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Administration of Blood and Blood ProductsPN 3 November 2005
Donation and Deferrals
• http://www.pbs.org/wnet/redgold/index.htm
• www.bloodservices.ca
Transfusions
Typing and Cross Matching
• To determine if blood of donor is compatible with blood or recipient
• If incompatible may result in “clumping” or agglutination and hemolysis of recipients blood cells. This may result in death.
• Typing determines blood type(A, B, AB, O)
• Cross match determines compatibility
Blood group AIf you belong to the blood group A, you have A antigens on the surface of your red blood cells and B antibodies in your blood plasma.
Blood group BIf you belong to the blood group B, you have B antigens on the surface of your red blood cells and A antibodies in your blood plasma.
Blood group ABIf you belong to the blood group AB, you have both A and B antigens on the surface of your red blood cells and no A or B antibodies at all in your blood plasma
Blood group 0If you belong to the blood group 0 (null), you have neither A or B antigens on the surface of your red blood cells but you have both A and B antibodies in your blood plasma
Agglutinin
• An antibody that causes a “clumping” of specific antigens
• Type A have an A antigen, type B have a B antigen, AB have both A and B antigens; type O have neither A or B
• A types have agglutinin for B; B have Agglutinin for A, AB have none and O has A and B agglutinins
Rh Factor
• Inherited antigen in human blood• There are 5 but we concern ourselves with
the one identified as “D”• A person who is identified as having “D” is
called Rh positive• Rh negative recipient must receive
negative blood• If the receive positive blood future tx may
cause death
Types of Transfusions
• Whole Blood
• Red blood cells
• Platelets
• Plasma
• Cryoprecipitate
Pre-Transfusion
• Agency policy
• Consent
• Hx of previous transfusion
• What symptoms do you want pt to report
Initiating the transfusion
• IV with large bore needle
• Blood tubing primed with 0.9% NaCl
• Blood filter
• Baseline vital
• Have pt. comfortable, i.e. go to bathroom
During the Transfusion
• Blood not initiated within 30 mins returned to lab
• Infused no longer than 4 hours
• All info on pt and blood must be exactly the same
• Check vital signs q5 mins x 3 and then q15 mins x 4 then hourly
Transfusion Reactions
• Listen to the pts complaints• Check vitals, observe the patientTypes of Reactions:
HemolyticAllergic FebrileBacterial
Circ overload
Hemolytic
• Blood type or Rh incompatibility• Destruction of cells and inflammatory
response• Maybe immediate or at next transfusion• Mild with fever and chills or life threatening• Apprehension, HA, chest pain, low back
pain, Tachycardia, Tachypnea, Hypotension, hemoglobinuria, impending doom
Allergic
• Clients with a history of allergy
• Uticaria, itching, bronchospasm, anaphylaxis.
• Occurs during and up to 24 hours after
• Sometimes given washed RBC to remove WBC and plasma
Febrile
• Occurs after multiple transfusions
• Develop anti WBC antibodies
• Give WBC reduced blood (filter, washed)
• S and S: chills, tachycardia, fever, hypotension, tachypnea
Bacterial
• Contaminated blood transfusion
• Gram negative because these grow fast in blood
• S and S: tachycardia, hypotension, fever, chills, shock
• Onset is rapid
Circulatory Overload
• Blood infused to quickly• Whole blood or multiple infusions• Older adults are most at risk• S and S, hypertension, bounding pulse,
distended jugular veins, dyspnea, restlessness, confusion.
• Manage and prevent by monitoring I & O; infusing slowly, diuretics, chest assessment!
Transfusion-Associated Graft-versus-Host Disease
• Rare but life-threatening
• Immune suppressed individuals
• 90% mortality rate
• Thrombocytopenia, anorexia, nausea, vomiting, chronin hep, wt loss, recurrent infections.
• Occurs 1-2 weeks
Incidentals
• Blood warmers
• Pumps and pressure bags
• Dilutents and concurrent fluid and meds
RPN Responsibility
• Pick up blood from blood bank• Prime blood tubing• Confirm client identity with other Registered
Nurses (not another RPN)• Independent double check of all ID• Re-verify the MD order and concent• Time the transfusion• WATCH and ASSESS the patient• Documentation
What not to Do
X