Download Module 2

Blood Administration made Bloody Easy
Module 2 – Indications and Compatibility
Content derived from
Bloody Easy Blood Administration handbook
& Bloody Easy for Nurses eLearning modules
Prepared by Ana Lima
Transfusion Safety Nurse
Sunnybrook Health Sciences Centre
October 2010
Learning Objectives
 Understand the major uses, appropriate storage and
expiration times for blood products and plasma derivatives.
 Describe tubing requirements and typical infusion times for
administering blood products and plasma derivatives.
 Understand the ABO and Rh blood groups and how they
impact on compatibility of blood products.
 Indicate which blood groups are appropriate in urgent
situations when the patient’s group is unknown.
NOTE: Always consult your hospital policy for
information specific to your facility as practice may vary.
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Blood Donation
 In Canada (excluding Québec) blood is
collected by Canadian Blood Services
(CBS) from volunteer donors.
 The donor undergoes a health screening
which includes vital signs, hemoglobin
check and a questionnaire.
 The collected blood is tested for blood group
and transmissible diseases.
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Blood Products/Components
 About 450mL of whole blood is collected into an
anticoagulant preservative solution and the majority of
donor white blood cells (WBC) are removed by a
leukoreduction filter.
 Each donation can be separated into up to 4 products or
components;




Red blood cells
Plasma and Cryosupernatant Plasma
Platelets
Cryoprecipitate
 Some blood products are collected using a cell separator
machine by a method called apheresis. Usually the donor
donates 1 type of blood product while the rest of their blood
is returned to them.
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Red Blood Cells
Major Uses
Bleeding or anemic
non-bleeding patients
with signs and
symptoms of impaired
tissue oxygen delivery.
Tachycardia
Shortness of breath
Dizziness
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Storage &
Expiration
2-6° C in approved
fridge only
Up to 42 days
Administration
Blood tubing required
Initiate transfusion
slowly for first 15
minutes unless massive
blood loss
Transfuse over no
more than 4 hours
Typically over 1 ½ - 2
hours with slower rates
for patients at risk for
circulatory overload
Plasma
Major Uses
Liver disease
coagulopathy
Massive transfusion
Plasma exchange for
TTP/HUS* when
cryosupernatant plasma
not available
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Storage &
Expiration
Frozen
1 year
Once thawed - stored
at 1-6° C
expires after 24 hours
or 5 days
(product specific as per
CBS recommendation)
* TTP/HUS = Thrombotic Thrombocytopenic Purpura/Hemolytic Uremic Syndrome
Administration
Blood tubing required
Initiate transfusion
slowly for first 15 minutes
unless massive blood
loss
Transfuse over no more
than 4 hours
Typically over 30
minutes - 2 hours
Platelets
Major Uses
Control or prevent bleeding
in patients with:
Low platelet counts
Congenital platelet
dysfunction
Platelets not functioning
due to the effects of
medications (ASA, Clopidogrel
- Plavix®)
Platelet dysfunction
following
cardiopulmonary
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bypass
Storage &
Expiration
20-240 C on an
agitator to prevent
clumping
5 days
Administration
Blood tubing required
New blood tubing
recommended
Initiate transfusion
slowly for first 15
minutes unless massive
blood loss
Transfuse over no
more than 4 hours
Typically over 60
minutes
Cryoprecipitate
Major Uses
To replace:
Fibrinogen: In
patients actively
bleeding who have a
low fibrinogen level
Coagulation Factors:
Only when more
specific factor
concentrates are not
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available
Storage &
Expiration
Frozen
1 year
Once thawed expires
after 4 hours stored at
20-240 C
Administration
Blood tubing required
Transfuse as rapidly
as tolerated
The ABO & Rh
Blood Group Systems
and Compatibility
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ABO
Blood Group
 The ABO blood group is
determined by the
presence or absence of
the A and B antigens on
the surface of the red
blood cells (RBC).
 By 4 months of age a
person will naturally
acquire antibodies against
the antigens that are not
present on their red blood
cells. These antibodies
are found in the plasma.
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ABO
Antigen Antibody
Group on RBC in plasma
Percentage
of
population
A
A
Anti-B
antibody
42%
B
B
Anti-A
antibody
9%
AB
A and B neither
3%
O
neither
46%
Anti-A and
Anti-B
antibodies
ABO Antibodies and Compatibility
 A patient’s antibodies will destroy transfused
red blood cells if they are incompatible.
