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Handout Hema BT

Handout Hema BT

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Published by: JOHN ARBIE TATTAO, RN on Jan 26, 2009
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09/29/2012

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HANDOUT on NURSING MANAGEMENT FOR CLIENT RECEIVING BLOODTRANSFUSIONBy: John Arbie T. Tattao, RN
Blood Groups
A. Erythrocytes carry antigens, which determine the different blood groups.B. Blood-typing systems are based on the many possible antigens, but the mostimportant are antigens of the ABO and Rh blood groups because they are mostlikely to be involved I transfusion reactions.
1. ABO typing
Antigens of system are labelled A and
Absence of both antigens results in type O blood
Presence of both antigens is type AB
Presence of either A or B results in type A and type B respectively
Nearly half the population is type O, the universal donor
Antibodies are automatically formed against the ABO antigens not onperson’s own RBC’S; transfusion with mismatched or incompatible bloodresults in a transfusion reaction2. Rh typing
Identifies presence or absence of Rh antigen (Rh positive or Rh negative).
Anti-Rh antibodies not automatically formed in Rh-negative person, but if Rh-positive blood is given, antibody formation starts and a second exposure toRh antigen will trigger a transfusion reaction.
Important for Rh-negative woman carrying Rh-positive baby; firstpregnancy not affected, but in a subsequent pregnancy with an Rh-positive positive baby, mother’s antibodies attack baby’s RBCs.Blood Transfusion and Component TherapyBLOOD TRANSFUSION –
the introduction of whole blood components of the blood(plasma, serum, erythrocytes, or platelets) into the venous circulation.
Purposes:
a.To increase the circulating blood volume as in shock due to haemorrhageb.To increase red cell volume of hemoglobin content of the blood as in anemiac.To increase WBC content of the blood as in agranulocytosis and leucopeniad.To increase the quantity of protein malnutrition, excessive loss of protein fromburns or vesicular skin diseases
A. Blood and blood products
1.Whole blood: provides all components
> 500 ml: 200 ml RBC and 300 ml Plasmaa. Large volume can cause difficulty: 12-24 hours for Hgb and hct to riseb. For massive blood loss and exchange transfusion in neonatesc. Complications: volume overload, transmission of hepatitis or AIDS,transfusion reaction, infusion of excess potassium and sodium, infusion of anticoagulant (citrate) used to keep stored blood from clotting.
 
2.
Packed Red blood cells
> 350 – 400 ml: 200 – 250 ml RBC and 150 ml Plasma and additivesolution (saline, glucose, mannitol)a. Provide twice the amount of Hgb as an equivalent amount of whole blood.b. Indicated in cases of blood loss, pre and post-op clients, and those withincipient congestive failurec. Complications: transfusion reaction (less common than with whole blooddue to removal of plasma protein)
3.Fresh frozen plasma
> 200 – 250 ml: contains all coagulation factors and 250 mg of fibrinogena. Contains all coagulation factors including V and VIIIb. To expand plasma volume, treat post operative hemorrhage or shock andcorrect coagulation factor deficienciesc. Can be stored frozen for 12 months; takes 20 minutes to thawd. Hang immediately upon arrival to unit (Rationale: loses its coagulationfactors rapidly)
4.Platelets
> 30 – 60 ml: half of the number of platelets originally found in 1 unitwhole blooda. Will raise recipient’s platelet count by 10,000/mm
3
b. For thrombocytopenia, acute leukemia, to restore platelet countpreoperatively.b. Pooled from 4-8 units of whole bloodc. Single-donor platelet transfusions may be necessary for clients who havedeveloped antibodies; compatibility testing may be necessary5.
Factor VIII fractions (cryoprecipitate)
: contains Factors VIII, fibrinogen, andXIII> Frozen 20 ml unit contains mostly coagulation factor VIII and 250 mgfibrinogena.For hemophilia A6.
Volume expanders
: albumin; percentage concentration varies (50-100ml/unit)> Serum albumin and Plasma Protein Fraction (PPF)> 25% albumin in 50 ml and 100 ml units> 5% albumin and PPF comes in 250 ml unitsa. For hypovolemia and hypoproteinuriab. Hyperosmolar solutions should not be used in dehydrated clients
7.Granulocytes
> Contains mostly granulocytes and RBC’s, plasma, and plateletsa. For severe gram negative infection or severe neutropenia, unresponsiveto routine forms of therapy in immunosuppressed patients
B. Nursing Interventions for patients receiving Blood Transfusion:
 
Nursing Responsibility Prior to Blood Transfusion
1.Verify doctor’s order and make a treatment cardRationale: To avoid mistakes2.Assess client for history of previous blood transfusions and any adversereactions.3.Request blood/blood component from hospital blood bank to include bloodtyping and cross matching4.Ensure that the adult client has an 18- or 19- gauge IV catheter in placeRationale: Large bore needle is indicated for BT since blood is viscous.5.Initiate an IV line with appropriate IV catheter with 0.9% NaCL (PNSS).Rationale: To flush out tubing and Keep IV open (KVO)6.Ensure that the blood should be transfused not more than 20 minutes fromthe time it arrives from the blood bankRationale: To prevent untoward blood reaction7.Have a doctor and a nurse or at least two nurses countercheck thecompatible blood to be transfused:a.Name and Identification numberb.Client’s blood group and Rh typec.Donor’s blood group and Rh typed.Cross-match compatibilitye.Blood unit and serial componentf.Expiration date of blood productRationale: To prevent any problem in relation to transfusion8.Take baseline vital signs before initiating transfusion.Rationale: To compare any change in vital signs before and during the BT9.Give pre medications 30 minutes before transfusion if any is orderedRationale: To prevent minor allergic reaction
Nursing Responsibility during Blood Transfusion:
1.Start transfusion slowly (2 ml/minute)2.Stay with the client during the first 15 minutes of the transfusion and takevital signs frequentlyRationale: Transfusion reactions occurs during the first 10 – 15 minutes of transfusion3. Maintain the prescribed transfusion ratea. Whole blood: approximately 3-4 hoursb. RBCs: approximately 2-4 hoursc. Fresh frozen plasma: as quickly as possibled. Platelets: as quickly as possiblee. Cryoprecipitate: rapid infusiond. Volume expanders: volume-dependent rate4.Observe the patient for any untoward signs and symptoms
(ICEFUD)
a.Itchinessb.Chillsc.Elevated temperatured.Flushed skine.Urticariaf.Dyspnea

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