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Blood Products

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Not all blood products are the same.

Not all blood products are the same.

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  • Red Blood Cells must be compatible with ABO antibodies present in the recipient serum, and crossmatched (serologic or electronic) to confirm compatibility with ABO and other antibodies prior to routine transfusion.
  • As a method of preventing transfusion transmitted CMV.
  • Platelet transfusions may contain some RBCs and WBCs (AABB, 2000). Platelets have a short lifespan of only 3 to 4 days Following transfusion, a patient's platelet count should rise by 10,000 Sometimes, however, the platelet count does not rise as expected and the patient is said to be refractory to platelet transfusions. This refractoriness to platelets is often caused by circulating anti-HLA antibodies which have bound to the platelets and destroyed them
  • It is not a concentrate of clotting factors. One unit is approximately 225 ml and must be ABO compatible with the recipient’s red cells, Rh need not be considered.
  • cryoprecipitate is currently used as a source of fibrinogen in acute DIC with bleeding, treatment of uremic bleeding, cardiothoracic surgery (fibrin glue), obstetric emergencies such as abruptio placentae and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, and rare factor XIII deficiency. No compatibility testing is required and ABO-Rh type is not relevant.
  • If a febrile reaction develops, the blood product must be stopped and the intravenous line disconnected at the lowest possible site to minimize the transfusion of additional blood. The blood must be returned to the blood bank for transfusion reaction evaluation. The patient may need blood cultures and IV antibiotics may be started.
  • If a febrile reaction develops, the blood product must be stopped and the intravenous line disconnected at the lowest possible site to minimize the transfusion of additional blood. The blood must be returned to the blood bank for transfusion reaction evaluation. The patient may need blood cultures and IV antibiotics may be started.
  • If a febrile reaction develops, the blood product must be stopped and the intravenous line disconnected at the lowest possible site to minimize the transfusion of additional blood. The blood must be returned to the blood bank for transfusion reaction evaluation. The patient may need blood cultures and IV antibiotics may be started.
  • Transcript

    • 1. BLOOD PRODUCTS & TRANSFUSION REACTIONS Sherry Knowles, RN, CCRN, CRNI 2008
    • 2. Blood Types Blood Group Antigens Antibodies Can give blood to Can receive blood from AB A and B None AB AB, A, B, 0 A A B A and AB A and 0 B B A B and AB B and 0 0 None A and B AB, A, B, 0 0
    • 3. Blood Types Type O blood is called the “universal donor” because it can be donated to people of any blood type. Type AB blood is called the “universal recipient” because people with this type can receive any blood type.
    • 4. Rh Factor The Rh factor ( Rhesus factor) is a red cell surface antigen also known as the D antigen. Approximately 85% of Americans have Rh+ blood.
    • 5. Rh Factor Rh-negative individuals may develop antibodies to the Rh factor if they are exposed to Rh-positive cells through transfusion or if cells from an Rh-positive fetus cross the placenta into an Rh-negative mother. Subsequent administration of Rh-positive blood to such an Rh-negative individual who has developed anti-Rh antibodies would result in hemolysis of the donor cells and could be fatal.
    • 6. Whole blood
      • Whole blood is occasionally used
      • for massive transfusion in circumstances
      • in which rapid correction of acidosis,
      • hypothermia or coagulopathy is required.
    • 7. Packed Red Blood Cells (PRBC’s)
      • RBCs are the component of choice
      • used to increase Hb.
      • Packed Red Blood Cells
      • consist of erythrocyte concentrated
      • from whole blood.
      • RBC’s are anticoagulated with citrate
      • and may have one or more preservatives added.
    • 8. Washed Red Blood Cells (PRBC’s)
      • Washed Red Blood Cells are red blood cells washed
      • with normal saline to remove most of the plasma.
      • Washed Red Blood Cells are not leukoreduced .
      • Washed Red Cells are used for patients who
      • have had repeated hypersensitivity reactions to
      • blood products despite prophylactic administration
      • of antihistamines.
    • 9. Leukoreduced Red Blood Cells (PRBC’s)
      • Leukoreduced Red Blood Cells contain
      • leukocytes in reduced amounts.
      • Leukoreduced Red Blood Cells are
      • used for patients who have
      • experienced multiple non- hemolytic
      • febrile transfusion reactions.
    • 10. Irradiated Blood Products
      • Radiation inactivates lymphocytes
      • Irradiated blood products are
      • used to prevent graft-vs-host
      • disease in patients at risk.
    • 11. Platelets
      • Given for:
        • stable patients with platelet counts <10,000/m L
        • patients with bleeding, fever or splenomegaly
        • with platelet counts <20,000/m L
        • patients with significant bleeding or
        • undergoing an invasive procedure
        • patients with documented platelet
        • function abnormalities
                                                     
