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ECG Abbreviations and glossary

AF atrial Iibrillation
A-FLUT atrial Ilutter
ASD atrial septal deIect
ASYS asystole
AT atrial tachycardia
AV atrioventricular
AVB atrioventricular block
AVNRT av nodal re-entry tachycardia
CHB complete heart block
Concordance: When T waves deIlect in the same direction as the terminal portion oI the QRS
complex in bundle branch blocks. This usually represents an abnormal route oI repolarization.
Coupling Interval: The interval between a normal sinus beat and the Iollowing premature beat
ECG electrocardiogram
EF ejection Iraction
EKG electrokardiogram
EMD electromechanical dissociation
ES extrasystole
HRV heart rate variability
HZ hertz
ILBBB incomplete leIt bundle branch block
IRBBB incomplete right bundle branch block
LAA leIt atrial abnormality
LAD leIt axis deviation
LAFB leIt anterior Iascicular block
LAH leIt anterior hemiblock
LBBB leIt bundle branch block
LPFP leIt posterior Iascicular block
LPH leIt Posterior Hemiblock
LVH leIt ventricular hypertrophy
MAT multiIocal atrial tachycardia
MI myocardial inIarction
MM millimetre
MV millivolt
NSR normal sinus rhythm
NSTEMI non st elevation myocardial inIarction
PAC premature atrial contraction
PAF paroxysmal atrial Iibrillation
PEA pulseless electrical activity
PRWP poor r wave progression
PVC premature ventricular contraction
QTc corrected QT interval (QTc QT \RR)
RAA right atrial abnormality
RAD right axis deviation
RBBB right bundle branch block
RVH right ventricicle hypertrophy
SA sinoatrial
SB sinus bradycardia
ST sinus tachycardia
STEMI st elevation myocardial inIarction
SVES supraventricular extra systole
SVT supraventricular tachycardia
TNT troponin t
TP torsades des pointes
V volts
VPB ventricular premature beat
VES ventricular extra systole
VF ventricular Iibrillation
VT ventricular tachycardia
WPW wolII-parkinson white syndrome

2,3-DPG 2,3-dishospyhoglycerate
AABB American Association of Blood Banks
ACT Activated Clotting Time
ADH Antidiuretic Hormone
AHG Antihuman Globulin
AHTR Acute Hemolytic Transfusion Reaction (also HTR)
AIDS Acquired mmune Deficiency Syndrome
ALT Alanine Aminotransferase
ANA Antinuclear Antibody
ANH Acute Normovolemic Hemodilution
,39-HBc Antibody to Hepatitis B Core Antigen
,39-HCV Antibody to Hepatitis C Virus
Antibody to Human T-cell Lymphotropic Virus type /
,PPT Activated Partial Thromboplastin Time
ARDS Acute Respiratory Distress Syndrome
AST Aspartate Transaminase
ATIII Antithrombin
CHD Coronary Heart Disease
CJD Creutzfeldt-Jakob Disease (see 3;CJD)
CMV Cytomegalovirus
CPD Citrate, Phosphate, Dextrose (solution)
CPDA-1 Citrate, Phosphate, Dextrose-Adenine (solution)
C/T Crossmatch-to-Transfusion ratio (C:T)
DDAVP -Desamino-8-D-Arginine Vasopressin (desmopressin)
DIC Disseminated ntravascular Coagulopathy
EACA Epsilon-Aminocaproic Acid
DA ood and Drug Administration
P resh rozen Plasma
NHTR ebrile Nonhemolytic Transfusion Reaction
GGTP Gamma Glutamyl Transferase (GGT)
GHVD Graft-Versus-Host Disease
HAM HTLV--Associated Myelopathy
HBOC Hemoglobin-Based Oxygen Carrier
HBsAg Hepatitis B Surface Antigen
HB Hemoglobin
HCT Hematocrit
HBV Hepatitis B Virus
HCV Hepatitis C Virus
HDN Hemolytic Disease of the Newborn
HES Hydroxyethyl Starch
HH Hemochromatosis
HIV Human mmunodeficiency Virus
HLA Human Leukocyte Antigen
HTLV-I/II Human T-cell Lymphotropic Virus type /
HTR Hemolytic Transfusion Reaction (also AHTR)
IAD ntraoperative Autologous Donation
IG mpaired asting Glucose
IgA mmunoglobulin A
ITP diopathic Thrombocytopenic Purpura
LD Lactate Dehydrognase
MAC Mycobacterium Avium Complex
MCH Mean Corpuscular Hemoglobin
MCHC Mean Corpuscular Hemoglobin Concentrate
MCV Mean Corpuscular Volume
2g/dL milligrams per deciliter
MPV Mean Platelet Volume
NAT Nucleic Acid Amplification Testing
3;CJD New Variation Creutzfeldt-Jakob Disease (3CJD)
PABD Preoperative Autologous Blood Donation
PAT Preoperative Autologous Blood Transfusion
PC Perflurochemical(s)
PLTs Platlets
PMNs Polymorphonuclear Leukocytes
PP Purified Protein raction
PRP Platelet-Rich Plasma
PT Prothrombin Time
PTP Posttransfusion Purpura
PTT Partial Thromboplastin Time
"-T from QRS complex to end of T wave (interval)
RBCs Red Blood Cells
Rh Rhesus actor
STS Serological Test for Syphilis
T&S Type and Screen
TA-GVHD Transfusion-Associated Graft-Versus-Host Disease
TEG Thromboelastograph
TRALI Transfusion-Related Acute Lung njury
TSH Thyroid Stimulating Hormone
TSP Tropical Spastic Paraparesis
TSE Transmissible Spongiform Encephalopathies
TTP Thrombotic Thrombocytopenic Purpura
TTTS Twin to Twin Transfusion Syndrome
TXA Transexamic Acid
BCs hite Blood Cells
;d von illebrand's Disease
;1 von illebrand's actor

