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A REQUIREMENT PRESENTED TO MR. ALFRANCIS VERDIDA, R.N. FACULTY OF THE NURSING DEPARTMENT COLLEGE OF HEALTH SCIENCES MINDANAO STATE UNIVERSITY MARAWI CITY
IN PARTIAL FULFILLMENT OF THR REQUIREMENTS FOR THE COURSE N.C.M. 104.1 N MNO1 SECOND SEMESTER, AY 2010 2011
MENDOZA, CESAR IAN III G.
busy making deliveries and pickups. Hospitals need blood for people who are injured. y To avoid a life-threatening reaction. and treatments for other diseases that affect the blood. a tiny tube that is inserted into a vein with a small needle. population) * AB positive (about 3% of the U. * White blood cells are part of the immune system. proteins. cancer treatments. and its main defense against infection. Red blood cells make up about 40% to 45% of a person's blood and live for 120 days. Blood also collects waste products.S. cholesterol. like sickle cell anemia.S. carbohydrates. a spongy substance contained within many of the bones in the body. But blood transfusions save lives every day. y . population) * B positive (about 9% of the U.S. As blood circulates throughout the body. They are: * O positive (about 38% of the U. They are about 5% of our blood. about 5 million people each year in the United States get blood transfusions. such as red blood cells or platelets. Blood is a mixture of cells and liquid. * Plasma is a pale yellow liquid mixture of water. hormones.S. 1.S. About 55% of our blood is plasma." People who have type AB blood are called "universal recipients" because they can safely receive any type of blood. A full-grown adult has about 10 pints of blood (almost 5 liters) in his or her body. blood from a donor needs to match the blood type of the person receiving it.S. population) * AB negative (only about 1% of the U. What Is a Blood Transfusion? y A transfusion is a relatively simple medical procedure that doctors use to make up for a loss of blood or any part of the blood. The whole procedure usually takes about 2 to 4 hours. and each component has a specific job: *Red blood cells carry oxygen to the body's tissues and remove carbon dioxide. Transfusions are usually given through an intravenous line. depending on how much blood is needed. * Platelets are cell fragments that help blood clot. electrolytes. The blood cells are made in the bone marrow. as well as for patients having heart surgery. Because of this. there are certain exceptions to the rule that the donor's blood type must match the recipient's exactly: Blood type O negative is the only type of blood that people of all other blood types can receive.JANUARY 2011 A Bit About Blood You'd probably feel a lot better if blood just stayed inside your body where it belongs. it delivers oxygen and nutrients to all the places they're needed. This is helpful in emergency situations when the patient needs a transfusion but their blood type is unknown. population) * A negative (about 6% of the U. which helps to prevent and control bleeding. and vitamins. In fact.S. population) * A positive (about 34% of the U. Blood is like the body's transportation system. and carries them to the organs responsible for making sure the wastes leave the body. population) * B negative (about 2% of the U. O negative donors are called "universal donors. organ transplants. There are eight major blood types.S. White blood cells make up less than 1% of a person's blood. population has this type) * O negative (about 7 % of the U. population) In emergencies. such as carbon dioxide.
Most patients choose to receive blood from volunteer blood donors.S. lightheadedness. All blood centers must pass regular inspections in order to continue their . The needles and other equipment used are sterile and they're used only on one person and then thrown away. y All blood donors must provide a thorough history. Occasionally. dizziness. This is when a family member or friend donates blood specifically to be used by a designated patient. certain blood components are tested for contamination with bacteria as well. including community blood banks and the federal government. For example. For example.BloodTrans a blood transfusion usually isn't whole blood it could be any one of the blood's components. If any of these things are found. An iron-fortified diet plus daily iron tablets can help rebuild a donor's red blood supply. The medical history includes questions that help blood bank staff decide if there's a risk that donors might have an infection that could be transmitted in their blood. and health problems. 4. y The donor's body usually replaces the liquid part of blood (plasma) within 72 hours after giving blood. they may choose to receive blood from one of several different places. donors may experience nausea. need plasma or the clotting factors contained in plasma to help their blood clot and prevent internal bleeding. and West Nile virus. but these symptoms usually resolve quickly. Donors who meet these requirements can give blood every 56 days. such as anemia. It generally takes about 4-8 weeks to regenerate the red blood cells lost during a blood donation. the American Red Cross requires that people be at least 17 years old and weigh more than 110 pounds. hepatitis C. the blood supply used for transfusions comes from people who volunteer to donate their blood at local blood banks. For these people. hepatitis B. the age is 16 with a parent's permission. 2. But some decide to donate their own blood before the surgery. y Another option for blood transfusions is called directed donation. Who Can Donate Blood? y To donate blood. work hard to ensure that the blood supply is safe. blood banks. but the United States has one of the safest blood supplies in the world. 3. the donor must have a blood type that is compatible with the recipient's. all blood donations are tested for several viruses. y When people know they are going to have an operation that might include a blood transfusion. Food and Drug Administration (FDA) regulates U.S.) Donors must be in good health and will be screened for certain medical conditions. y The U. including HIV (the virus that causes AIDS). For directed donation. Other people might need plasma or only certain parts of plasma. He or she must also meet all the requirements of a regular volunteer blood donor. medicines. the blood is destroyed. including recent travel. at community centers during blood drives. In addition. people who have hemophilia. (In some states. There is no medical or scientific evidence that blood from directed donors is safer or better than blood from volunteer donors. Many organizations. or through the American Red Cross. Are There Any Risks? y A person can't get an infection or disease from giving blood. This is called autologous (pronounced: aw-tah-luh-gus) blood donation. a disease that affects their blood's ability to clot. some people with cancer need blood transfusions because during chemotherapy the bone marrow may be temporarily unable to make new blood cells. syphilis. y People who meet the eligibility requirements will need to give their medical history and pass a physical exam before donating. or fainting. y There are a few health risks associated with donating blood. a transfusion of red blood cells or platelets can help. infections. How Safe Is Donated Blood? y Some people worry about getting diseases from infected blood. Many people's lives depend on others being willing to donate blood. Because blood can be infected with bacteria as well as viruses. . Where Does the Blood Come From? y In the United States.
