Blood Transfusion Therapy

Notes

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 Transfusion Therapy

Blood Transfusion Therapy

 

Blood components include:
  1. 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.
  2. Leukocyte-poor packed RBCs, indicated for patients who have experience previous febrile no hemolytic reactions.
  3. Platelets, either HLA (human leukocyte antigen) matched or unmatched.
  4. Granulocytes ( basophils, eosinophils, and neutrophils )
  5. Fresh frozen plasma, containing all coagulation factors, including factors V and VIII (the labile factors).
  6. 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.
  7. Albumin, a plasma protein.
  8. Cryoprecipitate, a plasma derivative rich in factor VIII, fibrinogen, factor XIII, and fibronectin.
  9. Factor IX concentrate, a concentrated form of factor IX prepared by pooling, fractionating, and freeze-drying large volumes of plasma.
  10. Factor VIII concentrate, a concentrated form of factor IX prepared by pooling, fractionating, and freeze-drying large volumes of plasma.
  11. Prothrombin complex, containing prothrombin and factors VII, IX, X, and some factor XI.
 Advantages of blood component therapy
  1. Avoids the risk of sensitizing the patients to other blood components.
  2. Provides optimal therapeutic benefit while reducing risk of volume overload.
  3. Increases availability of needed blood products to larger population.
Principles of blood transfusion therapy
  1. 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.
  2. Packed RBCs
    • Should be transfused over 2 to 3 hours; if patient cannot tolerate volume over a maximum of 4 hours, it may be necessary for the blood bank to divide a unit into smaller volumes, providing proper refrigeration of remaining blood until needed. One unit of packed red cells should raise hemoglobin approximately 1%, hemactocrit 3%.
  3. Platelets
    • Administer as rapidly as tolerated (usually 4 units every 30 to 60 minutes). Each unit of platelets should raise the recipient’s platelet count by 6000 to 10,000/mm3: however, poor incremental increases occur with alloimmunization from previous transfusions, bleeding, fever, infection, autoimmune destruction, and hypertension.
  4. Granulocytes
    • May be beneficial in selected population of infected, severely granulocytopenic patients (less than 500/mm3) not responding to antibiotic therapy and who are expected to experienced prolonged suppressed granulocyte production.
  5. Plasma
    • Because plasma carries a risk of hepatitis equal to that of whole blood, if only volume expansion is required, other colloids (e.g., albumin) or electrolyte solutions (e.g., Ringer’s lactate) are preferred. Fresh frozen plasma should be administered as rapidly as tolerated because coagulation factors become unstable after thawing.
  6. Albumin
    • Indicated to expand to blood volume of patients in hypovolemic shock and to elevate level of circulating albumin in patients with hypoalbuminemia. The large protein molecule is a major contributor to plasma oncotic pressure.
  7. Cryoprecipitate
    • Indicated for treatment of hemophilia A, Von Willebrand’s disease, disseminated intravascular coagulation (DIC), and uremic bleeding.
  8. Factor IX concentrate
    • Indicated for treatment of hemophilia B; carries a high risk of hepatitis because it requires pooling from many donors.
  9. Factor VIII concentrate
    • Indicated for treatment of hemophilia A; heat-treated product decreases the risk of hepatitis and HIV transmission.
  10. Prothrombin complex-Indicated in congenital or acquired deficiencies of these factors.
Objectives
  1. To increase circulating blood volume after surgery, trauma, or hemorrhage
  2. To increase the number of RBCs and to maintain hemoglobin levels in clients with severe anemia
  3. To provide selected cellular components as replacements therapy (e.g. clotting factors, platelets, albumin)
Nursing Interventions
  1. Verify doctor’s order. Inform the client and explain the purpose of the procedure.
  2. Check for cross matching and typing. To ensure compatibility
  3. Obtain and record baseline vital signs
  4. Practice strict Asepsis