Wbat Is a Blood Transfusion?
A blood transIusion is a saIe, common procedure in which blood is given to you through an
intravenous (IV) line in one oI your blood vessels.
Blood transIusions are done to replace blood lost during surgery or due to a serious injury. A
transIusion also may be done iI your body can't make blood properly because oI an illness.
During a blood transIusion, a small needle is used to insert an IV line into one oI your blood
vessels. Through this line, you receive healthy blood. The procedure usually takes 1 to 4 hours,
depending on how much blood you need.
Blood transIusions are very common. Each year, almost 5 million Americans need a blood
transIusion. Most blood transIusions go well. Mild complications can occur. Very rarely, serious
problems develop.
25ortant nfor2ation About Blood
The heart pumps blood through a network oI arteries and veins throughout the body. Blood has
many vital jobs. It carries oxygen and other nutrients to your body's organs and tissues. Having a
healthy supply oI blood is important to your overall health.
Blood is made up oI various parts, including red blood cells, white blood cells, platelets
(PLATE-lets), and plasma. Blood is transIused either as whole blood (with all its parts) or, more
oIten, as individual parts.
Blood Types
Every person has one oI the Iollowing blood types: A, B, AB, or O. Also, every person's blood is
either Rh-positive or Rh-negative. So, iI you have type A blood, it's either A positive or A
The blood used in a transIusion must work with your blood type. II it doesn't, antibodies
(proteins) in your blood attack the new blood and make you sick.
Type O blood is saIe Ior almost everyone. About 40 percent oI the population has type O blood.
People who have this blood type are called universal donors. Type O blood is used Ior
emergencies when there's no time to test a person's blood type.
People who have type AB blood are called universal recipients. This means they can get any type
oI blood.
II you have Rh-positive blood, you can get Rh-positive or Rh-negative blood. But iI you have
Rh-negative blood, you should only get Rh-negative blood. Rh-negative blood is used Ior
emergencies when there's no time to test a person's Rh type.
Blood Banks
Blood banks collect, test, and store blood. They careIully screen all donated blood Ior possible
inIectious agents, such as viruses, that could make you sick. (For more inIormation, see "What
Are the Risks oI a Blood TransIusion?")
Blood bank staII also screen each blood donation to Iind out whether it's type A, B, AB, or O and
whether it's Rh-positive or Rh-negative. Getting a blood type that doesn't work with your own
blood type will make you very sick. That's why blood banks are very careIul when they test the
To prepare blood Ior a transIusion, some blood banks remove white blood cells. This process is
called white cell or leukocyte (LU-ko-site) reduction. Although rare, some people are allergic to
white blood cells in donated blood. Removing these cells makes allergic reactions less likely.
Not all transIusions use blood donated Irom a stranger. II you're going to have surgery, you may
need a blood transIusion because oI blood loss during the operation. II it's surgery that you're
able to schedule months in advance, your doctor may ask whether you would like to use your
own blood, rather than donated blood.
II you choose to use your own blood, you will need to have blood drawn one or more times prior
to the surgery. A blood bank will store your blood Ior your use.
Alternatives to Blood Transfusions
Researchers are trying to Iind ways to make blood. There's currently no man-made alternative to
human blood. However, researchers have developed medicines that may help do the job oI some
blood parts.
For example, some people who have kidney problems can now take a medicine called
erythropoietin that helps their bodies make more red blood cells. This means they may need
Iewer blood transIusions.
Surgeons try to reduce the amount oI blood lost during surgery so that Iewer patients need blood
transIusions. Sometimes they can collect and reuse the blood Ior the patient.

