Blood transfusionpresentation

by Dr elhadi

1. Blood Transfusions By Christina Baier , Crystal Davidson, Dayna Legge, Christine Leblond , Jessica Luckett , and McKenzie Quevillion

2. Overview What is a blood transfusion? Purpose Indications Blood products Nursing implications Administering a blood transfusion (skill)

3. What is a Blood Transfusion? Administration of blood or one of its components through an intravenous line (IV) Reaches patient’s blood vessels and enters the circulatory system

4. Purpose of a Blood Transfusion R estore blood volume Replace clotting factors Improve oxygen carrying capacity Restore blood elements that are depleted Prevent complications

5. Question What would indicate the need for a blood transfusion?

6. Lab Tests Lab Test Normal Results Why is this ordered? Type and crossmatch Based on ABO system Positive = incompatibility Negative = probable compatibility To determine the primary blood group, screen for antibodies and determine donor-recipient compatibility. Hbg (hemoglobin ) Male 140-175 g/L Female 123-153 g/L Critical Value: Male <130 g/L Female < 110 g/L Hbg carries oxy gen in the blood. It can decrease due to blood loss. Hct ( hematocrit ) Male 41.5%-50.4% Female 25.9%-44.6% Critical Value: < 18% or >54 % Hct measures the proportion of blood volume occupied by RBCs. It decreases with blood loss and anemia. Platelet count 150,000-400000 cells/ uL Critical Value: <50,000 cells/ uL Platelets initiate the coagulation process. A decreased amount increases the risk for hemorrhage.

7. Whole Blood Composition: Red Blood Cells White Blood Cells Plasma Platelets Hematocrit Clotting Factors Purpose: Volume replacement Increase oxygen-carrying capacity Indications: Significant blood loss (>25% blood lost, i.e. hemorrhage) Newborn babies with hemolytic disease

8. Packed Red Blood Cells (RBCs) Composition: RBCs with little plasma ( hematocrit about 75%) Some platelets and WBCs remain Purpose: Increase RBC mass and oxygen-carrying capacity Assists the body to rid carbon dioxide and other waste products Indications: Symptomatic and chronic anemia Blood loss due to injury or surgery

9. Platelets Composition: Platelets Plasma RBCs WBCs Purpose: Helps to stop bleeding (restore clotting ability) Essential for coagulation of blood Indications: Decreased platelet count Hemophilia Thrombocytopenia Platelet dysfunction (End stage renal disease, DIC)

10. White Blood Cells (WBCs) Composition: WBCs or leukocytes suspended in 20% of the plasma Purpose: Increase number of WBC’s Replaces WBC’s that are functioning abnormally Indications: Sepsis (not responsive to antibiotics) Persistent fever Granulocytopenia

11. Fresh Frozen Plasma Composition: Plasma All coagulation factors Purpose: Increase blood plasma Replenish clotting factors Indications: Bleeding in patients with coagulation factor deficiencies; plasmapheresis Burn Liver Failure Severe Infection

12. Albumin Composition: Albumin Purpose: Volume expansion leading to increased blood volume Indications: Hypoproteinemia Burns Shock Trauma Surgery Infections

13. Nursing Implications Before transfusion: Check physician’s orders Review hospital policy Ensure informed and written consent is provided Check laboratory values Understand the indications and rationale Verification procedure occurs with two nurses

14. Nursing Implications Con’t Before transfusion ( con’t ): Compatibility of blood type and Rh factor Inspect the blood product for discolouration, clots, leaking, or presence of bubbles Check the unit number on the unit of blood and on the form Check the expiration date and time on unit of blood Ask client to state first and last name Check patient’s identification number on wristband and record

15. Nursing Implications Con’t During the transfusion: Monitor vital signs closely during the blood transfusion Inspect condition of IV site Observe for signs and symptoms of a reaction

16. Nursing Implications Con’t After the transfusion: Dispose of materials/equipment Observe patient for clinical improvements Assess the laboratory values for effectiveness of transfusion

17. Documentation Verification procedure Type of blood Amount administered Vital signs Patient’s response to therapy

18. Mechanism Onset Signs and Symptoms ABO, Rh incompatibility 5-15 minutes following initiation of blood transfusion Increased temperature, increased heart rate, heat and pain surrounding vein, chills, headache, nausea, chest or back pain, chest tightness, dyspnea , bronchospasm , hypotension, anxiety, vascular collapse, hemoglobinemia , hemoglobinuria , disseminated intravascular coagulation Acute haemolytic reaction

19. Delayed haemolytic reaction Mechanism Onset Signs and Symptoms Immune response against non-ABO donor antigens 2-14 days Fever, decrease in Hgb / Hct , increased bilirubin levels, jaundice