    • 12. Fresh Frozen Plasma (FFP)
      • FFP contains all coagulation factors in normal amounts
      • and is free of red cells, leukocytes and platelets.
      • FFP is indicated for patients with documented coagulation
      • factor deficiencies who are actively bleeding or who are
      • about to undergo an invasive procedure.
      • FFP may also be used to reverse
      • anticoagulating effects of warfarin.
      • Plasma must be ABO-compatible
      • with the red cells of the recipient.
    • 13. Granulocytes (WBC’s)
      • WBC’s may be transfused in the presence of
      • sepsis with profound persistent neutropenia
      • that is unresponsive to antibiotics.
      • Must be ABO Compatible
    • 14. Clotting Factors Factor VIII Factor VIIIa Factor IX Factor XIII von Willebrand factor And Many more!
    • 15. Cryoprecipitate
      • Cryoprecipitate is a concentrate
      • prepared from FFP.
      • A single bag of Cryo contains factor
      • VIII, von Willebrand factor, fibrinogen
      • and fibronectin.
      • No compatibility testing is required
      • and ABO-Rh type is not relevant.
    • 16. Immunoglobulin
      • Intravenous immunoglobulin is used in the
      • treatment of immuno-thrombocytopenia,
      • Guillain Barre syndrome and autoimmune
      • hemolytic anemias.
      • RhD immunoglobulin is used to prevent
      • exposure to D-positive red cells in D negative
      • patients. (usually given in pregnancy and
      • immediately after birth).
    • 17. Activated Protein C
      • Anti clotting
      • Anti Inflammation
      • Used early in Sepsis
      • Must watch for bleeding
    • 18. Synthetic Blood
        • Hemoglobin based oxygen carriers (HBOCs)
        • Perflurocarbon based products
        • (PFCs)
      •  
    • 19. Transfusion Reactions Can Be Life Threatening!
    • 20. Hemolytic Transfusion Reaction
      • This reaction results from incompatibility
      • of donor and recipient blood.
      • Results in the accelerated destruction
      • of red blood cells
      • Signs include fever, chills, headache,
      • hematuria, low back or flank pain, chest
      • tightness, acute sense of doom, shock
      • and DIC
    • 21.
      • Much more subtle!
      • Occurs in 3-14 days
      • following transfusion
      • Signs include unexplained
      • drop in hemoglobin and/or
      • rise in bilirubin, jaundice
      Delayed Hemolytic Transfusion Reaction
    • 22. Allergic Transfusion Reaction
      • Characterized by intense itchy with
      • welts (hives)
      • Usually involves stopping the
      • transfusion for a short period
      • of time and treating the symptoms
      • (usually with an antihistamine)
      • With appropriate monitoring
      • a transfusion may be restarted
      • at a slower rate
    • 23. Anaphalatic Transfusion Reaction
      • Classic severe reaction with
      • bronchospasm, shortness of breath,
      • respiratory distress and hypotension
      • Onset is sudden, within a few mL
      • of blood infusion
    • 24. Febrile Transfusion Reaction
      • Any elevation of temperature > than 1 degree C
      • suggests that a blood product being infused may
      • be bacterially contaminated, especially if the fever
      • is accompanied by intense shivering (rigors)
      • May include muscle cramps, nausea, flushing,
      • headache, tachycardia, chills, and rigors
      • Maintain comfort, anti-pyretic medication and
      • Meperidine (Demerol) for rigors
    • 25. Citrate Toxicity Reaction
      • Citrate is the anticoagulant added to blood
      • Following multiple blood transfusions
      • citrate may depress ionized calcium levels
      • Following multiple blood transfusions
      • watch for signs of hypocalcemia
      • (muscle irritability & cardiac arrhythmias)
    • 26. Transfusion Reaction Summary Type of Reaction Symptoms Possible Causes Acute Hemolytic Reaction Chills / Rigors, Headaches, Back / Loin Pain, Restlessness / Anxiety, Tachycardia, Shock, Hematuria, Oliguria – Anuria Rapid onset of Circulatory Collapse, Fever Major Blood Group Incompatibility       Bacterial Contamination Anaphylactic Reaction Respiratory and Cardiovascular Collapse, Dyspnea, Wheezing and Chest Tightness, Tachycardia, Hypotension, Nausea, Vomiting, Abdominal Pain, Itching Reaction due to a hypersensitivity to proteins present in the donor blood Allergic Reaction Skin Rashes / Bronchospasm Allergic Response to Elements in Donor Blood Febrile Reaction Fever / Chills, Headache / Flushing, Tachycardia Leucocyte Antibody Reaction of White cells in Donor Blood Transfusion Related Acute Lung Injury Acute Respiratory Distress, Bilateral Pulmonary Infiltrates Anti-Leucocytes Antibodies   in patient or donation
    • 27.
      • Assess patient VS’s and symptoms
      • Stop the blood, start NS and obtain
      • blood and urine samples for testing
      • Notify physician and follow instructions
      • for treatment of symptoms
      • Notify the Transfusion Service and
      • obtain a Transfusion Reaction Form
      • Complete all procedures for
      • managing a transfusion reaction
      Management of Transfusion Reaction
    • 28. The End Transfusion Reactions Can be Fatal!