Administration of Blood and Blood Products PN 3 November 2005

Donation and Deferrals

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 A If 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 B If 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 AB If 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 0 If 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 patient Types of Reactions: Hemolytic Allergic Febrile Bacterial 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