20. Febrile, nonhaemolytic reaction Mechanism Onset Signs and Symptoms Sensitivity to leukocytes or platelets in donor’s blood 30 minutes after initiation to 6 hours after completion of transfusion Fever, flushing, chills, headache, muscle pain

21. Allergic reaction Mechanism Onset Signs and Symptoms Allergy to a plasma protein or antigen in donor’s blood 5-15 minutes following initiation of blood transfusion, up to 1 hour after Local erythema , gives, urticaria , pruritus , coughing, nausea, vomiting, respiratory distress, wheezing, hypotension, loss of consciousness, cardiac arrest

22. Graft-versus-host disease Mechanism Onset Signs and Symptoms Attack of transfused lymphocytes on host lymphocytes Days to weeks Skin rash, fever, jaundice, liver dysfunction, bone marrow suppression

23. Circulatory overload Mechanism Onset Signs and Symptoms Transfused at an excessive volume or rate Any time during or within 1-2 hours after transfusion Dyspnea , cough, crackles, tachypnea , headache, hypertension, tachycardia, increased central venous pressure, distended neck veins

24. Sepsis Mechanism Onset Signs and Symptoms Bacterial contamination During transfusion to 2 hours after transfusion Fever, chills, abdominal cramping, vomiting, diarrhea , hypotension

25. Lab Tests Lab Test Normal Results Why is this ordered? Antiglobulin (DAT ) Negative Direct use is for post transfusion work-up to detect RBC incompatibility. Positive result = hemolytic transfusion reaction. Bilirubin Indirect: 0.1-1.0 mg/dL An elevated indirect value may indicate ABO incompatibility. Urinary Hemosiderin Negative Used to measure hemoglobin in urine resulting from intravascular hemolysis . Positive reaction = blood transfusion reaction. CBC (Complete Blood Count ) WBC 4.8-10.8 x10 9/L RBC 4.2-5.4x10 12/L HGB 120-160G/L HCT 0.370-0.470 MCV 78-98 FL MCH 25-24 PG MCHC 320-360 G/L RDW 0.110-0.150 Platelets 130-400 x10 MPV 7.0-11.0 FL Lymphocyte 0.15-0.41 x10 Neutrophil 0.6-0.7 x10 Monocyte 0.06-0.41 x10 Esoinophil 0-0.04 x10 Basophil 0-0.2 x10 Luc 0-0.4 x10 9/L To assess cellular characteristics of blood cells in response to transfusion i.e. ABO compatibility through  WBC.

26. Nursing Implications in a Reaction Stop transfusion Remove tubing that contains blood product Infuse with 0.9% normal saline Monitor vital signs Notify physician Notify blood bank and return blood component Administer medication depending on type of reaction Epinephrine, antihistamines, antibiotics, antipyretics, analgesics, diuretics, corticosteroids

27. Nursing Skill: Administering a Blood Transfusion

28. Questions?

29. References Bare, B., Smeltzer , S. C., Williams, B., Paul, P., & Day, R. A. (2004). Medical-surgical nursing (10th Ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Be Transfusion Smart. (2010). Screening and diagnosis . Retrieved from http://www.betransfusionsmart.com/patient/screening_diagnosis.jsp?site=PU019478&source=01030&irmasrc=EXJWB0221&usertrack.filter_applied=true&NovaId=4029461999768351678 Blood Book. (2005). Common blood products. Retrieved from http://www.bloodbook.com/products.html#Whole%20Blood Brundage , S., Curet , M., Dicker, R., Greco, R., Gregg, D., Morton, J., Nguyen, T., Norton, J., Shelton, A., Spain, D., Tavana , L., & Welton , M. (2004). Blood transfusion protocol at Stanford surgery ICU. Retrieved from www.scalpel.stanford.edu/ICU/.../Transfusion%20Medicine%20TICU.ppt Cincinnati Children’s Association. d(2010). Hematology and blood tests and procedures. Retrieved from http://www.cincinnatichildrens.org/health/info/blood/procedure/components.htm Day, R. A., Paul, P., Williams, B., Smeltzer , S. C., & Bare, B. (2007). Brunner and Suddarth’s textbook of medical-surgical nursing (1st Canadian Ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Malarkey, L., & McMorrow , M. (2005). Nursing guide to laboratory and diagnostic tests . St. Louis, MI: Elsevier Saunders. National Heart Lung and Blood Institute. ( n.d ). Types of blood transfusions. Retrieved from http://www.nhlbi.nih.gov/health/dci/Diseases/bt/bt_types.html North Bay General Hospital. (2006). Nursing practice manual: Transfusion, blood and blood products (Policy No. NP 1-90). Perry, A.G., & Potter, P. A. (2006). Clinical nursing skills & techniques (6th Ed.). St. Louis, MI: Mosby, Inc. Watson, D., & Hearnshaw , K. (2010). Understanding blood groups and transfusion in nursing practice. Nursing Standard, 24 (30), 41-48.