Chapter 40 Hematology and Blood Transfusions
Which intravenous solution is compatible for administration with blood products? Normal saline Ringer's lactate Dextrose in water Dextrose solution
Normal saline Normal saline solution is compatible and can be used as a solution for administration with blood products. Solutions such as Ringer's lactate, dextrose in water, and dextrose solution are not compatible with blood products because they may cause clotting or hemolysis of blood cells.
An older adult who is receiving rapid whole blood transfusion develops hypertension, bounding pulse, distended neck veins, and confusion. What could be the cause of the patient's condition? Circulating overload Febrile transfusion reaction Allergic transfusion reaction Hemolytic transfusion reaction
Circulating overload Circulating overload is manifested as hypertension, bounding pulse, distended neck veins, and confusion. Circulating overload can occur when the infusion rate is rapid, especially in older adults. Febrile transfusion reactions are characterized by the formation of anti-white blood cell antibodies and are manifested by chills, tachycardia, fever, hypotension, and tachypnea. Hemolytic transfusion reactions are characterized by fever, chills, disseminated intravascular coagulation, and circulatory collapse. Symptoms of allergic transfusion reactions include urticaria, itching, bronchospasm, or anaphylaxis.
The registered nurse teaches a student nurse about nursing interventions to be taken before starting transfusion therapy. Which intervention made by the student nurse shows ineffective understanding? Verifying the medical prescription Assessing laboratory values of the patient Diluting the blood products with normal saline Obtaining venous access using a central catheter
Diluting the blood products with normal saline Blood products are diluted with normal saline during the transfusion therapy, not before starting it. The nurse verifies the medical prescription for the type of product, dose, and transfusion time mentioned in the prescription before starting the therapy. The patient's laboratory values should meet the guidelines for blood product transfusion; this action should occur before starting the therapy. Obtaining venous access should be initiated before starting the blood transfusion.
What type of transfusion reaction is characterized by disseminating intravascular coagulation? Febrile transfusion reactions Bacterial transfusion reactions Hemolytic transfusion reactions Acute pain transfusion reactions
Hemolytic transfusion reactions Hemolytic transfusion reactions occur as a result of antigen antibody complexes formed due to incompatibility between the donor and recipient's blood. These complexes destroy the blood vessel walls and organs. This reaction is characterized by disseminating intravascular coagulation and circulatory collapse. Febrile transfusion reactions are characterized by the development of anti-white blood cell antibodies. Bacterial transfusion reactions are caused by the contamination of blood products. Acute pain transfusion reactions are manifested as severe chest pain, back pain, joint pa
Why is filtered tubing used during infusion of blood products? To reduce hemolysis To remove aggregates To prevent fluid overload To avoid blood borne pathogens
To remove aggregates Filtered tubing is used during the administration of blood product to remove aggregates and possible contaminants during the infusion. Hemolysis is prevented by diluting the blood products with normal saline only. Fluid overload is prevented by maintaining an adequate infusion rate if signs of fluid volume overload are present. Blood borne pathogens are prevented by proper handling of the equipment.
What intervention during the transfusion therapy of fresh frozen plasma may cause complications? Determining ABO compatibility Using small filters with shorter tubing Infusing fresh frozen plasma immediately after thawing Infusing the products as rapidly as tolerated by the patient
Using small filters with shorter tubing Fresh frozen plasma should be administered through a Y-set or straight filtered tubing to avoid complications. ABO compatibility determination is required for the transfusion of plasma products because the plasma contains the donor's ABO antibodies, which could react with the patient's RBC antigens. A delay in the infusion of plasma products after thawing makes the clotting factors inactive. Thus, fresh frozen plasma should be infused immediately and rapidly after thawing.
The registered nurse teaches a student nurse about the actions to be followed after an infusion of blood products. Which statement made by the student nurse shows ineffective understanding? "I will dispose of the bag safely after infusion." "I will dispose of the tubing safely after infusion." "I will document every detail of the transfusion." "I will monitor the vital signs of the patient after the transfusion."
"I will monitor the vital signs of the patient after the transfusion." The vital signs of the patient should be assessed before, during, and after the infusion therapy. Accurate vital signs help to determine any changes caused by transfusion reactions. Disposal of the bag and tubing safely after transfusion helps prevent the spread of blood borne pathogens. The transfusion details (such as the type of product infused, product number, volume infused, time of infusion, and any adverse reactions) should be documented in the patient record.
