Blood and Blood Products
Whole Blood
Contents
– RBC’s – WBC’s – Platelets – Plasma – Clotting factors
Whole Blood
Indications
– Acute loss of whole blood
Packed Cells
Contents
– RBC’s – 20% Plasma
Indications
– Replace O2 carrying capacity with less volume – Severe anemia, slow blood loss, CHF
Granulocytes
Contents
– WBC’s – 20% Plasma
Indications
– Life-threatening decreases in WBC count
Platelets
Contents
– Platelets – WBC’s – Plasma
Indications
– Low platelet counts
Plasma
Contents
– Clotting factors – Fibrinogen – Prothrombin – Albumin – Globulins
Plasma
Indications
– Clotting factor deficiency – Volume expansion
Plasma Protein Fraction
Contents
– 5% Albumin/Globin in saline
Indications
– Expand volume in burns – Hemorrhage – Hypoproteinemia
Albumin
Contents
– 5% or 25% albumin
Indications
– Replace volume in shock – Burns – Hypoproteinemia
Cryoprecipitate
Contents
– Factors VIII and XIII, Fibrinogen
Indications
– Hemophilia A – Fibrinogen deficiency – Factor XIII deficiency
Prothrombin
Contents
– Factors II, VII, IX, and X
Indications
– Hemophilia B – Liver disease
Blood Transfusion
Blood Transfusion
Blood must be typed prior to administration
Blood Transfusion
ABO Antigens
– A Antigen – B Antigens – A and B Antigens – No Antigens Type A Type B Type AB Type O
Blood Transfusions
Plasma Antibodies Agglutinate (Clump) Cells of other Types
Blood Transfusions
Type A = B Antibodies
– (Clumps B or AB)
Type B = A Antibodies
– (Clumps A or AB)
Blood Transfusions
Type AB = No Antibodies
– (Clumps Nothing)
Type O = A and B Antibodies
– (Clumps everything except O)
Blood Transfusions
O Negative = Universal Donor AB Positive = Universal Recipient
Blood Transfusions
Rh Factor
– 85% of Population »Rh Positive – 15% of Population »Rh Negative
Blood Transfusions
Rh Negative patients produce Rh antibodies only if exposed to Rh Positive blood
Blood Transfusions
Erythroblastosis Fetalis
– Rh Negative mother exposed to Rh Positive fetal blood during delivery – Mother produces Rh Antibodies – Antibodies cross placenta during subsequent pregnancy – Fetal blood hemolyses
Blood Transfusions
Erythroblastosis Fetalis
– Prevented by administration of Rhogam to mother
Transfusion Complications
Fever
Most common reaction Donor WBC incompatabilities Antipyretics
Allergic Reactions
Signs/Symptoms
– – – – – – – Itching Uticaria Chills Fever Facial edema Wheezing Anaphylactic shock
Allergic Reactions
Management
– Oxygen – IV fluids – Epinephrine – Antihistamines
Hemolytic Reaction
Signs/Symptoms
– – – – – – – – – Chills, fever Low back pain Headache Chest pain Dyspnea Cyanosis Restlessness, anxiety Hypotension Red urine
Hemolytic Reaction
Management
– Stop transfusion – Treat shock – Volume replacement – Mannitol
Volume Overload
Signs/Symptoms
– – – – – – Cough Chest pain Dyspnea Distended neck veins Rales Frothy sputum
Volume Overload
Management
– Slow infusion – Diuretics – Vasodilators
Transfusion Complications
Coagulation Disturbances
– Platelet/Clotting factor deterioration
Citrate Intoxication
– Hypocalcemia – Metabolic Alkalosis
Hyperkalemia
– RBC’s Lyse/Release K+
Transfusion Complications
Acid/Base Imbalances
– Banked blood gradually acidifies
Poor tissue Oxygenation
– Loss of 2,3 DPG
Transfusion Complications
Hypothermia
– Inadequate warming during transfusion
Viral Hepatitis
– Risk rises with each unit
Blood Transfusion
IV catheter 18g or larger No fluid other than saline
– D5W lyses RBC’s – LR contains calcium/triggers clotting
Two persons confirm ABO/Rh Blood filter in administration set
Blood Transfusion
Infusion pumps
– Excessive pressure can cause hemolysis
Rewarming above 380C can cause hemolysis Never add medications directly