and 20% of plasma originally present in one unit of whole blood). indicated for patients who have experience previous febrile no hemolytic reactions. like any medical procedure. nor does it contain therapeutic amounts of labile coagulation factors (factors V and VIII). Stopping the transfusion and giving the patient medications for allergy. 100% of leukocytes. 3. When the patient's temperature is back to normal. contact your local blood bank or the American Red Cross for more information on what's involved. In a few rare cases. This reaction can be life threatening. These include the following: * Fever Patients can experience a fever with a blood transfusion. and neutrophils ) 5. fractionating. Albumin. including factors V and VIII (the labile factors). can treat these reactions. 2. a concentrated form of factor IX prepared by pooling. If the reaction is mild. a concentrated form of factor IX prepared by pooling. The Red Cross estimates that 15% of all blood donors in the United States are high school or college students. 3. Granulocytes ( basophils. containing prothrombin and factors VII. Prothrombin complex. a plasma protein. and freeze-drying large volumes of plasma. indicated to increase the oxygen-carrying capacity of blood with minimal expansion of blood. * Hemolytic reaction The word hemolysis (prononounced: heh-mah-luh-sis) means the destruction of red blood cells. You could save someone's life. and freeze-drying large volumes of plasma. fractionating. the preferred product for reversal of Coumadin-induced anticoagulation. eosinophils. sometimes along with chills. One unit of whole blood consists of 450 mL of blood collected into 60 to 70 mL of preservative or anticoagulant. 6. Platelets. Leukocyte-poor packed RBCs. doctors may have to take other measures before the patient can be given a transfusion again. doctors stop the transfusion and treat the symptoms. 2. 10. These symptoms can be caused by a reaction between the recipient's immune system and immune cells in the donor blood. Hemolytic reaction is very rare. Factor VIII concentrate. IX. and fibronectin.operations. 11. factor XIII. Factor IX concentrate. But. or nausea. Blood transfusion therapy involves transfusing whole blood or blood components (specific portion or fraction of blood lacking in patient). though. Cryoprecipitate. 4. . Provides optimal therapeutic benefit while reducing risk of volume overload. a plasma derivative rich in factor VIII. 7. doctors will stop the transfusion and give the patient fever-reducing medication. an allergic reaction can be severe (a condition called anaphylaxis). the transfusion can start again. as health care professionals take many precautions to confirm a patient's and donor's blood are compatible before giving a transfusion. Packed RBCs (100% of erythrocyte. Fresh frozen plasma. there are some risks involved. including antihistamines and steroids. Do People Get Sick From Transfusions? y Most people tolerate blood transfusions very well. When this happens. * Allergic reaction Allergic reactions to blood transfusions (like hives or itching) happen because of a reaction between the recipient's immune system and proteins in the donated blood. Avoids the risk of sensitizing the patients to other blood components. y y In almost every situation. either HLA (human leukocyte antigen) matched or unmatched. 9. Advantages of blood component therapy 1. If it is more serious. and some factor XI. 6. 8. If you are eligible and wish to donate blood. fibrinogen. the benefits of having a blood transfusion far outweigh the risks. Increases availability of needed blood products to larger population. containing all coagulation factors. a headache. If a hemolytic reaction occurs. X. Single donor plasma. Whole blood stored for more than 6 hours does not provide therapeutic platelet transfusion. Blood components include: 1. When the types don't match. containing all stable coagulation factors but reduced levels of factors V and VIII. It occurs when the patient's blood and the donated blood do not match. the recipient's immune system attacks the red blood cells in the donated blood and destroys them. the transfusion can usually continue.