1 Cne(1) unlL of blood 300 ml

2 nSS 1he Cnly fluld compaLlble wlLh 8lood 1ranfuslon

3 Cauge 19 18 17 16 ( 18 19 mosL commonly use)

4 AdmlnlsLer wlLhln 30 mlnuLes Lo decrease bacLerlal growLh

3 lour(4) hours maxlmum Llme of lnfuslon

6 1wo(2) nurses check compaLlblllLy of blood

7 Warm Lhe blood wrap lL ln a dry Lowel
leL Lhe Lap waLer run over Lhe blood

8 Mlxlng blood LllL slde Lo slde

9 1wenLy(20) gLLs/mln for Lhe flrsL 20 mlns or 13 mlnuLes

10lf Lhere ls reacLlon such as lLchlness Plves ulfflculLy of breaLhlng lncrease 1emperaLure

SLop lnfuslon

Cpen Lhe nSS llne

noLlfy Lhe physlclan

8rlng blood aL Lhe 8lood 8ank

11 kvC 10gLLs

12 ConsenL needed for 8lood 1ransfuslon

The transIusion procedures described in this section have been approved Ior use in the University
oI Michigan Hospitals and Health Centers.
Patient care units may have speciIic patient care needs that require alterations in these policies
and procedures.
Alternative Procedures
Alternative procedures must be approved by the TransIusion Committee oI the University oI
Michigan Hospitals and Health Centers and must be available to patient care personnel.
Training and Co25etency Assess2ent
Personnel who participate in the administration oI blood components must be trained in
transIusion procedures and in recognition and management oI adverse reactions. The bedside
identiIication is to be perIormed by qualiIied individuals such as a physician and registered
nurse, two registered nurses, or by a registered nurse and a licensed practical nurse.
Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) must complete the Blood
TransIusion Course and pass the quiz oIIered with this education. LPNs must successIully
complete the state approved pharmacology course. LPNs having met this criterion can then
check blood products and monitor the recipient oI the product aIter the Iirst 15 minutes oI the
transIusion. The high risk oI transIusions reactions during the Iirst 15 minutes, necessitate that
an RN monitor the recipient oI the product to provide any necessary intervention.
Non-physician transIusionists and anyone who assists in double checking the units (i.e. physician
assistants, perIusion technicians, anesthesia allied health technicians, and emergency department
technicians) must complete the "Blood TransIusion Policies" course and examination.

