ATI Textbook: Chapter 40 - Blood and Blood Product Transfusions

What do blood components include?

Blood components include packed RBCs, washed red blood cells (WBC-poor RBCs), white blood cells (WBCs), fresh frozen plasma, albumin, clotting factors, cryoprecipitate, and platelets.

What is blood based on?

Blood is typed based on the presence of antigens

What are the nursing interventions to a mild allergic transfusion reaction?

- Stop the transfusion. - Initiate an infusion of 0.9% sodium chloride using new tubing. - Administer an antihistamine, such as diphenhydramine. - If the provider prescribes to restart the transfusion, do so slowly.

What are the nursing interventions to acute hemolytic transfusion reactions?

- Stop the transfusion. - Remove the blood tubing from the IV access. Avoid infusing further blood products into the circulatory system. - Initiate an infusion of 0.9% sodium chloride using new tubing. - Monitor vital signs and fluid status. - Send the blood bag and administration set to the lab for testing.

Autologous transfusions

- The client's blood is collected in anticipation of future transfusions (elective surgery). - This blood is designated for and used only by the client. - Clients can donate up to 6 weeks prior to the scheduled surgery. - If the client's hemoglobin and hematocrit remain stable, donation can occur weekly until the desired amount of blood for the anticipated transfusion is collected.

What are the nursing interventions to febrile transfusion reactions?

- Use WBC filter for administration to catch the WBCs and prevent the reaction from occurring. - Stop the transfusion and administer antipyretics. - Initiate an infusion 0.9% sodium chloride using new tubing.

What should a nurse do for an older adult patient who is receiving blood transfusion?

- Assess vital signs every 15 min throughout the transfusion because changes in pulse, BP, and respiratory rate can indicate fluid overload, or can be the sole indicators of a transfusion reaction. - Older adult clients who have cardiac or renal dysfunction are at an increased risk of heart failure and fluid-volume excess when receiving a blood transfusion. - Administer the blood transfusion over 2 to 4 hr for older adult clients. Withhold administration of other IV fluids during blood product administration to prevent fluid overload. - Notify the provider immediately if indications of a reaction occur.

What are potential diagnoses (indications) for people that need blood transfusion?

- Excessive blood loss: packed RBCs. - Anemia (Hgb less than 6, or 6 to 10 g/dL, depending on findings): packed RBCs. - Kidney failure: packed RBCs. - Coagulation factor deficiencies such as hemophilia: fresh frozen plasma. - Thrombocytopenia/platelet dysfunction: platelets. - Hemophilia A: cryoprecipitate. - Burns, hypoproteinemia: albumin

What are the nursing actions for patients receiving blood or blood product transfusions?

- Explain the procedure to the client. - Assess vital signs and the client's temperature prior to transfusion. - Remain with the client during the initial 15 to 30 min of transfusion. Most severe reactions occur within this time frame. - Review laboratory values to ensure the patient requires transfusion and to compare to post-transfusion values. - Verify the prescription for a specific blood product. - Obtain consent for procedure if required. - Obtain blood samples for compatibility determination, such as type and cross-match. - Assess for history of blood-transfusion reactions. - Initiate large-bore IV access. An 18- or 20- gauge needle is standard for administering blood products. - Obtain blood products from the blood bank. Inspect the blood for discoloration, excessive bubbles, or cloudiness. - Prior to infusion, two RNs (or an RN and a PN, depending on facility policy) must identify the correct blood product and patient by looking at the hospital identification number (noted on the blood product) and the number identified on the patient's identification band to make sure the numbers match. - The nurse completing the blood product verification must be one of the nurses who administers the blood product. - Prime the blood administration set with 0.9% sodium chloride only. Never add medications to blood products. Y-tubing with a filter is used to transfuse blood. - Begin the transfusion, and use a blood warmer if indicated. Initiate the transfusion within 30 min of obtaining the blood product to reduce the risk of bacterial growth.

What are the nursing considerations for white blood cell transfusion (granulocyte)?

- Immunocompromised clients rarely receive WBC transfusions because of the risk for severe reaction. - If the client is receiving amphotericin B antibiotics, 4 to 6 hr should be between the administration of the antibiotic and the WBC transfusion because amphotericin B can hemolyze the WBCs.

What are the nursing actions of washed RBCs (WBC-poor packed RBCs)?

- Infuse a unit of 200 mL over 2 to 4 hr. - Administer to a client who has a history of transfusion reactions or to a client who has had a hematopoietic stem cell transplant.

What are nursing actions for giving blood transfusions to older adult clients?

- No larger than a 19-gauge needle is used. - Assess kidney function, fluid status, and circulation prior to blood product administration. Older adult clients are at an increased risk for fluid overload. - Use blood products that are less than 1 week old. - Explain to the client the reason for the blood transfusion.

What are the nursing actions after patients receive blood transfusions (postprocedure)?

- Obtain vital signs upon completion of the tranfusion. - Dispose of the blood-administration set according to facility policy. - Complete paperwork, and file in the appropriate places. - Document the patient's response.

What are the considerations for plasma transfusion?