the most common type of reaction.g. The most rapid hemolysis occurs in ABO incompatibility. 3. but subsequent transfusions may be associated with acute hermolytic reaction. Syphilis . Fresh frozen plasma should be administered as rapidly as tolerated because coagulation factors become unstable after thawing. disseminated intravascular coagulation (DIC). In hemolytic reaction. Packed RBCs . 2. 9. Hepatitis B 3. Malaria 2. Several infectious diseases can be transmitted through blood transfusion.Indicated for treatment of hemophilia A. including: 1. Factor VIII concentrate . One unit of packed red cells should raise hemoglobin approximately 1%.Should be transfused over 2 to 3 hours. severely granulocytopenic patients (less than 500/mm3) not responding to antibiotic therapy and who are expected to experienced prolonged suppressed granulocyte production. poor incremental increases occur with alloimmunization from previous transfusions. fever. Febrile. Granulocytes . providing proper refrigeration of remaining blood until needed. 6. Each unit of platelets should raise the recipient s platelet count by 6000 to 10. erythrocytes hemolyzed by antibody are not detectible during crossmatched but are formed rapidly after transfusion. non-B hepatitis 4. severity of complications correlates with the amount of incompatible blood transfused. and hypertension. Delayed hemolytic transfusion reaction occurs 1 to 2 weeks after transfusion. Non-A. albumin) or electrolyte solutions (e. Allergic reactions may result from sensitivity to plasma protein or donor antibody. Complications of Blood Transfusion 1. other colloids (e. infection. 4. Von Willebrand s disease. 3. is commonly caused by sensitivity to leukocyte or platelet antigens. It generally is not dangerous. Plasma . Circulatory overload results from administration at a rate or volume greater than can be accommodated by the circulatory system. antibodies in the recipient s plasma combine with antigens on donor erythrocytes. complications from infusion of incompatible plasma are less severe than those associated with infusion of incompatible erythrocytes. Whole blood transfusion . antibodies in donor plasma combine with antigenon the recipient s eyhrocytes. carries a high risk of hepatitis because it requires pooling from many donors. 7.Indicated for treatment of hemophilia B. The large protein molecule is a major contributor to plasma oncotic pressure. Septic reaction is an often serious complication resulting from transfusion if a blood product contaminated with bacteria. heat-treated product decreases the risk of hepatitis and HIV transmission. Cryoprecipitate . however.. Prothrombin complex-Indicated in congenital or acquired deficiencies of these factors. 10. Hemolytic transfusion reaction. 8. if patient cannot tolerate volume over a maximum of 4 hours. which reacts with recipient antigen. 9. and uremic bleeding.000/mm3: however. Rh incompatibility is often less severe. causing agglutination and hemolysis in circulation or in the reticuloendothelial system. 2. it may be necessary for the blood bank to divide a unit into smaller volumes.g. hemactocrit 3%. 7. if only volume expansion is required. 4.Principles of blood transfusion therapy 1. precipitating congestive heart failure or pulmonary edema.Generally indicated only for patients who need both increased oxygen-carrying capacity and restoration of blood volume when there is no time to prepare or obtain the specific blood components needed. chances of fatal reactions are decreased if less than 100 ml of incompatible blood is infused. 5. 5. 8. Albumin . Factor IX concentrate . In hemolytic transfusion reaction. Ringer s lactate) are preferred. non hemolytic Transfusion reaction. Platelets .is a life-threatening complication occurring from transfusion of donor blood that is incompatible with the recipient s blood. autoimmune destruction.Because plasma carries a risk of hepatitis equal to that of whole blood..Indicated for treatment of hemophilia A.Indicated to expand to blood volume of patients in hypovolemic shock and to elevate level of circulating albumin in patients with hypoalbuminemia. Similarly.Administer as rapidly as tolerated (usually 4 units every 30 to 60 minutes). bleeding.May be beneficial in selected population of infected. 6.