The nurse educator is teaching a nursing student about the transfusion of blood products. Which statement made by the student nurse regarding the transfusion of red blood cells indicates effective learning? "Do not administer any other solution with the blood product." "Red blood cell transfusions should be completed within 4 hours of removal from refrigeration." "Increasing the speed of administration during the first 15 minutes of the transfusion is necessary." "Once the blood product has been released from the blood bank, it should be immediately transfused into the recipient's body within a few seconds."
"Red blood cell transfusions should be completed within 4 hours of removal from refrigeration." Red blood cell transfusions should be performed within 4 hours of after removal from the refrigeration. If the transfusion time extends longer than four hours, it may lead to infections in the recipient. Hemolytic reaction may occur if saline is not administered with the blood product. Increasing the rate of administration of the drug may lead to fluid overload. After the blood product is released from the blood bank, it must be transfused within 4 hours, not immediately.
A patient with anemia is prescribed a transfusion of packed red blood cells (PRBCs) to be administered over 4 hours. What is the approximate volume to be transfused? 100 - 150 mL 200 - 250 mL 300 - 350 mL 400 - 450 mL
200 - 250 mL Anemia is usually treated by administering 200 mL (200 ─ 250 mL) of packed red blood cells over 4 hours. A volume of 100 ─ 150 mL is below the range of the required volume of 200 ─ 250 mL and may not be sufficient for the patient to recover. A volume of 300 mL or higher is above the required range.
Which patient is least likely to require red blood cell transfusion therapy? A patient who sustained trauma. A patient with impaired red blood cell maturation. A patient with problems that destroy RBCs. A patient with a hemoglobin level of 8 g/dL.
A patient with a hemoglobin level of 8 g/dL. Blood transfusion therapy is initiated in a patient with anemia if the hemoglobin level is less than 6 g/dL. Thus a patient with a hemoglobin level of 8 g/dL would not receive a blood transfusion unless he or she is symptomatic. Red blood cell transfusion therapy is preferred in patients who sustained trauma and had blood loss. Patients with impaired red blood cell (RBC) maturation may need infusion therapy for maintaining perfusion. Patients with problems that destroy RBCs may require a transfusion to maintain vital functions.
What patient is an ideal candidate for plasma transfusion therapy? A patient with an albumin deficiency A patient with an electrolyte deficiency A patient with a hemoglobin deficiency A patient with a prothrombin deficiency
A patient with a prothrombin deficiency Plasma transfusion therapy is used to replace plasma volume and clotting factors. Patients with a prothrombin deficiency are most suitable for this therapy. Electrolyte deficiency is managed with electrolyte replacement therapy by infusing intravenous fluids. Hemoglobin deficiency is managed with red blood cell transfusion therapy. A deficiency of albumin is not managed by plasma transfusion therapy.
Which intervention may increase the risk of fluid overload during transfusion therapy in older adults? Administering normal saline concurrently in a second intravenous site Administering blood slowly at an infusion rate of 2 to 4 hours per unit Maintaining a gap of 2 full hours after administration of 1 unit before the next unit Monitoring the patient's kidney function and fluid status before initiating the therapy
Administering normal saline concurrently in a second intravenous site Older patients undergoing transfusion therapy are at a high risk of fluid overload; concurrent administration of normal saline into the other intravenous site should be avoided. The infusion rate in older patients should be one unit per 2 to 4 hours to avoid the risk of fluid overload. Maintaining a specific interval of time between consecutive transfusions is necessary to prevent fluid overload. Assessing the kidney function and fluid status of the patient before initiating the therapy is very important. This helps to determine the volume and infusion rate to reduce the risk of fluid overload.
A patient develops urticaria, itching, bronchospasm, and anaphylaxis 24 hours after a blood transfusion therapy. What could be the possible reason behind this? Febrile transfusion reactions Allergic transfusion reactions Hemolytic transfusion reactions Acute pain transfusion reactions
Allergic transfusion reactions Allergic reactions usually occur during or up to 24 hours after a transfusion. The common manifestations include utricaria, itching, bronchospasm, or anaphylaxis. Febrile transfusion reactions are characterized by the formation of anti-white blood cell antibodies. Hemolytic transfusion reactions are characterized by dissemination intravascular coagulation and circulatory collapse. Acute pain transfusion reactions are manifested as severe chest pain, back pain, joint pain, hypertension, and redness.
