Nursing Assignment:
Mary Vanderhoef MSN, ARNP
Revised by Octavia Mercado, BSN, RN, CCRN
SEPT 2015
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- Blood transfusion is the process of transferring blood or blood-based products from one person to another
- Can be life saving as in massive blood loss due to trauma
- Treatment for severe anemia
- Thrombocytopenia
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- First fully documented human blood transfusion by Dr. Jean-Baptiste Denis, physician to King Louis XIV of France in 1667.
- Transfusion of blood from a sheep into a 15 year old boy that survived
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- Dr. James Blundell, British Obstetrician, performed the first successful blood transfusion of human blood in 1818 for treatment of post partum hemorrhage.
- Used the blood of the patient’s husband and directly infused into the patient.
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- In the 1910’s it was discovered that by adding anticoagualnt and refrigerating the blood, it was possible to store the blood for several days..
- First non-direct transfusion was performed in 1914
Dr. Luis Agote (2nd from right) overseeing one of the first safe and effective blood transfusions in 1914
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- In the 1930’s and 1940’s Dr Charles Drew’s research led to discovery that blood could be separated into plasma and red blood cells.
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Indications for blood transfusion
- ANEMIA: A decrease in red blood cells (rbc’s) secondary to blood loss or deficient production
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- Normal Hgb Levels
- Males: 14-18 g/dl
- Females 12-16 g /dl
- Hematocrit is the proportion of rbc’s in total volume of blood
- Males: 40-54%
- Females 38-48%
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- Transfusions are generally ordered when Hgb 8 g/dl or less
- OR
- If patient is symptomatic
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- Effects of Anemia and decreased O2 delivery:
- Tachycardia, dyspnea, palpitations, fatigue, weakness, light headedness
- If severe, anemia could lead to:
- CVA, or MI secondary to decreased perfusion to heart and brain
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- Causes of Anemia
- Sudden blood loss
- Chronic bleeding
- Phlebotomy in critically ill patients (increases with blood draws 3 x greater in ICU patients)
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- Whole Blood
- Packed Red Blood Cells (prbc’s)
- Platelets
- Fresh Frozen Plasma (FFP)
- Cryoprecipitate
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- Rarely used in the US
- Restores fluid volume and circulation
- Contains rbc’s, wbc’s plasma and platelets
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- Most common transfusion
- Restores blood’s ability to carry O2
- Contains few platelets and wbc’s
- Generally 250- 350 mls per unit
- Transfuse over 2-4 hours: based on pts need to receive blood and pts other issues
- Shorter transfusion time: symptomatic
- Longer transfusion time: CHF, ESRD
- Increases the Hgb 1 g/Hct 3-4 %
- Shelf life 42 days
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- Platelets are thrombocytes
- Restores clotting ability
- Usual dose is 5-10 units
- OK for rapid transfusion (1 unit over 10 min)
- Increases platelet count by 5000 per one unit
- 4-5 day shelf life
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- Unconcentrated source of all clotting factors and proteins from a single unit of blood (contains albumin, fibrinogen, and antibodies)
- Treats bleeding caused by factor deficiencies and for Liver failure, DIC, and reversal of coumadin/warfarin therapy
- Is frozen and can be stored for up to 1 year
- Notify blood bank 30 minutes prior to when needed in order for them to thaw the FFP
- After thawing by blood blank must infuse within 6 hours
- Generally 250-300 ml per unit ordered
- OK for rapid transfusion (1 unit over 10 min)
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- Concentrate of 4 clotting factors from FFP. Usually used for patients with specific bleeding disorders sucha as hemophilia, von Willibrands disease.
- Storage and usage same as for FFP
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- A+
- B+
- AB+
- O+
- A-
- B-
- AB-
- 0-
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- Universal Donor O- (only 6.6% of the population)
- Universal Recipient AB+
- Most prevalent blood type O+ (37% of the population)
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http://www.thebloodcenter.org/donor/BloodFacts.aspx
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- Rh typing Looks at 8 different genes
- Rh present (positive)
- Rh absent (negative)
- Typing is done to prevent complications from giving incompatible blood
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- If transfusion reaction suspected
- STOP the transfusion
- Notify Physician
- Give supportive treatment (per orders/protocol):
- Normal saline fluids
- Antipyretics
- antihistamines
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- Viral is the most common transfusion-transmitted infection
- Hepatitis B
- Hepatitis C
- HIV (most feared)
- Long period for seroconversion (25-45 days)
- CMV which belongs to the herpes group (transmitted by whole blood and rbc’s)
- Can cause immunosuppression leading to risk of pneumonia, gastroenteritis, and hepatitis particularly in the critically ill
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- Stored units can become contaminated with bacteria and cause infection to recipient
- Mortaility rate from bacteremia = 50%
- Causes:
- Inadequate skin prep at phlebotomy site, small leaks in blood containers, contaminated containers, asymptomatic bacteremia at time of donation
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- Whole Blood ~ 35 days
- PRBC’s ~ 42 days (after this there is a decline in the quality with an increase in inflammatory mediator release)
- Can be frozen up to 10 years
- WBC’s ~ <42 days (after this wbc’s begin to die and release toxic cell enzymes)
- Platelets 5 days
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- Autologous
- Allogenic/Homologous
- Cell Saver
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- Safest
- Giving pt their own blood
- Can donate 72 hours before the scheduled surgery
- Limiting factors:
- Hgb < 12.5 g/dl
- Age < 17
- Weight < 110 lbs (50kg)
- No chronic health problems
- Tatoos/body piercing < 1 year
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- All other donated blood, other than the patients own blood.
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- Collects, Washes and spins blood that has been suctioned from patient during surgery
- Debris and hemolytic by products removed
- Reinfused into patient
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- Malignancy
- Sepsis
- Enteric contamination
- Coagulopathy
- Pulmonary infection
- Impaired renal function
- Excessive hemolysis
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- HIV – 1: 2 million
- Hepatitis B - 1: 200,000
- Hepatitis C – 1: 1-2 million
- Creuzfeldt-Jacob disease – very rare
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Blood Reaction Signs and Symptoms
Allergic reaction
Rash, hives (urticaria), pruitus, laryngeal edema, hypotension,
anaphylactic shock
Febrile non-hemolytic
reaction
Chills, fever increase of >1�˸ଉ C or >2�˸ଉ F, nausea, vomiting, back or
leg pain, dyspnea
Hemolytic transfusion
reaction
Anxiety, chills, fever, back pain, shock, dyspnea, abnormal bleeding,
red or dark brown urine (hemoglobinuria)
Transfusion associated
circulatory overload
(TACO
Coughing, cyanosis, difficulty in breathing, rapid incr ease in systolic
blood pressure
Transfusion –
associated sepsis
severe rigors, high fever > 40�˸ଉ C, shock, hemoglobinuria, DIC, renal
failure
Transfusion – related
acute lung injury
(TRALI)
Coughing, cyanosis, difficulty in breathing