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ADMINISTRATION
Bruno Talerico MSN, RN
Objectives
Discuss indications for transfusion
Identify ABO and Rh blood groups
Discuss common blood products in critical care setting and
their uses
Identify correct procedure for blood transfusion
Discuss risks associated with blood transfusions
Discuss S/S and management of acute transfusion
reactions
History of Transfusions
Blood Therapy
Indications
Significant hypovolemia due to acute blood loss
Symptomatic anemia
Decreasing hemoglobin
Decreasing hematocrit
To increase oxygen carrying ability
Decreased clotting factors
Blood Typing
Type O
Rh Factor
Rh positive
Possess D antigen
Rh negative
Possess no D antigen
Rh negative patients may develop antibodies to D
antigens with exposures to Rh positive blood
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A-, O- blood
A+ blood
B- blood
B-, O- blood
B+ blood
AB- blood
AB-, Oblood
AB+ blood
O- blood
O- blood
O+ blood
O-, O+ blood
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Cross Match
Indications
Specific blood for specific patient
Procedure
Incubate donor cells with recipient serum
If incompatible, RBCs will agglutinate
Coombs test
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Indications
Increases Hgb/Hct while minimizing volume increases
Promotes oxygen delivery in patients who are actively
bleeding
Symptomatic anemia unresponsive to conservative
management
Shelf-life 21-42 days
Transfusion based on clinical status of patient
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Blood
Products
cont
Indications
correction of coagulopathies
supplying deficient plasma proteins
PT (>17-18 sec) and PTT (>55-60 sec)
Cross-matching not required but donor/recipient must be
ABO/Rh compatible
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Platelets
Indications
Platelet counts 40-50,000 before invasive
procedure/surgery
Post-surgical counts of 50-90,000
Expires 5-7 days after collection
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Cryoprecipitate
Indications
Hemo A, von Willebrands dz, factor VIII
deficiency
Fibrinogen levels < 150mg/dL
May be frozen for one year
Only good 4 hours after thawing
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Albumin
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Blood Administration
Equipment needed
Patient Consent
Physicians order
Blood typed and cross matched
Venous access (20G or larger)
Filtered administration set
0.9% NS
Thermometer
BP Cuf
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Transfusion Procedure
Preparation of patient
Confirm order for blood
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Transfusion Procedure
Preparation of blood
Check blood for
Right patient
Right blood product
Right type
Expiration date
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Transfusion Precautions
Do not mix blood with
D5W - causes hemolysis
LR - causes clotting
Medications - may react
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Transfusion Procedure
Procedure
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Transfusion Rate
Procedure
Initially @ rate of 1 ml/min
Evaluate for hemolytic reaction
Monitor vital signs q 15 minutes
After 30 minutes, adjust flow rate
Evaluate for hemolytic reaction
Monitor vital signs q 30 minutes
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Transfusion Rate
Whole blood
2-3 hours
No more than 4 hours
30-60 min
Less than 2 hours
1- 2 ml/min
Use w/i 6hours of thawing
Platelets
Cryoprecipitate
30- 60 minutes
Less than 2 hours
Albumin
5% 1-2ml/min
25% 0.2-0.4ml/min
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Transfusion Reactions
Hemolytic Reaction
Chills/shaking
Fever
Pain
N/V
Chest tightness
Red/black urine
H/A
Flank pain
Shock/renal failure/DIC
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Transfusion Reactions
Bacterial Sepsis
Rigors/chills
Fever
Shock
Febrile Reactions
Fever
Chills
Allergic Reactions
Urticaria
Flushing
Asthmatic wheezing
Laryngeal edema
Hypothermia
Chills
Low temperature
Irregular heartrate
Possible cardiac arrest
Circulatory Overload
Dyspnea
Rhales
Cyanosis
Dry cough
Distended neck veins
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Transfusion Reaction
Treatment
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Transfusion Reaction
Treatment
Medications
Benadryl
Epinephrine
Tylenol
Lasix
Notify physician
Treat for signs and symptoms of shock
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Documentation
Record
Baseline vital signs
Time transfusion started
Transfusion flow rate
Patients response and ongoing vital signs
Time transfusion ended
Pertinent observations and clinical manifestations
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Trends in Blood
Administration
TRICC Trials, 1999
Lower transfusion thresholds
NIH: Hg 7g/dL
American College of Physicians: Hgb 7-10g/dL
American Society of Anesthesiologists: Hgb 7g/dL
American College of Pathologists: Hgb 5-8g/dL
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Transfusion Risks
Infection
Transfusion-related Graft-versus-host disease
Transfusion Related Immunosuppression
T killer cell activity/macrophage antigen presentation
Transfusion Related Acute Lung Injury (TRALI)
Leading cause of transfusion related mortality in 2003
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TRALI: Definition
Bilateral patchy infiltrates on CXR
No evidence of left atrial hypertension
Hypoxemia with a P/F ratio <300
Onset of symptoms that occur 2-6 hours post-transfusion
Carries 5-13% mortality
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TRALI
Occurs with all plasma-containing blood and blood
components
PRBC
Whole Blood
Random donor platelets
Apheresed platelets
Cryoprecipitate
Granulocytes
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TRALI: Etiology?
Two proposed reasons for vascular permeability:
Leukocyte specific antibodies
Biologically active substances
Two Hit Hypotheses:
1st condition: primed neutrophils exist first (surgery,
inflammation, infection)
2nd condition: transfusion of either leukocyte specific
antibodies to recipient or from donor
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TRALI
Symptoms/Treatment?
Usually self-limiting
Mild-severe
Dyspnea
Hypotension
Cyanosis
Hypoxia
Tachycardia
Mechanical ventilation
Hemodynamic support
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Any Questions?????
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Case
Study
Two units of packed RBCs, one unit of single donor platelets, and four
units of FFP are ordered for an immunocompromised client who is
actively bleeding. The client's hematocrit is 24%, and he is
bleeding from his nose and upper gastrointestinal tract.
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Blood Administration
Any Questions???
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References
American Association of Blood Banks.(2004). Primer for blood
administration.
Archives of Surgery 2002; 137: 711-717
Annals of Thoracic Surgery 2002; 73: 138-142.
Hebert, PC, Wells, G, Blajchman, MA, et al (1999) A multicenter,
randomized, controlled clinical trial of transfusion requirements in
critical care. N Engl J Med 340,409-417[
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