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Blood Transfusion Blood transfusion therapy involves transfusing whole blood or blood components (specific portion or fraction of blood

lacking in patient). One unit of whole blood consists of 450 mL of blood collected into 60 to 70 mL of preservative or anticoagulant. Whole blood stored for more than 6 hours does not provide therapeutic platelet transfusion, nor does it contain therapeutic amounts of labile coagulation factors (factors V and VIII). Blood components include: Packed RBCs (100% of erythrocyte, 100% of leukocytes, and 20% of plasma originally present in one unit of whole blood), indicated to increase the oxygen-carrying capacity of blood with minimal expansion of blood. Leukocyte-poor packed RBCs, indicated for patients who have experience previous febrile no hemolytic reactions. Platelets, either HLA (human leukocyte antigen) matched or unmatched. Granulocytes ( basophils, eosinophils, and neutrophils ) Fresh frozen plasma, containing all coagulation factors, including factors V and VIII (the labile factors). Single donor plasma, containing all stable coagulation factors but reduced levels of factors V and VIII; the preferred product for reversal of Coumadin-induced anticoagulation. Albumin, a plasma protein. Cryoprecipitate, a plasma derivative rich in factor VIII, fibrinogen, factor XIII, and fibronectin. Factor IX concentrate, a concentrated form of factor IX prepared by pooling, fractionating, and freezedrying large volumes of plasma. Factor VIII concentrate, a concentrated form of factor IX prepared by pooling, fractionating, and freezedrying large volumes of plasma. Prothrombin complex, containing prothrombin and factors VII, IX, X, and some factor XI. Advantages of blood component therapy Avoids the risk of sensitizing the patients to other blood components. Provides optimal therapeutic benefit while reducing risk of volume overload. Increases availability of needed blood products to larger population. Principles of blood transfusion therapy Whole blood transfusion 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.

carries a high risk of hepatitis because it requires pooling from many donors.g. infection. disseminated intravascular coagulation (DIC). Factor IX concentrate Indicated for treatment of hemophilia B. Ringer s lactate) are preferred. it may be necessary for the blood bank to divide a unit into smaller volumes. Granulocytes May be beneficial in selected population of infected. autoimmune destruction. Plasma Because plasma carries a risk of hepatitis equal to that of whole blood. Prothrombin complex-Indicated in congenital or acquired deficiencies of these factors. other colloids (e.000/mm3: however.. Cryoprecipitate Indicated for treatment of hemophilia A. . severely granulocytopenic patients (less than 500/mm3) not responding to antibiotic therapy and who are expected to experienced prolonged suppressed granulocyte production. Platelets Administer as rapidly as tolerated (usually 4 units every 30 to 60 minutes). Fresh frozen plasma should be administered as rapidly as tolerated because coagulation factors become unstable after thawing. heat-treated product decreases the risk of hepatitis and HIV transmission. hemactocrit 3%.. and hypertension. poor incremental increases occur with alloimmunization from previous transfusions. Each unit of platelets should raise the recipient s platelet count by 6000 to 10.g. Factor VIII concentrate Indicated for treatment of hemophilia A. Albumin Indicated to expand to blood volume of patients in hypovolemic shock and to elevate level of circulating albumin in patients with hypoalbuminemia. albumin) or electrolyte solutions (e. The large protein molecule is a major contributor to plasma oncotic pressure. bleeding. Von Willebrand s disease. providing proper refrigeration of remaining blood until needed. fever.Packed RBCs Should be transfused over 2 to 3 hours. and uremic bleeding. One unit of packed red cells should raise hemoglobin approximately 1%. if patient cannot tolerate volume over a maximum of 4 hours. if only volume expansion is required.

chances of fatal reactions are decreased if less than 100 ml of incompatible blood is infused. severity of complications correlates with the amount of incompatible blood transfused. complications from infusion of incompatible plasma are less severe than those associated with infusion of incompatible erythrocytes. Septic reaction is an often serious complication resulting from transfusion if a blood product contaminated with bacteria. antibodies in donor plasma combine with antigenon the recipient s eyhrocytes. Similarly. In hemolytic transfusion reaction. precipitating congestive heart failure or pulmonary edema. Febrile. Several infectious diseases can be transmitted through blood transfusion. Delayed hemolytic transfusion reaction occurs 1 to 2 weeks after transfusion. antibodies in the recipient s plasma combine with antigens on donor erythrocytes.Complications of Blood Transfusion Hemolytic transfusion reaction. which reacts with recipient antigen. Reactions associated with massive transfusions (>10 units of packed RBCs on 1 or 6 hours) include: Hypocalcemia. which triggers the immune response of the graft against the host. is commonly caused by sensitivity to leukocyte or platelet antigens. non hemolytic Transfusion reaction. including:      Hepatitis B Non-A.is a life-threatening complication occurring from transfusion of donor blood that is incompatible with the recipient s blood. The most rapid hemolysis occurs in ABO incompatibility. however. non-B hepatitis Malaria Syphilis Acquired immunodeficiency syndrome (AIDS) Graft-versus-host (GVH) disease results from engraftment of immunocompetent lymphocytes in bone marrow of immunosuppressed recipients. the most common type of reaction. but subsequent transfusions may be associated with acute hermolytic reaction. resulting from binding of recipient s circulating calcium to anticoagulant (citrate) in packed RBC s. It generally is not dangerous. . Circulatory overload results from administration at a rate or volume greater than can be accommodated by the circulatory system. causing agglutination and hemolysis in circulation or in the reticuloendothelial system. In hemolytic reaction. Rh incompatibility is often less severe. erythrocytes hemolyzed by antibody are not detectible during crossmatched but are formed rapidly after transfusion. Allergic reactions may result from sensitivity to plasma protein or donor antibody. Citrate intoxication due to accumulation of citrate.