  5. At least 2 licensed nurse check the label of the blood transfusion
    • Check the following:
      • Serial number
      • Blood component
      • Blood type
      • Rh factor
      • Expiration date
      • Screening test (VDRL, HBsAg, malarial smear) – *this is to ensure that the blood is free from blood-carried diseases and therefore, safe from transfusion.
  6. Warm blood at room temperature before transfusion to prevent chills.
  7. Identify client properly. Two Nurses check the client’s identification.
  8. Use needle gauge 18 to 19. This allows easy flow of blood.
  9. Use BT set with special micron mesh filter. To prevent administration of blood clots and particles.
  10. Start infusion slowly at 10 gtts/min. Remain at bedside for 15 to 30 minutes. Adverse reaction usually occurs during the first 15 to 20 minutes.
  11. Monitor vital signs. Altered vital signs indicate adverse reaction.
  12. Do not mix medications with blood transfusion. To prevent adverse effects
    • Do not incorporate medication into the blood transfusion
    • Do not use blood transfusion lines for IV push of medication.
  13. Administer 0.9% NaCl before; during or after BT. Never administer IV fluids with dextrose. Dextrose causes hemolysis.
  14. Administer BT for 4 hours (whole blood, packed RBC). For plasma, platelets, cryoprecipitate, transfuse quickly (20 minutes) clotting factor can easily be destroyed.
  15. Observe for potential complications. Notify physician.
Complications of Blood Transfusion
  1. Allergic Reaction – it is caused by sensitivity to plasma protein of donor antibody, which reacts with recipient antigen.
    • Assessments:
      • Flushing
      • Rush, hives
      • Pruritus
      • Laryngeal edema, difficulty of breathing
  2. Febrile, Non-Hemolytic – it is caused by hypersensitivity to donor white cells, platelets or plasma proteins. This is the most symptomatic complication of blood transfusion
    • Assessments:
      • Sudden chills and fever
      • Flushing
      • Headache
      • Anxiety
  3. Septic Reaction – it is caused by the transfusion of blood or components contaminated with bacteria.
    • Assessment:
      • Rapid onset of chills
      • Vomiting
      • Marked Hypotension
      • High fever
  4. Circulatory Overload – it is caused by administration of blood volume at a rate greater than the circulatory system can accommodate.
    • Assessment:
      • Rise in venous pressure
      • Dyspnea
      • Crackles or rales
      • Distended neck vein
      • Cough
      • Elevated BP
  5. Hemolytic reaction. It is caused by infusion of incompatible blood products.
    • Assessment:
      • Low back pain (first sign). This is due to inflammatory response of the kidneys to incompatible blood.
      • Chills
      • Feeling of fullness
      • Tachycardia
      • Flushing
      • Tachypnea
      • Hypotension
      • Bleeding
      • Vascular collapse
      • Acute renal failure
Assessment findings
  1. Clinical manifestations of transfusions complications vary depending on the precipitating factor.
  2. 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)
  3. Clinical signs and laboratory findings in delayed hemolytic reaction include:
    • fever
    • mild jaundice
    • gradual fall of hemoglobin
    • positive Coombs’ test
  4. Febrile non-hemolytic reaction is marked by:
    • Temperature rise during or shortly after transfusion
    • Chills
    • headache
    • flushing
    • anxiety
  5. Signs and symptoms of septic reaction include;
    • Rapid onset of high fever and chills
    • vomiting
    • diarrhea
    • marked hypotension
  6. Allergic reactions may produce:
    • hives
    • generalized pruritus
    • wheezing or anaphylaxis (rarely)
  7. Signs and symptoms of circulatory overload include:
    • Dyspnea
    • cough
    • rales
    • jugular vein distention
  8. Manifestations of infectious disease transmitted through transfusion may develop rapidly or insidiously, depending on the disease.
  9. Characteristics of GVH disease include:
    • skin changes (e.g. erythema, ulcerations, scaling)
    • edema
    • hair loss
    • hemolytic anemia