Equi52ent and Su55lies
4 All blood co25onents 2ust be filtered during administration.
4 A blood component administration set containing an in-line blood Iilter is
recommended. Either a "Y-Type" administration set or a single line set may be
4 An add-on Iilter, such as a leukocyte reduction Iilter, may be used when the
component was not leukocyte-reduced by the blood supplier.
4 Because oI the large number oI Iilters available, the instructions Ior use on the
package or on the product insert should be read to determine priming instructions
and the maximum number oI units that may be administered using the Iilter.
ntravenous Solutions
4 Only isotonic saline (0.9) is recommended Ior use with blood components.
4 Other isotonic electrolyte solutions that have been approved by the FDA Ior this
purpose may be used.
4 Other commonly used intravenous solutions will cause varying degrees oI
diIIiculty when mixed with red cells. For example, 5 dextrose in water will
hemolyze red cells. Intravenous solutions containing calcium, such as Lactated
Ringer's solution, can cause clots to Iorm in blood.
4 Prior to blood transIusion, completely Ilush incompatible intravenous solutions
and drugs Irom the blood administration set with isotonic saline.
Co25onent nfusion Sets
Component and Platelet Administration sets with shorter tubing are available Irom the Materiel
Service Center (MSC) section oI Materiel Services.
Leukocyte-Reduction Filters
4 With the exception oI autologous units, the components stocked by the Blood
Bank are leukocyte-reduced by the blood supplier.
4 In rare circumstances, a beside leukocyte-reduction Iilters may be required.
4 Granulocyte, hematopoetic progenitor cells, and mononuclear cell transIusions
must NOT be administered through these white cell removal Iilters.
4 Follow the priming instructions on the product package.
Pressure nfusion Devices
Follow the Iilter, port or catheter manuIacturer`s instructions regarding the use oI pressure
inIusion devices. The Ilow through some blood Iilters may be compromised and some catheters
may cause catheter wall rupture iI a pressure inIusion device is used.
O InIusion pumps are available Irom the Patient Equipment section oI Materiel
O Equipment Ior transIusion must be used in accordance with the manuIacturer's
instructions Ior use and quality control oI the instrument.
O Do not use equipment that does not have a current Biomedical Engineering tag
indicating it has been tested Ior appropriate Iunction and saIety.
O CuIIs Ior pressure inIusion may be used iI care is taken not to exceed the
designated pressure.
Blood War2ers
Blood warmers are available Irom the operating rooms.
Blood warmers may be used as long as the device has a temperature alarm and visible
temperature monitor. Blood warming devices are most appropriate Ior massive and rapid blood
replacement, such as exchange transIusion oI the newborn.
Patient nstructions and Pre5aration
Blood Bank personnel will notiIy patient unit personnel by telephone when ordered blood is
ready Ior transIusion.
nfor2ed Consent
4 InIormed consent Ior blood transIusion is a process in which the patient is
inIormed oI the medical indications Ior the transIusion, the possible risks, the
possible beneIits, the alternatives, and the possible consequences oI not receiving
the transIusion.
4 InIormed consent may be obtained by a physician, a nurse, or a physician
extender who is knowledgeable about blood transIusion and the patient`s
condition so as to be able to explain the elements oI inIormed consent above.
4 The risks of transfusion, including adverse symptoms and alternatives to
homologous (allogeneic) transIusion, must be discussed with the patient well
beIore the transIusion. The booklet, "Blood Transfusion, Your 5tions"
describing transIusion options are available Irom Moore. This booklet should be
provided to patients as early as possible beIore transIusion.
4 The patient is then given a choice to accept or decline transIusion. Consent should
be obtained suIIiciently in advance oI the transIusion that the patient can truly
understand what is said and have suIIicient time to make a choice.
4 Consent should be documented in the medical chart using the Iorm "Consent to
Receive Blood TransIusion" (available on-line or Irom Moore).
4 A single inIormed consent may cover many transIusions iI they are part oI a
single course oI treatment.
4 It may be advisable, though, to obtain a new consent when there is a significant
change in the patient's care status, such as a transIer Ior care to another service,
an inpatient admission, or an outpatient transIusion.
4 In e2ergency situations the physician ordering the transIusion must make a
reasonable judgement that the patient would accept the transIusion. TransIusion
should not be delayed in a liIe-threatening situation iI it is likely that the patient
would agree to transIusion. AIter the event, the circumstances oI the transIusion
decision should be documented in the medical chart.
Refusal of Blood Transfusion
4 The Iorm "Patient`s Release Form Ior ReIusal oI Blood or Treatment" should be
used to document the patient`s reIusal oI transIusion. The Iorm is available on the
Blood Bank web site.
Post Transfusion nstructions to the Patient
4 Outpatients or patients who will be leaving the hospital within one week oI
transIusion should be given written instructions regarding delayed transIusion
4 The patient handout "Post-TransIusion Instructions Ior the Patient" may be used
Ior this purpose.
4 Copies oI this Iorm are available Irom Moore order number 2201460.
Release and Trans5ort of Blood Co25onents
To reduce the potential Ior waste oI the component, do the Iollowing beIore requesting that a
blood component be issued Irom the Blood Bank:
1 veriIy the physician's order Ior the product, volume and transIusion rate
Note: Orders Ior blood components shall Iollow the policies Ior patient care
orders and verbal orders Ior inpatient and out patients ( UMHHC Policy 62-
10-003 Patient Care Orders, UMHHC Policy 62-10-006 Inpatient Verbal
Orders and UMHHC Policy 62-10-007 Verbal Orders - Ambulatory Care).
(Added 1/10/05)
2. administer any pretransIusion medication
3. record the patient's vital signs
4. initiate or veriIy patency oI an intravenous line