 Donor antibodies found in plasma and
platelet products can destroy a patient’s red
blood cells if they are incompatible.
 The resulting potentially fatal reaction is
called an
Acute Hemolytic Transfusion Reaction
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Rh(D) Blood Group
 The Rh(D) blood group is
determined by the presence or
absence of the D antigen on the
surface of the RBC.
 Anti-D antibodies can be
produced by an Rh negative
person after they are exposed to
Rh positive RBCs (or platelets).
 This can occur with transfusion
or during pregnancy if the fetus
is Rh positive.
 It is important to prevent the
development of Anti-D
antibodies in females who may
in future become pregnant as
the Anti-D antibodies can
seriously harm an Rh positive
fetus.
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Rh(D)
Group
Rh(D) Percentage
Antigen of
population
Rh
Positive
Present
Rh
Absent
Negative
85%
15%
Patient
Blood
Group
Compatible Donor Blood Group
Plasma/
Cryosupernatant
Plasma
Cryoprecipitate
Red Blood Cells
Platelets
O Positive
O Pos
O Neg
Rh Pos or Neg
O preferred
Any Group
Any Group
O Negative
O Neg
Rh Neg
O preferred
Any Group
Any Group
A Positive
A Pos, A Neg
O Pos, O Neg
Rh Pos or Neg
A preferred
A, AB
Any Group
A Negative
A Neg
O Neg
Rh Neg
A preferred
A, AB
Any Group
B Positive
B Pos, B Neg
O Pos, O Neg
Rh Pos or Neg
B preferred
B, AB
Any Group
B Negative
B Neg
O Neg
Rh Neg
B preferred
B, AB
Any Group
AB Positive
Any Group
Pos/Neg
Rh Pos or Neg
AB preferred
AB
Any Group
13 Negative
AB
Any Group
Neg
Rh Neg
AB preferred
AB
Any Group
Compatibility and Urgent Transfusions
 As well as the ABO and Rh
groups, a pre-transfusion
sample also screens for other
more uncommon antibodies that
can be acquired with blood
exposure or pregnancy.
 Some antibodies can cause
acute or delayed hemolysis.
 In urgent situations, where the
blood group and screen testing
have not been completed, the
patient may need to receive a
transfusion from a universal
donor group.
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Patient
Red Blood
Cell
Transfusion
Plasma
Transfusion
*
Females
less than
45 years of
age
O Negative
AB
All others
O Positive
or
O Negative
AB
* Rh of Plasma (and cryoprecipitate) is not relevant for compatibility
Plasma Derivatives
 Some donor plasma is sent to fractionation plants
that extract and purify certain proteins to make
plasma derivatives including;





Albumin
Intravenous Immune Globulin (IVIG)
Rh Immune Globulin (RhIg)
Other Immune Globulins
Coagulation factors
The most commonly infused plasma derivatives are
reviewed in the next slides
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Albumin 5% and 25%
Major Uses
 Ascites patients
undergoing large volume
paracentesis greater than
5 litres (25% albumin)
Spontaneous Bacterial
Peritonitis (25% albumin)
Hepatorenal syndrome
(25% albumin)
Plasma exchange
procedures
(5% albumin)
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Storage &
Expiration
Administration
Standard vented IV set –
no blood tubing or filtering
required.
Bottles must be vented –
Expires as indicated on most standard IV sets
packaging
have a vent that can be
opened otherwise a
vented set is required
Begin infusion slowly
then as tolerated
Room temperature
< 30° C
Intravenous Immune
Globulin (IVIG)
Major Uses
Storage &
Expiration
Replacement of
immunoglobulins
Storage variable by
brand
Control of some
infections and
autoimmune diseases
Expires as indicated
on packaging
Administration
Standard vented IV set – no blood
tubing or filtering required
Bottles must be vented – most
standard IV sets have a vent that can
be opened otherwise a vented set is
required
Compatible with D5W. Some brands
are not compatible with normal saline.