The student nurse starts the infusion of packed red blood cells in a patient who is already on intravenous (IV) antibiotic therapy; the infusion goes through the same IV line. What complication would be expected? Allergy Clotting Hemolysis Fluid overload
Clotting When added to or infused along with blood products, drugs may cause blood clotting. Therefore, an additional intravenous site should be used in order for blood to be infused without any other medications. Allergies do not arise from a co-administration of drug and blood products. It is seen in patients with a history of other allergies, including asthma. Hemolysis occurs due to blood type or Rh factor incompatibilities. Fluid overload occurs due to rapid infusion of blood products, not due to the co-administration of drug and blood products.
A patient develops fever, chills, and shock rapidly after initiation of infusion therapy. The primary health care provider diagnoses the condition as a bacterial infection and advises termination of the therapy. Which assessment finding supports the diagnosis? Urticaria Bounding pulse Redness of the head and neck Cloudiness of the product in the blood bag
Cloudiness of the product in the blood bag A bacterial contamination of the blood products leads to a rapid development of fever, chills, and shock. Any presence of discoloration, gas bubbles, or cloudiness in the blood bag is an indication of a bacterial infection. Urticaria is observed in patients with allergic transfusion reactions. A bounding pulse is a manifestation of circulating overload. Redness of the head and neck is a manifestation of acute pain transfusion reactions.
What intervention performed during a transfusion reaction may further complicate the condition? Stopping the transfusion and removing the blood tubing Providing the access for infusions and flushing with normal saline Returning the component bag, labels, and all tubing to the laboratory Flushing the intravenous contents of the tubing with normal saline before removing
Flushing the intravenous contents of the tubing with normal saline before removing Flushing the contents of the blood transfusion tubing will allow more blood to enter the patient and aggravate transfusion reactions. The transfusion should be stopped immediately and the blood tubing should be removed to prevent more blood from entering the patient's circulation. If the patient does not have any other intravenous access, the access site should be flushed with normal saline. The component bag, labels, and all tubing should be returned to the laboratory or blood bank for further investigation if hemolytic reaction or bacterial reaction is suspected.
Which changes should be monitored during the first 15 to 30 minutes in a patient who is undergoing blood transfusion? Hyperkalemia Fluid overload Febrile reaction Hemolytic reaction
Hemolytic reaction Hemolytic reaction may occur during the infusion of the first 50 mL of the blood. Therefore the nurse should remain with the patient for the first 15 to 30 minutes in order to monitor for hemolytic reaction. The use of frozen samples or samples that are more than a week old may lead to hyperkalemia. The nurse monitors an older patient's vital signs every 15 minutes throughout the transfusion to check for signs of fluid overload. Fluid overload may also occur as a result of rapid transfusion. Febrile reaction is observed after multiple transfusions, or during white blood cell and platelet transfusions.
Which statements are true regarding blood group compatibility? Select all that apply. Individuals with a positive Rh factor have the Rh antigen. Individuals with blood type A have A antigens and anti-B antibodies. Individuals with blood type B have B antigens and anti-A antibodies. Individuals with blood type AB have A and B antigens and anti-A and B antibodies. Individuals with blood type O have A and B antigens and no antibodies.
Individuals with a positive Rh factor have the Rh antigen. Individuals with blood type A have A antigens and anti-B antibodies. Individuals with blood type B have B antigens and anti-A antibodies. Patients with positive Rh factor have Rh antigen. They can receive blood from patients with or without Rh antigen. Patients with blood type A have A antigens and anti-B antibodies. They can receive blood only from same blood type and O blood type. Patients with blood type B have B antigens and anti-A antibodies. They can receive blood only from the same blood type and the O blood type. The patient with blood type AB have A and B antigens and no circulating antibodies. Therefore, this blood type is known as a universal acceptor. Patients with blood type O have no antigens.
The nurse is infusing platelets to a patient who is scheduled for a hematopoietic stem cell transplant (HSCT). What procedure does the nurse follow? Administer intravenous (IV) corticosteroids before starting the transfusion. Allow the platelets to stabilize at the patient's bedside for 30 minutes. Infuse the transfusion over a 15- to 30-minute period. Set up the infusion with the standard transfusion "Y" tubing.
Infuse the transfusion over a 15- to 30-minute period. The volume of platelets—200 or 300 mL (standard amount)—needs to be infused rapidly over a 15- to 30-minute period. Administering steroids is not standard practice in administering platelets. Platelets must be administered immediately after they are received; they are considered to be quite fragile. A special transfusion set with a smaller filter and shorter tubing is used to get the platelets into the patient quickly and efficiently.