  10. Reactions associated with massive transfusion produce varying manifestations
Possible Nursing Diagnosis
  1. Ineffective breathing pattern
  2. Decreased Cardiac Output
  3. Fluid Volume Deficit
  4. Fluid Volume Excess
  5. Impaired Gas Exchange
  6. Hyperthermia
  7. Hypothermia
  8. High Risk for Infection
  9. High Risk for Injury
  10. Pain
  11. Impaired Skin Integrity
  12. Altered Tissue Perfusion
Planning and Implementation
  1. 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.
    • Inspecting the blood product for any gas bubbles, clothing, or abnormal color before administration.
    • Beginning transfusion slowly ( 1 to 2 mL/min) and observing the patient closely, particularly during the first 15 minutes (severe reactions usually manifest within 15 minutes after the start of transfusion).
    • Transfusing blood within 4 hours, and changing blood tubing every 4 hours to minimize the risk of bacterial growth at warm room temperatures.
    • Preventing infectious disease transmission through careful donor screening or performing pretest available to identify selected infectious agents.
    • Preventing GVH disease by ensuring irradiation of blood products containing viable WBC’s (i.e., whole blood, platelets, packed RBC’s and granulocytes) before transfusion; irradiation alters ability of donor lymphocytes to engraft and divide.
    • Preventing hypothermia by warming blood unit to 37 C before transfusion.
    • 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.
  2. On detecting any signs or symptoms of reaction:
    • Stop the transfusion immediately, and notify the physician.
    • Disconnect the transfusion set-but keep the IV line open with 0.9% saline to provide access for possible IV drug infusion.
    • Send the blood bag and tubing to the blood bank for repeat typing and culture.
    • Draw another blood sample for plasma hemoglobin, culture, and retyping.
    • Collect a urine sample as soon as possible for hemoglobin determination.
  3. Intervene as appropriate to address symptoms of the specific reaction:
    • Treatment for hemolytic reaction is directed at correcting hypotension, DIC, and renal failure associated with RBC hemolysis and hemoglobinuria.
    • Febrile, nonhemolytic transfusion reactions are treated symptomatically with antipyretics; leukocyte-poor blood products may be recommended for subsequent transfusions.
    • In septic reaction, treat septicemia with antibiotics, increased hydration, steroids and vasopressors as prescribed.
    • Intervene for allergic reaction by administering antihistamines, steroids and epinephrine as indicated by the severity of the reaction. (If hives are the only manifestation, transfusion can sometimes continue but at a slower rate.)
    • For circulatory overload, immediate treatment includes positioning the patient upright with feet dependent; diuretics, oxygen and aminophylline may be prescribed.
Nursing Interventions when complications occurs in Blood transfusion
  1. If blood transfusion reaction occurs. STOP THE TRANSFUSION.
  2. Start IV line (0.9% Na Cl)
  3. Place the client in fowler’s position if with SOB and administer O2 therapy.
  4. The nurse remains with the client, observing signs and symptoms and monitoring vital signs as often as every 5 minutes.
  5. Notify the physician immediately.
  6. The nurse prepares to administer emergency drugs such as antihistamines, vasopressor, fluids, and steroids as per physician’s order or protocol.
  7. Obtain a urine specimen and send to the laboratory to determine presence of hemoglobin as a result of RBC hemolysis.
  8. Blood container, tubing, attached label, and transfusion record are saved and returned to the laboratory for analysis.
Evaluation
  1. The patient maintains normal breathing pattern.
  2. The patient demonstrates adequate cardiac output.
  3. The patient reports minimal or no discomfort.
  4. The patient maintains good fluid balance.
  5. The patient remains normothermic.
  6. The patient remains free of infection.
  7. The patient maintains good skin integrity, with no lesions or pruritus.
  8. The patient maintains or returns to normal electrolyte and blood chemistry values.

