Blood Transfusion

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