Trans5ort of Blood Co25onents
Blood may be obtained by one oI the Iollowing methods:
O pneumatic tube
O unit personnel picking up at the Blood Bank window Room 2F225 University
O transport oI blood components using phlebotomy service when the blood order is
large or the pneumatic tube system cannot be used.
When calling the Blood Bank Ior pneumatic tube delivery oI a unit oI blood provide the
1 intended blood recipient's Iull name and CPI number
2. blood component ordered
3. number oI units required
4. veriIication that the order was correct when the request is read back
O Transport personnel must present to Blood Bank personnel written notiIication
indicating Iollowing:
1 intended blood recipient's Iull name and CPI number
2 blood component ordered
3 number oI units required
O Blood components will be released to physicians and registered nurses on the
basis oI an oral request stating this inIormation.
O Patient care units Without a Blood Refrigerator: Only one unit oI blood will be
released at a time Ior a patient unless the patient has two intravenous lines in
place that allow Ior the simultaneous administration oI two components.
O Patient Care Units With a Blood Refrigerator: Multiple blood units will be
released only to patient care units with monitored blood reIrigerators.
Recei5t of Blood Co25onents
The person receiving the blood being transported or opening the tube at the receiving location
must immediately upon receipt
Step Action
1 VeriIy
O Product is designated Ior a patient at the receiving location
O Name and CPI number recorded on the TransIusion Record Form
attached to the unit correspond with that oI the intended recipient
O Unit has a normal appearance.
2 The person receiving the blood component should:
O Record the date and time that the blood was received/removed Irom the
pneumatic tube on the Blood Delivery Iorm
O Sign the Blood Delivery Iorm
3 Return the signed and dated Blood Delivery Form to the Blood Bank using
hospital mail
4 VeriIy that red blood cells and plasma components were received within 30
minutes oI the dispensed time stamp on the Iorm.
II Then
II more than 30
minutes have elapsed
since the time stamp
on the Blood
Delivery Form
the Red Blood Cells or plasma may be used Ior
i22ediate transfusion that will be co25leted within
4 hours of the ti2e sta25, transIuse the component.
Do not store Red Blood Cells and 5las2a that has
been out oI reIrigeration Ior more than 30 minutes in
patient care unit Blood ReIrigerators.
II the blood component is not needed Ior immediate
transIusion, return the Red Blood Cells or plasma to the
blood bank Ior proper disposal.
O Red Blood Cell and plasma components must be stored between 1 and 6 C and
the temperature during transport cannot exceed 10 C. ReIrigerated blood
components will warm to above 10 C in approximately 30 minutes aIter removal
Irom reIrigeration.
O Platelets and Cryoprecipitate are stored at room temperature. These components
may be used until the outdate time on the label.
O Consult with the Blood Bank iI there is any question about the suitability or
identiIication oI a blood component.
S5ecial Labels
4 When blood is released Ior transIusion under unusual circumstances a special
notation will be indicated on the TransIusion Record Form.
4 This inIormation will oIten suggest to physicians and nurses that particular
caution must be exercised during transIusion, and that the blood transIusion
should be terminated at the Iirst sign oI an untoward reaction.
4 Personnel initiating the transIusion who have questions concerning the
signiIicance oI this inIormation should contact the Blood Bank.
Pretransfusion Vital Sign Docu2entation
4 To provide a baseline, record the patient's blood pressure, pulse, respirations and
temperature in the chart or on the transIusion record Iorm
II a patient is Iebrile, consideration should be given to postponement oI blood transIusion, since
the Iever may mask the development oI a Iebrile reaction to the blood component itselI.
O VeriIy physician's orders Ior transIusion and any that any pretransIusion
medications have been administered
O PerIorm bedside veriIication oI patient and component Using the
O labels on the bag,
O the TransIusion Record Form and
O the patients attached positive patient identiIier.
Two qualiIied individuals must
1hese steps must never be bypassed
1 Ask the patient to state his or her name. VeriIy patient and component
identiIication inIormation.
2 VeriIy the blood type, donor number, component name
3 VeriIy compatibility: a compatibility chart is on the back inside cover
oI this booklet.
4. VeriIy the product is not outdated
5. Sign the TransIusion Record Form beIore blood transIusion is initiated.
6. The person who hangs the blood must record the date and time the
transIusion was started
7. Record the date, time, component and unit number on the appropriate
sheet on the patient's chart. ReIer to unit policy and procedures.
A1 S1AR1 the transfusion if there is any discrepancy.
Contact the Blood Bank.
nitiating the Transfusion
4 Immediately beIore transIusion, mix the unit oI blood thoroughly by gentle