- Plasma is frozen immediately following donation and is then in the form of fresh frozen plasma (FFP). - FFP is transfused as soon as the unit is thawed while clotting factors are still active. - The client can react to the FFP transfusion if the ABO compatibility is not matched.

What are nursing actions for platelet transfusion?

- Platelets are fragile and must be immediately infused once brought to the client's room, and given over 15 to 30 min using a special transfusion set with a small filter and short tubing. - Vital signs are taken before the infusion, 15 min after the infusion starts, and upon completion.

What are the expected findings of allergic transfusion reaction?

- Results from a sensitivity reaction to a component of the transfused blood products. - Findings are usually mild and include itching, uticaria, and flushing. - The client can develop an anaphylactic transfusion reaction resulting in bronchospasm, laryngeal edema, hypotension, and shock.

What are the expected findings of acute hemolytic transfusion reactions?

- Results from a transfusion of blood products that are incompatible with the client's blood type or Rh factor. Can occur following the transfusion of as few as 10 mL of a blood product. - Can be mild or life-threatening, resulting in disseminated intravascular coagulation (DIC) or circulatory collapse. - Findings include chills, fever, low-back pain, tachycardia, flushing, hypotension, chest tightening or pain, tachypnea, nausea, anxiety, hemoglobinuria, and an impending sense of doom.

What are the expected findings of bacterial transfusion reaction?

- Results from a transfusion of contaminated blood products. - Findings include wheezing, dyspnea, chest tightness, cyanosis, hypotension, and shock.

What are the expected findings of circulatory overload?

- Results from a transfusion rate that is too rapid for the patient. Older adult patients or those who have a preexisting increased circulatory volume are at an increased risk. - Findings include crackles, dyspnea, cough, anxiety, jugular vein distention, and tachycardia. Manifestations can progress to pulmonary edema.

What are the expected findings of febrile transfusion reactions?

- Results from the development of anti-WBC antibodies. Can be seen when the client has received multiple transfusions. - Findings include chills, increase 1 F (0.5 C) or greater from the pretransfusion temperature, flushing hypotension, and tachycardia.

What are nursing interventions to circulatory overload?

- Slow or stop the transfusion depending on the severity of manifestations. - Position the patient upright with feet lower than the level of the heart. - Administer oxygen, diuretics, and morphine as prescribed.

Intraoperative blood salvage

- Sterile blood lost during a procedure is saved or retrieved into a device that filters and drains the blood into a bag for transfusion intraoperatively or postoperatively. - Reinfusion must occur within 6 hr of salvaged blood collection.

What are the nursing interventions to bacterial infusion reactions?

- Stop the transfusion. - Administer antibiotics and an IV infusion of 0.9% sodium chloride using new tubing. - Send a blood culture specimen to the lab for analysis.

What are the nursing interventions to an anaphylactic reaction?

- Stop the transfusion. - Administer epinephrine, corticosteroids, vasopressors, oxygen, or CPR if indicated. - Remove the blood tubing from the patient's IV access. - Initiate an infusion of 0.9% sodium chloride using new tubing.

What is the onset of circulatory overload?

Can occur any time during the transfusion.

What is the onset of febrile transfusion reaction?

Commonly occurs within 2 hr of starting the transfusion.

What is the onset of allergic transfusion reaction?

During or up to 24 hr after transfusion.

What is the onset of bacterial transfusion reaction?

During or up to several hours after transfusion.

What is the onset of acute hemolytic transfusion reaction?

Immediate or can manifest during subsequent transfusions.

What is a major concern when administering blood or blood products?

Incompatibility is a major concern when administering blood or blood products. Preventing incompatibility requires strict adherence to blood transfusion protocols.

What are the nursing actions of white blood cell transfusion (granulocyte)?

Infuse WBCs suspended in 400 mL plasma over 45 to 60 min and vital signs are taken every 15 min. The presence of the provider may be required according to agency policy.

What are nursing actions for plasma transfusion?

Infuse the unit of 200 mL of FFP rapidly over 30 to 60 min through a regular Y-set or straight filtered tubing.

Why do patients receive transfusions of whole blood or components of whole blood for replacement?

Patients can receive transfusions of whole blood or components of whole blood for replacement due to blood loss or blood disease.

What is the Rh factor?

Patients who are Rh-negative are born without the Rh antigen in their RBCs. As a result, they do not develop antibodies unless sensitization occurs. Once this occurs, any transfusion with Rh-positive blood will cause a reaction.

What blood products are typed for ABO compatibility but not cross-matched for antigens?

Plasma products are typed for ABO compatibility but not cross-matched for antigens. The other cells (WBCs, platelets) in the plasma products can carry ABO antigens.

What are considerations for platelet transfusion?

Platelets do not need to match the client blood type. Platelet infusion bags contain 200 to 300 mL.

What are the main nursing actions during blood transfusions (intraprocedure)?

Remain with the client for the first 15 to 30 min of the infusion (reactions occur most often during the first 15 min) and monitor vital signs and rate of infusion per facility policy.

Standard donation

Transfusion from compatible donor blood.

What is necessary for packed red blood cells?

Type and cross match is necessary for packed red blood cells. Blood products containing RBCs are typed and cross-matched for antigens.