Blood Transfusion

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Blood Transfusion

Procuring blood & blood products

Donors must meet minimal requirements

Body weight at least 50 kg (110 pounds)

Age – no upper limit; if 17 or younger parental consent needed

Oral temperature less than 37.5◦C (99.6◦F)

Regular pulse rate between 50-100 bpm

SBP 80-180; DBP 50-100

Hemoglobin levels 12.5 g/dL

Types of Donations

Directed

Standard

Autologous

Intraoperative Blood Salvage

Hemodilution

Complications of Donation

Excessive bleeding from venipuncture site

Fainting

Emotional factors

Vasovagal response

Prolonged fasting

Rare (requires further medical evaluation)

Anginal pain

Seizures

Blood Processing

Testing

HIV

Hepatitis B, C

Human T-Cell lymphotropic virus

(anti-HTLV-I/II)

Syphilis

CMV

Typing

ABO and Rh systems

Type O in emergency no longer recommended

Pre-Transfusion

Assessment

Patient history

Previous transfusions/reactions

Females: number of pregnancies

Cardiac, pulmonary, and vascular disease

Physical assessment

Base-line VS

Cardiac and respiratory systems

Skin and sclera

Once other nurse checks the blood and makes sure everything is right; do not rush and administer the blood. Take a minute and double check

First 15 min in PT room; severe reactions occur within the 15 min

Make sure blood is going into PT vein

Document during 15 min

VS taken every 15 minutes

Education

Risks and benefits and what to expect during/after transfusion

Signs/Symptoms of transfusion reaction

Fever

Chills

Respiratory distress

Low back pain

Nausea

Pain at IV site

Anything “unusual”

Reassure blood typing/testing

Types of Complications

Febrile nonhemolytic reaction

Caused by antibodies to donor leukocytes

↑ in patients who have had previous transfusions

Exclude other causes

Chills, fever

Prevent: Use leukocyte reduction filter

Acute hemolytic reaction

Life-threatening

Donor blood incompatible with recipient (Type II hypersensitivity)

Errors in blood labeling/patient identification

Fever, chills, low back pain, nausea, chest tightness, dyspnea, anxiety, hemoglobinuria

May result in hypotension, bronchospasm, vascular collapse, ARF, DIC

Allergic reaction

Sensitivity to plasma

Urticaria

Generalized itching

Flushing

Responds to Diphenhydramine

Severe: epinephrine, corticosteroids, vasopressors

Prevent: Pre-medicating with diphenhydramine or corticosteroids. Wash blood components to remove plasma proteins

TransfusionAssociated Circulatory Overload (TACO)

Hypervolemia

Dyspnea, orthopnea, tachycardia, sudden anxiety, ↑BP

JVD, crackles, hypoxemia

Assess for risk

Prevent/treat

Diuretics

Slow rate of infusion

Oxygen/morphine

Bacterial Contamination

Risk is very low

Can occur at any point during procurement or processing, but often results from organisms of patient’s skin

Platelets at greatest risk of contamination because stored at room temperature; blood centers have developed rapid methods of culturing platelet unit

Prevention: meticulous procurement and processing. PRBCs or whole blood transfused within 4 hours

S/S: fever, chills, hypotension

Tx: fluids and broad-spectrum antibiotics

Transfusion-related acute lung injury (TRALI)

Potentially fatal

Development of TRALI occurring within 6 hours after a transfusion >>> vascular endothelium injury >> interstitial/interalveolar edema and sequestration of WBCs in pulmonary capillaries

Onset is abrupt (2 to 6 hours)

SOB, hypoxia, hypotension, fever, eventual pulmonary edema

Bilateral pulmonary infiltrates without evidence of cardiac failure

Aggressive supportive therapy that may prevent death: oxygen, intubation, fluid support

More likely to occur with plasma and platelets

Nurse Management with Transfusion Reactions

STOP TRANSFUSION IMMENDIATELY!!!

Maintain IV line with NS with new tubing at a slow rate

ASSESS PATIENT

Compare VS with baseline

Respiratory: oxygen saturation, lung sounds, AMS

Any chills, diaphoresis, JVD, back pain or urticaria

Continue to monitor VS, cardiac, respiratory, and renal status

NOTIFY HCP

Assessment findings

Prescribed treatments

NOTIFY BLOOD BANK

SEND BLOOD PRODUCT WITH TUBING BACK TO BLOOD BANK

IF NECESSARY, COLLECT AND SEND SERUM/URINE SPECIMENS

Pharmacologic Alternatives to Transfusion

Growth Factors

Erythropoietin

epoetin alfa (Epogen, Procrit)

Granulocyte Colony-Stimulating Factor (G-CSF)

filgrastim (Neupogen)

GranulocyteMacrophage Colony-Stimulating Factor (GM-CSF)

sargramostim (Leukine)

Thrombopoietin