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Commonly Transfused Blood Products and Blood Components
GeneralConsiderations:
Wear gloves and face shield when working with blood products; ideally a 20g or larger IV catheter is preferred unless the patient isvery young or very old and has smaller veins; use normal saline only between transfusions and to keep the vein open if there is areaction; hang and start blood infusion within 30 minutes of obtaining blood from the blood bank; remain with the patient andassess vital signs/patient complaints during the first 15 minutes of the transfusion. If no signs of a reaction, adjust flow to orderedrate or as fast as patient's circulatory system can tolerate.
SYMPTOMS OF A TRANSFUSION REACTION:
flushing, feverish feeling, chills, nausea, low back pain and headache
OTHER SYMPTOMS:
palpitations (usually when hypotension is present); difficulty swallowing or breathing (possibleanaphylaxis); tingling of fingers, muscle cramps, vomiting, faintness (hypotension, arrhythmia, hypocalcemia); muscleweakness, irritability, bradycardia (hyperkalemia when large volumes of older stored blood is transfused)
ComponentWhat's in itWhy use itAdministration/Nursing ConsiderationsWhole Blood
one unit contains 500 mL of allblood components: RBCs,WBCs, plasma, platelets,clotting factors (someclotting factors are not viableIncreases blood volume andoxygen carrying capacity afterhemorrhage
Packed RedBlood Cells(RBCs)
one unit contains 250 mL of whole blood (RBCs, WBCs,platelets and plasma) with80% of the plasma removedIncreases red blood cell mass andoxygen carrying capacity inchronic anemia not due tonutritional or drug therapy andother bleeding conditionsmust be ABO and Rh compatibleone unit
must
be infused within a 4-hour time perioduse a Y-type blood administration set with filter (to removemicroaggregates of degenerating platelets and fibrinstrands)one unit increases Hgb by 1 gm/dL
White BloodCells (WBCs)
one unit contains 150 mL of WBCs or leukocytessuspended in 20% of theplasmaSepsis that has beenunresponsive to antibioticswith positive blood cultures,persistent fever, andgranulocytopeniamust be ABO and Rh compatiblecan use a straight-line or component drip IV administrationset with an in-line blood filterperiodically agitate the bag of cells to prevent the WBCs fromsettling and to prevent accidental bolus of white bloodcellsfever and chills in the patient is an expected occurrencemay reduce flow rate per MD order for patient comfort if fever and chills occurgive antipyretics or premedicate with Benadryl if ordered
Platelets
one unit contains 35 to 50 mL of platelet sediment from RBCsor plasma, may have smallnumbers of RBCs and WBCsblood bank may pool up to 8units for one infusionBleeding due tothrombocytopenia, decreasedplatelet counts or presence of abnormal platelets; leukemia;aplastic anemia; DIC; post-transfusion thrombocytopeniamust be ABO compatible when possible and Rh compatible ispreferreduse a filtered component drip administration setinfuse at rate of 100mL per 15 minutesshould not be given if patient has a feverplatelet count should be drawn 1 to 3 hours after platelettransfusion
Fresh FrozenPlasma(FFP)
one unit contains 200 to 250 mLof plasma and all clottingfactorsBleeding, coagulation factordeficiencies, Warfarin reversal,thrombotic thrombocytopenicpurpuramust be ABO compatible; Rh match is not requireduse a straight-line IV administration setinfuse rapidlyhypocalcemia can occur with multiple transfusions of FFP dueto presence of citric acid in the FFP which binds serumcalcium
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