Download Red Blood Cells

NUR 251
Blood Administration
Components of Blood- Review
o Cells – represents 45% of total blood volume and consists of erythrocytes (red blood
cells – RBCs), leukocytes (white blood cells – WBCs), and thrombocytes (platelets).
o Plasma – Responsible for the additional 55% of blood. Consists of 90% water and 10%
solutes. The solutes are composed of proteins, glucose, lipids, and various other
substances.
Antigens & Antibodies
o Antigens are substances capable of formulating an antibody. When specific antigens
& antibodies in blood combine, it causes agglutination (clumping) of blood.
o Antibodies are protein substances found in plasma. Names derive from the antigen
with which they react – anti – A, anti – B. Inactivates antigens.
o Example: A person with “A” blood type will not have anti-A antibodies in the plasma.
ABO System Review
o Classification of blood based on antigens on RBC and antibodies in the plasma: A, B,
AB, O
o O contains no antigens, both antibodies, so this is the universal donor.
o A contains A antigen and anti-B antibodies.
o B contains B antigen and anti A antibodies.
Blood types…
o O+ is most common
o O is the universal donor
o AB is the universal recipient
o In order to avoid antigen/antibody reactions….
o A person with type A blood can receive A or O
o A person with type B blood can receive B or O
o A person with type O can receive type O
o A person with type AB blood can receive all types
Rhesus (Rh) Factor
o There are additional antigens present on the RBC, but most important is the “D”
antigen.
o If a patient is Rh +, they have the D antigen and can receive both Rh+ and Rh- blood.
o If a patient is Rh -, they lack anti-Rh antibodies. If you give them Rh+ blood, hemolysis
can occur with RBC destruction.
 1st transfusion will produce antibodies
 2nd transfusion produces agglutination
Testing
o The blood supply is commonly tested for:
o Hepatitis B & C
o HIV antibodies
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HTLV (Human T-Lymphotropic Virus)
Rare in US, associated with IV drug use, causes neurological illness
Syphilis
NAT (Nucleic Acid Amplification Testing )
Directly detect the genetic material of viruses like HCV and HIV enabling detection
prior to antibody formation – not yet FDA approved
o West Nile Virus (as of 2003)
Blood Storage
o RBCs – up to 42 days
o Platelets – 5 days
o FFP – fresh frozen plasma – 1 year
o Cryoprecipitate – 1 year
o Granulocytes (WBCs) – use asap
------------------Breaking them down…-----------------------------------------------------------------------------------------------o Whole blood – used in emergency situations where up to 25% of blood volume is lost.
 Contains all components: RBCs, WBCs, Platelets & Plasma
Apheresis – a.k.a. separation
o Apheresis means that only specific components of blood are taken for a temporary
measure until medications can be initiated. Examples are:
 Platelet pheresis – platelets are removed from the patient to decrease the
amount of circulating platelets.
 Plasmapheresis – plasma exchange plasma platelets are removed to treat some
neurological and renal diseases.
 Erythrocytapheresis – RBC’s are removed and exchanged – often done for sickle
cell disease.
Red Blood Cells
o Transfusion of RBCs can increase oxygen carrying cells, raising the H & H while
minimizing volume increase.
o One unit of packed red cells can increase the hematocrit by 3% and the hemoglobin
by 1 gm
o Excellent for chronic conditions or for patient who cannot tolerate additional fluid.
Plasma
o A protein/salt bath where red & white cells and platelets are suspended.
o Plasma is 90% water and constitutes 55% of the blood volume
o FFP, or fresh frozen plasma, is often used to treat bleeding disorders related to
clotting deficiencies. It is a volume expander and replaces clotting factors
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Cryoprecipitate
o Cryoprecipitated antihemophilic factor (AHF) –
o Portion of plasma that is rich in certain clotting factors, including Factor VIII,
fibrinogen, von Willebrand factor and Factor XIII.
o It is used to prevent or control bleeding in individuals with hemophilia and von
Willebrand’s disease, which are common, inherited major coagulation abnormalities.
Platelets a.k.a. Thrombocytes
o Stick to the lining of blood vessels and assist in the clotting process.
o Prevents massive blood loss and leakage.
o Platelets are concentrated from a unit of whole blood and can be stored at room
temp up to 5 days.
Granulocytes a.k.a. WBCs
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o
o
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Protect the body from invasion of foreign bodies such as bacteria, fungi, and viruses.
Need to be transfused within 24 hours of collection.
Used when infections are not responsive to antibiotics
Usefulness is questionable…
Autologous Donations
o Commonly done as a preoperative donation prior to elective surgery.
o Can make autologous donations up to 72 hours prior to surgery.
o Patient may still have a reaction to their own blood, so policy for transfusion still
needs to be meticulously followed.
---------------------------------------------------------------------------------------------------------------------------------------------------------**Initiating a Transfusion**
o Verify the physician’s order and obtain a signed consent for transfusion.
o Establish a large bore IV line if at all possible – 18g (20g can be used). When using
existing line, check patency.
o Use 0.9% NS to prime transfusion set that contains a micron filter.
o Obtain unit of blood from blood bank. Remember that the unit of blood cannot
remain outside of a controlled refrigeration unit longer than 30 minutes.
o If a delay occurs, return the blood to the blood bank. Check for clots!
o Complete and document a pre-transfusion assessment of your patient that includes a
complete set of vital signs – these are your baseline vitals.
o Assess fluid status of the patient.
o Make sure that the patient has no further questions. Document all teaching
completed.
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Blood Administration
o Know the policy and procedure for administering blood in your facility!
 Identification must be checked by two people at the bedside of the patient. Make
sure that all information on the bag and the patient match. If there is a question
about compatibility – do not give the unit.
