AB positive is an universal recipient, and can accept blood from all blood types. O negative is a universal donor, and can give to all blood types
Blood AdministrationSafety Protocols and Recognition of Adverse EffectsBy:Brian Bosworth, BSNStudent
Basic Pathophysiology ofHematological SystemBone marrow is the blood-forming organ Stem cell production within the marrow ultimately differentiates into red blood cells, white blood cells, and platelets Growth factor and cytokines secreted from the kidneys are responsible for the differentiation of these unspecialized cells •Erythropoietin is growth factor that potentiates the differentiation of stem cells into RBCs (erythropoiesis) (Ignatavicius & Workman, 2010).
Blood ComponentsCellular Components Erythrocytes or red blood cells (RBCs) •Largest proportion of blood cells •Enucleate, biconcave, and connective tissue •Perfuse oxygen to all body cells •O2 binds to hemoglobin Leukocytes or white blood cells (WBCs) • Neutrophils, eosinophil, basophil, monocytes, and macrophages •Immunological/inflammatory function Platelets •Fragments of precursor megakaryocyte •Responsible for blood clotting (Ignatavicius & Workman, 2010)
Blood Components (cont.)Plasma •Is an extracellular fluid (ECF) which contains vital proteins •Albumin, globulins, and fibrinogen are the primary plasma proteins found in the CV system Albumin •Increases osmotic pressure, which prevents capillary leakage into the interstitial spaces Globulins •Responsible for transportation •Protection against infection, main protein of antibodies Fibrin •Create the mesh scaffolding to allow for platelet aggregation (Ignatavicius & Workman, 2010)
Laboratory Reference Ranges Lab Reference range RBC Female: 4.2 to 5.4 million/mm^3 Male: 4.7 to 6.1 million/mm^3 Hemoglobin Females: 12 to 16 g/dL Males: 14 to 18 g/dL Hematocrit Females: 37 to 47% Males: 42 to 52 % WBC 5,000 – 10,000/mm^3 Platelet 150,000 – 400,000/mm^3 Fibrinogen 1.5 – 2.77 g/dL Globulin 2.2 – 3.9 d/dL Albumin 3.5- 5.0 g/dL Note: lab values are indicated in adult s, children will have different values
Key DefinitionsAntibody: immune protein that neutralizes a threat to thehost i.e. Infectious organism, chemical, or foreign bodyAntigen: substance which is capable of inducing an immuneresponse and triggering production of antibodiesApheresis: process which separates blood into its constituentcomponentsAutologous: originating from the organism itself i.e. bloodwhich the host has banked for their own useCryoprecipitate: insoluble concentrate of coagulation factorsHematocrit: the percentage of blood which is RBCs
Key Definitions (cont.)Refractory: resistance to treatment; recipient immuneresponse which develops in response to frequent bloodtransfusionSerum: the clear, liquid component of blood that remainsafter coagulation has occurredThrombocytopenia: a condition characterized by lowplatelet count
RH SystemWhen combined with the 4 blood types, this conceptcan be a difficult one to understand, and lack ofunderstanding can contribute to fatal flaws in bloodadministrationRF factors are classified based on the presence orabsence of major D antigen on the surface of RBCs •Presence of antigen = RH + •Lack of Antigen = RH –The lack of antigen D, or RH-, is able to donate to RH+individuals; however, RH+ individuals may only donateto other RH+ recipients. •This is because the presence of Antigen D would trigger an antibody response in the RH- individual (ATI, 2012)
Benefits of Blood Component TherapyThe use of blood components rather than whole bloodtransfusion has marked advantages, and is a moreefficient use of the blood supply •Patients whom only need a specific component of the blood for their therapy will only get the constituent which is indicated for their condition i.e. anemic patient would only need RBCs •One donor’s blood is able to treat multiple patients •Blood components will be less likely to trigger an antibody response •More efficient use of supply (ATI, 2012)Whole Blood •Indicated for use in patients who have undergone significant trauma and blood loss, need to restore blood volume
Sentara Procedural Guidelines for SafeBlood Administration1. Verify physicians order2. Ensure informed consent has been obtained3. Hand hygiene4. Use two patient identifiers, verify that arm band is correct before administration5. Baseline vitals no older than 30 minutes, prior to blood administration6. Establish IV: large gauge IV catheter is preferred i.e. 18 or 20 gauge7. Explain procedure, and articulate adverse reactions client should notify nurse about8. Pre-medication if ordered by physician9. Position patient for optimal comfort10. Assemble equipment: 100 or 250 mL NS to prime tube
Sentara Procedural Guidelines for SafeBlood Administration11. Verify availability of blood products with transfusion services prior to administration of blood or components12. Transfusion services will require patient identifiers, physician’s name whom ordered treatment, date and time, reason for transfusion, will release one unit at a time.13. Inspect blood for integrity and evidence of contamination14. Verify two patient identifiers at the bedside, and second check performed by licensed clinical associate15. Agitate blood or blood components gently prior to administration16. Hand hygiene and don gloves17. Prime blood administration set tubing with NS, infuse with standard Y-type IV adaptor or straight filter (170-260 micron filter). Flush IV with 10 mL of NS prior to administration18. Stop infusion of NS and insert administration set and spike into unit of blood.
