Administration of Blood and Blood ProductsPN 3 November 2005

Donation and Deferrals

• http://www.pbs.org/wnet/redgold/index.htm

• www.bloodservices.ca

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 AIf 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 BIf 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 ABIf 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 0If 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 patientTypes of Reactions:

HemolyticAllergic FebrileBacterial

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

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