Week 7: blood products & blood therapy

● Types of blood components

○ Packed red blood cells (PRBCs)
■ Replaces erythrocytes; infusion time for 1 unit is between 2-4 hours
■ Each unit increased hemoglobin levels by 1 g/dL
○ Platelet transfusion
■ Treats thrombocytopenia and platelet dysfunctions
■ Crossmatching isn’t required but is still done because some may contain
trace amounts of RBCs so this reduces the chance of reactions
■ Given rapidly, over 15-30 minutes; each unit increases platelets by
5000-10,000 mm^3
○ Fresh-frozen plasma
■ Provides clotting factors or volume expansion
■ Infused within 2 hours of thawing and given over 15-30 minutes
■ Rh and ABO compatibility is required!!
○ Cryoprecipitates
■ Replaces clotting factors; especially factor VIII and fibrinogen
■ Prepared from fresh-frozen plasma, cryoprecipitates can be stored for 1
year if frozen. Once thawed, the product must used and it is infused over
15-30 minutes
■ effective response - monitor coagulation studies and fibrinogen levels
○ Granulocytes
■ Treats patients with sepsis or neutropenic client with an infection that isn’t
responsive to antibiotics
● Types of blood donations
○ Autologous
■ The patient donates their own blood before a scheduled procedure
■ Should begin within 5 weeks of the transfusion date and end at least 3
days before the date of transfusion
○ Blood salvage
■ Autologous donation that involves suctioning blood from body cavities,
join spaces or other closed body sites
○ Designated donor
■ When recipients select their own compatible donors
● Compatibility
○ Cross Matching is done between donors and recipients to ensure the recipients are
being given the same type of blood as the donation
○ O- is the universal donor and the universal recipient is AB positive
○ Nurses should ENSURE compatibility of the blood products that are being
administered to patients by checking multiple times and getting a 2nd RN
● Infusion pumps
○ Some infusion pumps are used to administer blood products if they are allowed to
be used with opaque solutions
● Blood warmers
○ Warms the blood to prevent hypothermia and adverse reactions when several
units of blood are being administered
● Complications of a blood transfusion
○ Transfusion reactions
○ Circulatory overload
○ Septicemia
○ Iron overload
○ Disease transmission
○ Hypocalcemia
○ Hyperkalemia
○ Citrate toxicity
● Signs of an immediate transfusion reactions
○ Chills, diaphoresis, muscle aches, back pain or chest pain, raches, hives, itching
and swelling, rapid, therapy pulse, dyspnea, cough or wheezing, pallor and
cyanosis, apprehension, tingling and numbness, headache, N&V, abdominal
cramping and diarrhea
● Signs of a transfusion reaction in an unconscious patient
○ Weak pulse, fever, tachycardia, or bradycardia, hypotension, visible
hemoglobinuria, oliguria, or anuria
● Delayed transfusion reactions
○ May occur days to years after a transfusion
○ Signs: fever, mild jaundice, decreased hematocrit level
● Nursing interventions
○ Circulatory overload
■ Infusion is too rapid for the pt to tolerate
■ Cough, dyspnea, chest pain, wheezing, headache, HTN, tachycardia,
distended neck veins
■ Slow the rate of the infusion, place pt in upright position, administer
oxygen, diuretics, morphine, monitor dysrhythmias
○ Septicemia
■ Occurs when infusion is contaminated with microorganisms
■ Rapid onset of chills and high fever, vomiting, diarrhea, hypotension,
shock
■ Notify HCP, obtain blood cultures and blood bag cultures, administer
oxygen, IV fluids, antibiotics, vasopressors, and corticosteroids
○ Iron overload
 ■ Delayed transfusion for pts that receive multiple blood transfusions
■ Vomiting, diarrhea, hypotension, altered hematologic values
■ Administer deferoxamine IV to remove accumulated iron via the kidneys
(urine will turn red)
○ Disease transmission
■ Most common disease transmitted is hepatitis C; in the past, HIV, used to
be transmitted through this
■ Symptoms come 4-6 weeks following transfusion
■ Donor screenings is important and testing of the blood prior to
administration decreases these transmissions
○ Hypocalcemia
■ Citrate in transfused blood binds with calcium and is excreted
■ Hyperactive reflexes, paresthesia, tetany, muscle cramps, positive
Trousseau’s sign and positive Chvostek’s sign
■ Slow the transfusion and notify the HCP
○ Hyperkalemia
■ Stored blood liberates potassium through hemolysis, increasing potassium
levels
■ The older the blood, the greater the risk, so assess the date on the blood
and the serum potassium level before and after the transfusion
■ Monitor symptoms of hyperkalemia (paresthesia, weakness, abdominal
cramps, diarrhea and dysrhythmias
■ Slow the transfusion and notify the HCP
○ Citrate toxicity
■ Citrate is an anticoagulant used in blood products - this is metabolized by
the liver
■ Rapid administration of multiple units of blood may cause hypocalcemia
and hypomagnesemia - resulting in citrate toxicity
■ Liver dysfunction - increased risk
■ slow or stop the transfusion!