Infusion pump required
Begin infusion slowly and increase
as tolerated
For maximum rate – check package
insert/hospital policy as brand specific
Frequent Vital Sign monitoring
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required
Rh Immune
Globulin (RhIg)
Major Uses
Storage &
Expiration
Used for Rh-negative patients:
2-8° C
Following exposure or possible
exposure to Rh-positive blood
To prevent sensitization to the
Rh(D) antigen during pregnancy
Expires as
indicated on
packaging
Treatment of nonsplenectomized Rh-positive
patients with Immune
Thrombocytopenic Purpura (ITP)
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Administration
Administered usually IM
but may be given IV
Administered IV through
a standard IV set
May be given slow push
usually by Physician
Monitoring for hemolysis
required
Prothrombin Complex
Concentrate (PCC)
octaplex®
Major Uses
Reversal of warfarin
(Coumadin®) or Vitamin
K deficiency in bleeding
patients and those
requiring emergency
surgery
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Storage &
Expiration
2-25° C
Expires as
indicated on
packaging
Use immediately
once reconstituted
Administration
Full dosage may be pooled into an
empty minibag
Standard IV set – no blood tubing or
filtering required
Usually infused over 15 - 30 minutes
May also be given slow push usually
by Physician
Dosage based on patient weight and
INR value – usually 2 - 4 vials for
adults
Effect is immediate and lasts 6 - 12
hours
For complete reversal, Vitamin K 10
mg. IV must also be given
Assessment Quiz
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1.
Where can Red Blood Cells be
stored?
a.
b.
c.
d.
e.
Ward fridge
Medication fridge if only for a short time
Blood Transfusion Laboratory fridge
All of the above
None of the above
Answer:
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2.
A 17 year old female is admitted to Emergency after
being hit by a car. She requires an immediate Red
Blood Cell transfusion for active bleeding before her
blood group can be determined. Which blood group is
appropriate for this patient?
a.
b.
c.
d.
e.
Group AB positive
Group O negative
Group O positive
Group AB negative
Any blood group is appropriate in this urgent
situation
Answer:
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3.
The physician has ordered 3 units of plasma. The
patient’s blood group is B negative. You are checking
the first unit of plasma which is blood group B.
What is the next step?
a. Wait for the other 2 units of plasma to be ready
and then start the transfusion
b. After completing the bedside check begin the
transfusion
c. Contact the physician immediately
d. Contact the Blood Transfusion Laboratory
immediately to request B negative plasma
Answer:
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4.
Which blood product is used to control
significant bleeding in a patient who has been
taking daily ASA?
a.
b.
c.
d.
e.
Albumin
Cryoprecipitate
Red blood cells
Plasma
Platelets
Answer:
24
5.
Which of the following must be transfused
through a blood tubing?
a.
b.
c.
d.
e.
f.
Platelets
Intravenous Immune Globulin
Albumin
Rh Immune Globulin
All of the above
None of the above
Answer:
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6.
For a red blood cell transfusion which blood
groups are likely compatible for a patient
whose blood group is A positive?
a.
b.
c.
d.
A pos, A neg, O pos and O neg only
A pos and A neg only
A pos and AB pos only
Apos, B pos, AB pos and O pos
Answer:
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7.
An individual whose blood group is B negative
has the following antigens and antibodies:
a. B antigen on their red blood cells and anti-O
antibodies
b. A antigen on their red blood cells and anti-B
antibodies
c. B and D antigens on their red blood cells and antiD antibodies
d. B antigen on their red blood cells and anti-A
antibodies
Answer:
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8.
Which of the following plasma derivatives
would be appropriate for a patient actively
bleeding who is on daily warfarin (Coumadin®)?
a.
b.
c.
d.
e.
Albumin
Intravenous Immune Globulin
Tetanus Immune Globulin
Rh Immune Globulin
Prothrombin Complex Concentrate (Octaplex®)
Answer:
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9.
How should red blood cells be
transfused?
a.
b.
c.
d.
e.
Using a standard IV set primed with D5W
Using a vented IV set primed with D5W
Over 5 to 6 hours
Typically over 1 ½ to 2 hours
Diluted with 200mL of Saline to decrease viscosity
Answer:
29
10. Which of the following is True?
a. In Canada blood is collected from volunteer
donors by Canadian Blood Services
b. The universal plasma for urgent transfusion is
group B
c. Plasma and cryoprecipitate do not need to be
transfused through a blood tubing
d. Platelets are not associated with any transfusion
reactions
Answer:
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Assessment Quiz Answers
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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c
b
b
e
a
a
d
e
d
a
NAME:
Blood Administration Made Bloody Easy
Module 2 – Indications and Compatibility
Date:_________
End of Module 2
 Module 1 – Transfusing the Patient
 Module 2 – Indications and Compatibility
 Module 3 – Transfusion Reactions
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