 


References:

J.Q. Udan, RN, MAN 2004. Mastering Fundamentals of Nursing 2nd ed. Educational Publishing House

Image courtesy of : http://www.beltina.org/pics/blood_transfusion.jpg

 

Exam

Welcome to your NCLEX Practice Exam for Blood Transfusion! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 15 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Tips For Success

  • Read each question carefully. Take your time and don't rush.
  • Understand the rationale behind each answer. This will not only help you during this exam, but also assist in reinforcing your learning.
  • Don't be discouraged by incorrect answers. Use them as an opportunity to learn and improve.
  • Take breaks if you need them. It's not a race, and your understanding is what's most important.
  • Keep a positive attitude and believe in your ability to succeed.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Think about the primary function of platelets and how their increase would affect the patient's symptoms.

1 / 15

1. Nurse Jessica is monitoring a patient who is receiving a platelet transfusion. To evaluate the effectiveness of the therapy, what positive outcome should she look for?

💡 Hint

Focus on the action that directly addresses early detection of possible complications during a transfusion.

2 / 15

2. Nurse Taylor is monitoring a newly admitted patient who has just started receiving a blood transfusion. To ensure patient safety, which intervention should Nurse Taylor prioritize?

💡 Hint

Think about which option ensures the blood is most compatible with the patient's own system.

3 / 15

3. Nurse Carter is preparing a patient for surgery, where there's a possibility of needing a blood transfusion. To minimize the risk of a transfusion reaction, what suggestion should Nurse Carter offer?

💡 Hint

Consider the equipment that directly addresses temperature-related complications during rapid or large-volume blood transfusions.

4 / 15

4. Nurse Rodriguez is preparing to administer multiple blood transfusions to a patient who has experienced severe blood loss. To reduce the risk of cardiac dysrhythmias during the transfusions, which piece of equipment should Nurse Rodriguez prioritize?

💡 Hint

Think about what baseline data is crucial before starting any transfusion to monitor for immediate reactions.

5 / 15

5. Nurse Lee, after carefully verifying the blood unit with a fellow nurse, is about to start a blood transfusion for her patient. Before proceeding, which assessment should Nurse Lee prioritize?

💡 Hint

Consider the type of tubing that is specifically designed for safe and effective blood transfusions.

6 / 15

6. Nurse Thompson is preparing to administer 2 units of packed red blood cells to a patient with low hemoglobin levels. Which equipment should Nurse Thompson use to ensure proper blood transfusion?

💡 Hint

Think about the first step in responding to a suspected transfusion reaction.

7 / 15

7. Nurse Evans is monitoring a patient who is receiving a transfusion of packed red blood cells when the patient suddenly begins to experience difficulty breathing, flushed skin, and chills. What should Nurse Evans do first?

💡 Hint

Consider the only IV solution that is compatible with blood products to prevent hemolysis.

8 / 15

8. Nurse Alvarez is preparing to administer one unit of packed red blood cells to a patient. Which intravenous solution should Nurse Alvarez ensure is available to hang with the blood product at the patient's bedside?

💡 Hint

Consider what FFP is specifically used for in cases of acute blood loss or coagulopathy.

9 / 15

9. Nurse Williams is caring for a patient in the emergency department who has suffered significant blood loss from a deep puncture wound. The physician orders 3 units of Fresh Frozen Plasma (FFP). What is the primary reason for administering FFP in this situation?

💡 Hint

The highest risk for acute transfusion reactions typically occurs early during the transfusion.

10 / 15

10. Nurse Parker is administering a first-time blood transfusion of packed red blood cells to a patient. To monitor for any immediate transfusion reactions, how long should Nurse Parker remain with the patient after starting the transfusion?

💡 Hint

Look for the label detail that indicates the shelf life of the blood product.

11 / 15

11. Nurse Patel is about to administer a unit of blood and wants to ensure the blood cells are still viable. Which information should Nurse Patel check to confirm the age of the blood cells?

💡 Hint

Consider the primary purpose of cryoprecipitate in managing certain blood conditions.

12 / 15

12. Nurse Lee is administering a transfusion of cryoprecipitate to a patient. To evaluate the effectiveness of the treatment, which lab results should Nurse Lee focus on?

💡 Hint

Consider the priority action to maintain venous access while managing a transfusion reaction.

13 / 15

13. Nurse Kelly notices her patient is showing signs of a transfusion reaction. She promptly stops the blood transfusion. What should Nurse Kelly do immediately after?

💡 Hint

Focus on the combination of symptoms like fever, hypotension, and gastrointestinal distress, which can point to a serious transfusion-related complication.

14 / 15

14. Nurse Daniels is closely observing a patient receiving a transfusion of packed red blood cells (PRBCs). The patient suddenly becomes nauseous, begins to vomit, and experiences a drop in blood pressure from 110/70 mm Hg to 95/40 mm Hg. The patient's temperature rises from 99.5°F to 100.5°F. What condition might Nurse Daniels suspect?

💡 Hint

Consider the importance of addressing any pre-transfusion issues that could complicate the procedure.

15 / 15

15. Nurse Ellen is preparing to administer packed red blood cells to a patient with low hemoglobin and hematocrit levels. Before starting the transfusion, she notes the patient’s temperature is 100.8°F. What should Nurse Ellen do next?