Graft-versus-host (GVH) disease results from engraftment of immunocompetent lymphocytes in bone marrow of immunosuppressed recipients. Acquired immunodeficiency syndrome (AIDS) 10. Manifestations of infectious disease transmitted through transfusion may develop rapidly or insidiously. Reactions associated with massive transfusion produce varying manifestations Possible Nursing Diagnosis 1. Ineffective breathing pattern 2. 2. in which stored red cells progressively increase extracellular potassium concentrations. depending on the disease. 6. Fluid Volume Excess Impaired Gas Exchange Hyperthermia . Fluid Volume Deficit 4. resulting from accumulation of these aggregates during blood storage. in which transfusion of cold blood (below 37 C) at rates >100 mL/min may produce dysrhythmias and cardiac arrest. Decreased Cardiac Output 3. Allergic reactions may produce: y hives y wheezing or anaphylaxis (rarely) y generalized pruritus 7. Reactions associated with massive transfusions (>10 units of packed RBCs on 1 or 6 hours) include: y Hypocalcemia. Clinical signs and laboratory findings in delayed hemolytic reaction include: y fever y gradual fall of hemoglobin y mild jaundice y positive Coombs test 4. y Rapid onset of high fever and chills y diarrhea y vomiting y marked hypotension 6. Clinical manifestations of transfusions complications vary depending on the precipitating factor. 5. scaling) y hemolytic anemia y edema 10. Signs and symptoms of circulatory overload include: y Dyspnea y rales y cough y jugular vein distention 8.5. resulting from binding of recipient s circulating calcium to anticoagulant (citrate) in packed RBC s. y hair loss ulcerations. Signs and symptoms of septic reaction include. Febrile non-hemolytic reaction is marked by: y Temperature rise during or shortly y flushing after transfusion y anxiety y Chills y headache 5. Assessment findings 1.g. y Hemorrhage resulting from excessive dilution of the recipient s platelets and clotting factors. Characteristics of GVH disease include: y skin changes (e. erythema. y Hyperkalemia. 11. y Hypothermia. y Aggregates of leukocytes and platelets in the lungs. y Exacerbation of liver disease die to increased ammonia levels in stored blood. 9. Signs and symptoms of hemolytic transfusion reaction include: y Fever y flushing y Chills y tachycardia y low back pain y tachypnea y flank pain y hypotension y headache y hemoglobinuria (cola-colored urine) y nausea 3. y Citrate intoxication due to accumulation of citrate. which triggers the immune response of the graft against the host.
y Preventing GVH disease by ensuring irradiation of blood products containing viable WBC s (i. The patient demonstrates adequate cardiac output. leukocyte-poor blood products may be recommended for subsequent transfusions. y Inspecting the blood product for any gas bubbles. Altered Tissue Perfusion 7. with no lesions or pruritus. On detecting any signs or symptoms of reaction: y Stop the transfusion immediately. y Transfusing blood within 4 hours. and retyping. 4. Evaluation 1. y Intervene for allergic reaction by administering antihistamines. and changing blood tubing every 4 hours to minimize the risk of bacterial growth at warm room temperatures. nonhemolytic transfusion reactions are treated symptomatically with antipyretics. transfusion can sometimes continue but at a slower rate. and renal failure associated with RBC hemolysis and hemoglobinuria. y Preventing infectious disease transmission through careful donor screening or performing pretest available to identify selected infectious agents. steroids and epinephrine as indicated by the severity of the reaction.9% saline to provide access for possible IV drug infusion. diuretics. y Preventing hypothermia by warming blood unit to 37 C before transfusion. Hypothermia 8. The patient reports minimal or no discomfort.) y For circulatory overload. The patient maintains or returns to normal electrolyte and blood chemistry values. treat septicemia with antibiotics. The patient maintains normal breathing pattern. The patient remains free of infection. irradiation alters ability of donor lymphocytes to engraft and divide. 6. (If hives are the only manifestation. y Send the blood bag and tubing to the blood bank for repeat typing and culture. platelets. y Disconnect the transfusion set-but keep the IV line open with 0. y In septic reaction. immediate treatment includes positioning the patient upright with feet dependent. and notify the physician. y Draw another blood sample for plasma hemoglobin. 8. High Risk for Injury 10. y Beginning transfusion slowly ( 1 to 2 mL/min) and observing the patient closely. High Risk for Infection 9. packed RBC s and granulocytes) before transfusion. oxygen and aminophylline may be prescribed. clothing. . 7. 3.. The patient maintains good skin integrity.12. 2. Intervene as appropriate to address symptoms of the specific reaction: y Treatment for hemolytic reaction is directed at correcting hypotension. DIC. 3. Impaired Skin Integrity Planning and Implementation 1. y Collect a urine sample as soon as possible for hemoglobin determination. or abnormal color before administration. y Removing leukocytes and platelets aggregates from donor blood by installing a microaggregate filter (20-40um size) in the blood line to remove these aggregates during transfusion. steroids and vasopressors as prescribed. The patient maintains good fluid balance. 5. culture. whole blood. 2. y Febrile. Help prevent transfusion reaction by: y Meticulously verifying patient identification beginning with type and cross match sample collection and labeling to double check blood product and patient identification prior to transfusion. The patient remains normothermic. Pain 11. increased hydration.e. particularly during the first 15 minutes (severe reactions usually manifest within 15 minutes after the start of transfusion).
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