The nurse is assessing a patient who will be undergoing a hematopoietic stem cell transplantation. The medical history of the patient shows past allergic reactions to this type of transfusion therapy. What would be the correct line of treatment? Infusion of pooled platelets Infusion of packed red blood cells Infusion of leukocyte-reduced red blood cells Infusion of white blood cells
Infusion of leukocyte-reduced red blood cells Patients with a history of allergic reactions to transfusion therapy who have undergone hematopoietic stem cell transplantation are at greater risk. An infusion of leukocyte-reduced red blood cells is preferred because this procedure is least likely to cause a transfusion reaction. An infusion of pooled platelets is preferred for patients with thrombocytopenia without a history of transfusion reactions. An infusion of packed red blood cells helps treat patients with a hemoglobin level less than 6 g/dL without a history of transfusion reactions. Infusion of white blood cells is usually done to treat patients with sepsis or a neutropenic infection.
A patient diagnosed with thrombocytopenia is advised transfusion therapy with platelets from a single donor. Which nursing intervention helps in improving the effectiveness of the therapy? Ensuring the ABO compatibility Using a straight filtered tubing Assessing febrile reactions during infusion therapy Initiating the therapy immediately after receiving the product
Initiating the therapy immediately after receiving the product A patient with thrombocytopenia should undergo platelet transfusion therapy. Platelets are fragile and must be infused immediately after being brought to the patient's room. Platelet transfusion therapy does not require ABO compatibility. Using straight filtered tubing causes occlusion of the lumen of the tube due to adhesion of platelets. A single donor is advised for this patient to reduce the chances of febrile transfusion reactions.
What clinical manifestation is associated with hemolytic transfusion reactions? Anorexia Vomiting Low back pain Thrombocytopenia
Low back pain Low back pain is the clinical manifestation associated with hemolytic transfusion reactions. Anorexia, vomiting, and thrombocytopenia are associated with transfusion-associated graft-versus-host disease.
Which data is least required when initiating a transfusion process? Patient's band name Patient's band number Patient's room number Patient's date of birth
Patient's room number According to The Joint Commission's National Patient safety goals, the patient's room number is not an acceptable form of identification. As per the safety goals, the patient's identification is based on the patient's band name, band number, and identification of the blood component. The date of birth is part of the standard identification process.
A patient with neutropenia who is receiving amphotericin B therapy is prescribed white blood cell (WBC) transfusion therapy. Which intervention needs correction? Infusing the WBC products at a slow rate Placing a long filtered tubing for infusion Stricter monitoring of the patient for transfusion reactions Terminating the infusion of amphotericin B 4 to 6 hours before WBC transfusions
Placing a long filtered tubing for infusion Long filtered tubing equipment is used for infusing products such as platelets, plasma, and red blood cells (RBCs); it should not be used to infuse white blood cells (WBCs). WBC products should be infused slowly. Transfusion reactions are more common during WBC infusion; thus patients often require strict monitoring. Infusion of amphotericin B should be terminated 4 to 6 hours before WBC transfusions.
Which type of transfusion therapy may be safe even if the ABO factors are incompatible? Packed red blood cells Washed red blood cells Pooled platelets Fresh frozen plasma
Pooled platelets ABO compatibility is not necessary during platelet transfusions because platelets do not contain antigens that can evoke an antigen-antibody reaction. Transfusions of packed red blood cells (RBCs) and washed RBCs require ABO compatibility determination. Fresh frozen plasma contains the donor's ABO antibodies, which could react with the recipient's RBC antigens.
What type of transfusion reaction can be prevented by using irradiated blood products? Febrile transfusion reactions Bacterial transfusion reactions Hemolytic transfusion reactions Transfusion-associated graft-versus-host disease (TA-GVHD)
Transfusion-associated graft-versus-host disease (TA-GVHD) Transfusion-associated graft-versus-host disease (TA-GVHD) occurs when the donor's T-cell lymphocytes attack host tissue. Irradiated blood products can be used to prevent TA-GVHD because irradiation destroys T-cells and their cytokine products. Febrile transfusion reactions are prevented by using white blood cell poor blood products. Bacterial transfusion reactions are prevented by using contamination-free blood products and equipment. Hemolytic transfusion reactions are prevented by determining the ABO compatibility before transfusion.
What is the priority action performed by the nurse to avoid blood transfusion complications? Use Ringer's lactate and dextrose in water for infusion. Administer normal saline solution with the blood products. Use of appropriate filters to remove the sediment formed in the stored blood. Verify the patient's name and number, check blood compatibility, and note the expiration date.