 There is NEVER a viable reason for a patient to receive the wrong unit of blood.
Beginning the Transfusion
o Begin the transfusion slowly. Administer the blood at approximately 1ml/min. for the
first 15 minutes. Stay with the patient if at all possible. Check VS q 15 min x 4, then q
30 min – and document them.
o After 15 min. adjust infusion to complete transfusion in 2 – 4 hours dependent on
fluid status.
o Maximum time for infusion is 4 hours. Discard any blood remaining after that time.
o Monitor your patient frequently for signs of transfusion reaction and fluid tolerance.
o Complete the transfusion by documenting all actions and reactions on designated
forms as
o Know the policies, procedures, and documentation guidelines related to blood
transfusions required by your facility.
**Transfusion Reactions**
o Transfusion reactions can be fatal, but these are rare.
o When there are adverse reactions to a blood transfusion, the blood bank must
verbally notify the FDA within 24 hours and provide a written report within 7 days.
o Types of transfusion reactions include: Hemolytic, Allergic & Febrile Nonhemolytic
1. Acute Hemolytic Reaction
o Reaction that occurs when there is an antigen/antibody reaction due to blood
incompatibility.
o Hemolysis
o Onset is usually during the 1st 15 min., can occur at any time.
o Patient will experience chills, fever, flushing, burning along vein, chest pain, dyspnea,
back pain, N & V, bleeding at catheter site, shock and DIC.
o Clumping of hemoglobin can cause renal failure.
What to do…
 Stop the transfusion.
 Obtain a new tubing for the NS and keep the line open – do not allow the blood in
the tubing to be infused.
 Take vital signs
 Call physician and blood bank
 Save the blood bag and tubing. A sample of the patient’s blood will be sent to the
blood bank.
 Fill out transfusion reaction sheet.
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Blood Administration
 Monitor the urine output. A sample of urine will go to lab.
2. Allergic Reactions
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Allergic reactions are caused by plasma antigens.
They can occur at any time during the infusion or up to 1 hr following.
Hives and edema are common – occasionally chills and fever occur.
Severe allergic reactions include asthmatic symptoms and anaphylactic shock.
Treatment includes administration of antihistamines. Severe reactions may require
epinephrine and steroids.
How do you think we can cut down on this type of reaction?
3. Febrile Nonhemolytic
o Caused by an antigen-antibody reaction to WBCs or platelets.
o Reaction may occur immediately, during, or after completion.
o S/S include flushing of face, palpitations, cough, chest tightness, increased pulse,
fever, n/v
o Treatment is based on symptoms – treated with Tylenol.
o May pre-medicate patient if HX of this issue.
o Leukopoor Filter:
Irradiated unit:
Adverse Effects of Transfusions
o Circulatory Overload- Occurs when too much volume is delivered. May complain of
pounding headache, chest tightness, increased BP and P. Stop infusion, raise HOB,
take VS, notify physician.
o Hypothermia – Occurs when large quantities of cold blood are infused rapidly.
Pt. will experience shaking chills, hypotension, and cardiac arrhythmias.
Stop the infusion, warm the patient, call physician. A blood warmer should be used
when infusing large amounts of cold blood.
o Hyperkalemia – increase in potassium is related to RBC destruction in stored blood.
If large amounts of stored blood are given, patient may experience cramping, &
muscle twitching
Transmission of Infectious Diseases
o Blood supply is extremely safe, and screens for these diseases, but it is still possible
to transmit the following in blood transfusions:
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 Viral Hepatitis
 HIV
 Cytomegalovirus (CMV)
Documentation
o Beginning and ending time of transfusion
o Type of component and unit number
o Fluid volume infused
o Vital signs before, during, and after transfusion (per policy)
o Any significant assessments or patient reactions/complaints.
Case Study
Mrs. B is a 59 year old female. S/P GI Bleed. H/H 7.5/22.5. Order 1 unit PRBC’s to infuse over
2-4 hours.
1. What steps are taken to match blood for patient? What steps do you take in
administering blood?
2. How much can you expect H/H to rise?
3. Infusion is started. How fast should infusion begin? What is the total volume to be
infused?
4. Mrs. B after 1 hour complains of chills and nausea. Her temperature has increased by
1 degree C. The remainder of her vital signs are stable. What do you expect is
occurring? What do you do?
5. Your patient has blood type AB+ which of the following is true?
a. Anti B antibody is present in the plasma
b. Anti A antigen is present on the RBC
c. A antigen is present on the RBC
d. The patient is Rh negative
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6. Other than a blood type discrepancy hemolytic reaction, what other potential
reaction is of great concern?
a. The result of a patient getting a second unit of type specific blood through the
same tubing as the first unit
b. The B negative patient that has not received RhoGAM in the past that is now
receiving Rh-positive blood for the second time
c. The hemophiliac who is receiving cryoprecipitate
d. None of the above
7. What blood product can you predict will be ordered for a patient who has an H/H of
6.5/19.5 mg/dl?
a. Fresh frozen plasma
b. Cryoprecipitate
c. Platelets
d. Packed RBC’s
8. What is the nurse’s responsibility before hanging blood on a patient?
a. Assure baseline vitals are done
b. Check the unit of blood with another nurse prior to hanging
c. Visually confirm that the patient or the POA has signed the blood transfusion
from.
d. B and C only
e. All of the above
9. What is a good indicator that your patient is not tolerating the increase in fluid
related to your packed RBC infusion?
a. The patient is now displaying coarse lung sounds upon lung auscultation
b. The patient has a temperature of 99.2
c. The patient’s blood pressure changed from 103/62 to 112/68 over 1 hour
d. The patient’s hourly urine output is unchanged
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