Blood Transfusions & Blood

Products

R.Smith DNP, EdD(c), ACNP

Trauma Program Manager
St. Francis Medical Center
Procedure of Transfusion Therapy
• Physician’s order---written order
– component of the blood
– duration of the transfusion
– sequence in which to be transfused
– any pretransfusion medication

• Patient preparation
– informed consent (ED/Trauma Setting-Emergency
implied consent)
– baseline of the vital signs
Procedure of Transfusion Therapy (cont.)
• Equipment
– Cannula
– solution
– tubing and filter
– blood warmer

• Blood product(s)
• Preparation for administration
• Initiation of transfusion
• Monitoring the transfusion
• Discontinuation
Blood and Blood Products
• Whole Blood: No More, except direct donation-
military/conflict settings

• Packed RBCs: to replace RBCs, each unit will increase the Hgb level by
1g/dL, & hct by 2% to 3%
• Monitor via lab draw or Istat for decrease anemia symptoms, &
increase H&H
• Use blood warmer (Level I or Hotline), don’t place blood in a
microwave or under hot water!
Blood Warmers
• Level I : Warms fluids & is rapid infuser!
Blood Warmers
• Hotline: Warms fluids not rapid infuser!
Blood Products
• Platelets: used to treat thrombocytopenia &
platelet dysfxn, PLUG AREA OF INJURY
• Crossmatching is not required but is done
(platelets can contain a few RBCs)
• Volume of platelets can vary, check bag for
mls & document on I&O
Platelets
• Platelets: are administered immediately
after arrival from blood bank, given rapidly
over 15-30mins
• Evaluate response by increase in platelet
count, check count at 1hr, 18hrs, 24 hrs
Fresh Frozen Plasma
• Fresh Frozen Plasma: used to provide clotting
factors or volume expansion, contains NO
platelets
• FFP is infused within 2 hours of thawing, while
clotting factors are still viable, infuse a rapid as
possible
• Rh compatibility & ABO are required for
transfusion of plasma products
• Eval response by PT, PTT, coag studies &
resolution hypovolemia
Cryoprecipitate
• Cryoprecipitate: prepared from FFP, can be
stored for 1 yr, once thawed product must
be used
• Used to replace clotting factors, especially
VIII & fibrinogen-Replace FIBRIN
• DIC treatment too
Albumin
• Albumin: is prepared from plasma & can be
stored for 5 yrs
• Used to treat hypovolemic shock, or
hypoalbuminemia
• Albumin 25g/100ml is equal to 500ml of
plasma
MTP CRITERIA
• >10 UNITS OF BLOOD PRODUCTS WITHIN 24
HOURS
• MAINTAIN 1:1 RATIO OF PRODUCT AS POSSIBLE
• GET BEHIND? BLEEDING CAN OCCUR THINK
COAGULOPATHY
• GET CAUGHT UP ASAP!
• TXA ROLE??? SOON PCC (prothrombin
complex concentrate)
 Transfusion Reactions
• Hemolytic reactions
– acute
– delayed
• Nonhemolytic febrile reactions
• Allergic Reactions
• Circulatory overload
• Hypothermia
• Potassium toxicity
• Hypocalcemia
 Risk of Transfusion Therapy
• Fever, chills, urticaria 1:100
• Hemolytic transfusion reaction 1:11,000
• Fatal hemolytic reaction 1:150,000
• Viral hepatitis 1:30,000
• HIV infection 1:450,000
Interventions of Transfusion Reaction

• Terminate the transfusion immediately

• Maintain patency of IV with 0.9% NaCl
• Notify the physician and blood bank
• Implement other interventions
NCLEX Review ?
The nurse is told by a MD that a client in
hypovolemic shock will require plasma
expansion. The nurse anticipates receiving an
order to transfuse which product?
• 1. Albumin
• 2. Platelets
• 3. Cryoprecipitate
• 4. PRBCs
1
NCLEX Review ?
A client is brought to the ED having experienced blood loss
related to an arterial laceration. FFP is ordered &
tranfused to replace fluid and blood loss. The nurse
understands that the rationale for transfusing FFP in this
client is:
• 1. to treat the loss of platelets
• 2. to promote rapid volume expansion
• 3. that the tranfusion must be done slowly
• 4. that it will increase the hemoglobin and hemotocrit
levels
2
Any Questions?