
experiencing dypnea, crackles in the lungsbases and an increasin BP. The nurse can anticipate the physician to do
Lasix 40 mg IV push