Verify the patient's name and number, check blood compatibility, and note the expiration date. The first precautionary action that should be performed to avoid blood transfusion complications is to verify the patient's name and check whether the hospital identification band name and number are identical to those on the blood component tag. This action ensures that the correct blood component is administered to the patient. The expiration date is checked at the same time to avoid use of a contaminated sample. Ringer's lactate and dextrose in water is not infused with blood products as it may cause hemolysis of the blood cells. Instead, a normal saline solution is administered with blood products; however, this is done only after the patient's name, number, blood compatibility, and blood product expiration date are verified. Using appropriate filters is necessary to remove sediment from the stored blood; however, this is not done before the patient's name, number, blood compatibility, and blood product expiration date are verified.
Which patient is at greatest risk for having a hemolytic transfusion reaction? 34-year-old patient with type O blood 42-year-old patient with allergies 58-year-old immune-suppressed patient 78-year-old patient
34-year-old patient with type O blood Hemolytic transfusion reactions are caused by blood type or Rh incompatibility. When blood that contains antigens different from the patient's own antigens is infused, antigen-antibody complexes are formed in the patient's blood. Type O is considered the universal donor, but not the universal recipient. The patient with allergies would be most susceptible to an allergic transfusion reaction. The immune-suppressed patient would be most susceptible to a transfusion-associated graft-versus-host disease. The older adult patient would be most susceptible to circulatory overload.
A patient is prescribed a 200 mL infusion of packed red blood cells to be administered over 2 hours. What would be the consequence if the blood product is diluted with normal saline and infused at a rate of 3 mL/min? Allergy Clotting Hemolysis Fluid overload
Fluid overload The infusion rate prescribed by the healthcare provider is 1.6 mL/min (200 mL in 2 hours). Infusion of the blood product at a rate of 3 mL/min may cause rapid infusion leading to fluid overload. Allergies may occur in patients with a medical history of allergic transfusion reactions. Clotting occurs when blood products are diluted with any intravenous solution other than normal saline. Hemolysis is caused by a blood type or Rh incompatibility.
A patient reports anorexia, nausea, and vomiting. The laboratory findings of the patient show decreased levels of platelets and chronic hepatitis. The patient had received transfusion therapy 2 weeks before the manifestations appeared. What could be the possible reason behind the patient's condition? Hemolytic transfusion reactions Acute pain transfusion reaction (APTR) Transfusion-related acute lung injury (TRALI) Transfusion-associated graft-versus-host disease (TA-GVHD)
Transfusion-associated graft-versus-host disease (TA-GVHD) Signs of transfusion-associated graft-versus-host disease (TA-GVHD) include anorexia, nausea, vomiting, thrombocytopenia, and chronic hepatitis; these symptoms occur 1 or 2 weeks after receiving a transfusion. Apprehension, headache, chest pain, low back pain, tachycardia and tachypnea are clinical manifestations of hemolytic transfusion reactions. Acute pain transfusion reactions (APTR) are manifested as severe chest pain, back pain, joint pain, hypertension, and redness. A transfusion-related acute lung injury (TRALI) occurs when donor blood contains antibodies against the recipient's neutrophil antigens, HLA, or both. Thrombocytopenia, anorexia, nausea, vomiting, chronic hepatitis, weight loss, and recurrent infection are clinical manifestations of transfusion-related acute lung injury.
What type of transfusion reaction is characterized by rapid onset of dyspnea and hypoxia within 6 hours of transfusion? Hemolytic transfusion reactions Acute pain transfusion reaction (APTR) Transfusion-related acute lung injury (TRALI) Transfusion-associated graft-versus-host disease (TA-GVHD)
Transfusion-related acute lung injury (TRALI) Transfusion-related acute lung injuries (TRALI) are characterized by a rapid onset of dyspnea and hypoxia within 6 hours of the transfusion. This transfusion reaction occurs when donor blood contains antibodies against the recipient's neutrophil antigens, human leukocyte antigen, or both. Hemolytic transfusion reactions occur because of an ABO incompatibility. Apprehension, headache, chest pain, low back pain, tachycardia, and tachypnea are clinical manifestations of hemolytic transfusion reactions. Acute pain transfusion reactions (APTR) are manifested as severe chest pain, back pain, joint pain, hypertension, and redness of the head and neck. Transfusion-associated graft-versus-host disease (TA-GVHD) occurs when the donors T-cell lymphocytes attack host tissue. Thrombocytopenia, anorexia, nausea, vomiting, chronic hepatitis, weight loss, and recurrent infection are symptoms of transfusion-related acute lung injury.