Sentara Procedural Guidelines for SafeBlood Administration19. Attach the administration set to the patients IV access device using aseptic technique20. Regulate the flow to 60 mL/hour via infusion pump or at prescribed rate for first 15 minutes (as little as 30 mL of blood can cause extreme adverse reactions)21. Direct observation of patient for first 15 minutes22. Adjust flow rate according to order or patient tolerance23. Discard equipment in appropriate biohazard containers24. Remove gloves and wash hands25. Monitor and assess the patient’s VS throughout procedure, 15 minutes by 2, 30 minutes by 1, and 60 minutes by 3 for adverse reactions26. Document findings and VS on the blood transfusion flow sheet27. Wash hands and don gloves at completion of infusion28. Purge and discard blood transfusion set appropriately29. Reassess IV patency
Sentara Procedural Guidelines for SafeBlood Administration30. Document post-procedure information on blood transfusion flow sheet31. Place transfusion tag and flow sheet in the patient’s medical record at conclusion of therapy32. Provide the patient with post-transfusion reaction education and document in EMR with DAR note (Sentara, 2012)Note: ER department has additional protocols not discussed here
Additional Infusion InformationBlood products are an exceptionally good growth mediumfor bacteria; therefore, must be fully administered within 4hours to reduce risk of bacteremiaBlood must be spiked and infusing within 30 minutes ofrelease from transfusion services, or must be returnedBlood can be left uninfused for extended periods inapproved cooler (thermo sticker affixed), but typically onlyused ER. Return unused blood to infusion servicesTwo pre-serotype tests must be conducted to ensureappropriate match to blood being infused (Sentara, 2012)
Additional InformationShelf life of blood products •Whole blood: within 24 hours •RBCs “packed red blood cells”: 42 days or 10 years when frozen •Plasma proteins: 1-7 years frozen, must be used within 24 hours when thawed •Immune globulin can withstand 10 hours at 140 degrees F – sterilization technique •Cryoprecipitate: 1 year when frozen •Platelets: 5 days at room temperature •Highly susceptible to contamination •Granulocytes: must be transfused within 24 hours (ATI, 2012)
Transfusion Related InfectionsIn the United States, transfusion related infections arerare, and all blood units are ran through the gamut ofSTD tests to ensure the safety of blood transfusionHowever, there are other non-traditional risks whichmany health care workers may fail to disclose becauseof lack of knowledge or belief that it is too rare toacknowledge •Subclinical cancer cells can be transmitted through blood, and metastasize in the recipient •Atypical pathogens, helminthes, bacteria, fungus, protozoa, and non-STD viruses, i.e. dengue fever or malaria.Full disclosure is essential, and these topics should bebroached with the recipients of blood products.
ReferencesATI. (2012). Skills module: Blood administration. AssessmentTechnologies Institute LLC. Retrieved from http://www.ati.comIgnatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed.). St. Louis, MO: Saunders Elsevier.Sentara. (2012). Blood and blood component administration for inpatientand outpatient (Adult). Norfolk, Va: Sentara Health Care System.