Hemorrhage resulting from excessive dilution of the recipient s platelets and clotting factors. Hypothermia. Exacerbation of liver disease die to increased ammonia levels in stored blood. in which transfusion of cold blood (below 37 C) at rates >100 mL/min may produce dysrhythmias and cardiac arrest. in which stored red cells progressively increase extracellular potassium concentrations.Hyperkalemia. Signs and symptoms of hemolytic transfusion reaction include: Fever Chills low back pain flank pain headache nausea flushing tachycardia tachypnea hypotension hemoglobinuria (cola-colored urine) Clinical signs and laboratory findings in delayed hemolytic reaction include: fever mild jaundice gradual fall of hemoglobin positive Coombs test Febrile non-hemolytic reaction is marked by: Temperature rise during or shortly after transfusion . Assessment findings Clinical manifestations of transfusions complications vary depending on the precipitating factor. Aggregates of leukocytes and platelets in the lungs. resulting from accumulation of these aggregates during blood storage.

scaling) edema hair loss hemolytic anemia Reactions associated with massive transfusion produce varying manifestations Possible Nursing Diagnosis Ineffective breathing pattern . depending on the disease. Rapid onset of high fever and chills vomiting diarrhea marked hypotension Allergic reactions may produce: hives generalized pruritus wheezing or anaphylaxis (rarely) Signs and symptoms of circulatory overload include: Dyspnea cough rales jugular vein distention Manifestations of infectious disease transmitted through transfusion may develop rapidly or insidiously. Characteristics of GVH disease include: skin changes (e. ulcerations.Chills headache flushing anxiety Signs and symptoms of septic reaction include.g. erythema.

platelets. Transfusing blood within 4 hours.e. particularly during the first 15 minutes (severe reactions usually manifest within 15 minutes after the start of transfusion). Preventing hypothermia by warming blood unit to 37 C before transfusion.. whole blood. and changing blood tubing every 4 hours to minimize the risk of bacterial growth at warm room temperatures. Removing leukocytes and platelets aggregates from donor blood by installing a microaggregate filter (20-40-um size) in the blood line to remove these aggregates during transfusion. irradiation alters ability of donor lymphocytes to engraft and divide. . clothing. and notify the physician. Inspecting the blood product for any gas bubbles. packed RBC s and granulocytes) before transfusion.Decreased Cardiac Output Fluid Volume Deficit Fluid Volume Excess Impaired Gas Exchange Hyperthermia Hypothermia High Risk for Infection High Risk for Injury Pain Impaired Skin Integrity Altered Tissue Perfusion Planning and Implementation Help prevent transfusion reaction by: 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. Beginning transfusion slowly ( 1 to 2 mL/min) and observing the patient closely. Preventing GVH disease by ensuring irradiation of blood products containing viable WBC s (i. Preventing infectious disease transmission through careful donor screening or performing pretest available to identify selected infectious agents. or abnormal color before administration. On detecting any signs or symptoms of reaction: Stop the transfusion immediately.

and renal failure associated with RBC hemolysis and hemoglobinuria.9% saline to provide access for possible IV drug infusion. steroids and vasopressors as prescribed. The patient maintains or returns to normal electrolyte and blood chemistry values. treat septicemia with antibiotics. Intervene for allergic reaction by administering antihistamines. nonhemolytic transfusion reactions are treated symptomatically with antipyretics. Send the blood bag and tubing to the blood bank for repeat typing and culture. In septic reaction. The patient maintains good fluid balance. oxygen and aminophylline may be prescribed. The patient remains normothermic. The patient reports minimal or no discomfort. (If hives are the only manifestation. and retyping. diuretics. DIC. The patient remains free of infection. leukocytepoor blood products may be recommended for subsequent transfusions. increased hydration. The patient maintains good skin integrity. steroids and epinephrine as indicated by the severity of the reaction. The patient demonstrates adequate cardiac output. transfusion can sometimes continue but at a slower rate. Evaluation The patient maintains normal breathing pattern.) For circulatory overload. Collect a urine sample as soon as possible for hemoglobin determination. Intervene as appropriate to address symptoms of the specific reaction: Treatment for hemolytic reaction is directed at correcting hypotension. Draw another blood sample for plasma hemoglobin. Febrile.Disconnect the transfusion set-but keep the IV line open with 0. with no lesions or pruritus. culture. . immediate treatment includes positioning the patient upright with feet dependent.