4 Follow the manuIacturer's instruction Ior the use oI special Iilters and ancillary
devices. Additional administration instructions Ior selected components are
printed at the end oI this chapter and are available upon request Irom the Blood
4 II any part oI the unit is transIused, the unit is considered transIused.
Flow Rates
Initial Flow Rate Slowly at no more 1 mL/minute to allow Ior
recognition oI an acute adverse reaction.
Proportionately smaller volume Ior pediatric
Standard Flow Rate - Adults II no reaction occurs in the Iirst 15 minutes,
the rate may be increased to 4 mL/minute
Pediatrics 10-20 mL/kg over 30-60 minutes
Usual InIusion time Red Blood Cells: two hours unless the
patient can tolerate only gradual expansion
oI the intravascular volume
Platelets, plasma and cryoprecipitate: 10 mL
per minute. The transIusion may be
administered as rapidly as the patient can
tolerate, usually 30 minutes.
Maximum InIusion Time InIusion time should not exceed 4 hours Ior
any component.
II rate slows appreciably investigate immediately
Consider measures that may enhance blood
O repositioning the patient's arm,
O changing to a larger gauge needle,
O changing the Iilter and tubing,
O and elevating the IV pole, iI gravity
rather than a pump is being used.
During the Transfusion Docu2ent
What O temperature, blood pressure, respirations
and pulse, and examine the skin Ior
O Assess Ilow rate
When O beIore initiating the transIusion
O aIter the Iirst 15 minutes
O aIter 30 minutes
O hourly until one hour aIter completion oI
the transIusion
Outpatient Post TransIusion Vital Signs For outpatient transIusions, the vital signs may be
taken at 30 minutes post transIusion.
See Chapter 7 Ior details concerning the signs and symptoms oI a transIusion reaction.
f the 5atient has a 5reexisting fever
The need Ior transIusion must be balanced with the risk oI transIusion. Contact the patient`s
physician to determine iI pretransIusion medications should be administered.
f a 5atient is being trans5orted with blood hanging
Patients should not be transported with blood components inIusing unless accompanied by a
clinician who can monitor and respond to a potential reaction. Additionally, the receiving
clinic/area must have a clinician who can manage a patient while they are receiving blood
4 Do not add medications directly to a unit oI blood during transIusion.
4 Medications that can be administered "IV Push" may be administered by stopping
the transIusion, clearing the line at the medication injection site with 5-10 mL oI
normal saline, administering the medication, reIlushing the line with saline and
restarting the transIusion.
Units entered and not transfused
II a unit oI blood or a blood component has been entered Ior any reason by personnel not
working in the Blood Bank, and the unit has not been transIused
O Record on the transIusion Record Form the volume transIused as "NONE"
O Indicate the disposition oI the unit "Discarded on patient unit" and sign and date
the notation.
O Return the TransIusion Record Form to the Blood Bank
f Co25onents Are No Longer Needed
To avoid unnecessary waste oI blood resources, notiIy the Blood Bank staII immediately iI
components are no longer needed Ior a patient, as the component may be suitable Ior transIusion
to another patient. Return any unneeded units to the blood bank.
At the Ter2ination of an Unco25licated Transfusion
AIter the completion oI each uncomplicated transIusion, the responsible physician or nurse
should veriIy that the "TransIusers Must Complete" section oI the TransIusion Record Form
is complete, including
date and time transIusion was stopped
volume oI blood inIused
Check the box documenting the presence/absence oI a transIusion
Discontinue the isotonic saline solution used to initiate the transIusion aIter the completion oI the
transIusion unless speciIically ordered.
Document the patient's response to the transIusion in the patient's medical record.
f a Transfusion Reaction is Sus5ected
4 Stop the transIusion
4 Maintain the IV.
4 Save the bag and attached tubing and reIer to Chapter 7 Ior additional
Dis5osal of Blood Bags f No Reaction is Sus5ected
Discard empty blood bags with attached blood inIusion sets on the patient unit in a biohazard
waste container such as a red bag.
Transfusion Record For2 Distribution
Following completion oI the Iorm, the white copy oI this Iorm should be retained in the patient
unit Ior attachment to the patient's chart; the pink copy oI the Iorm must be returned to the Blood
Bank in hospital mail.
Autologous stem cells are the patient's own stem cells that are harvested Irom the marrow or
peripheral blood and then cryopreserved.
Allogeneic Bone Marrow is Iresh stem cells taken Irom a donor's bone marrow. Allogeneic stem
cells are taken Irom the peripheral blood by apheresis. AIter collection these cells may be
Physician Orders There must be a written order Irom a hematology/oncology staII
physician Ior the inIusion.
HPC must be administered by a physician or an experienced
Bone Marrow Transplant RN or Physician Assistant under the
direct supervision oI a physician. A physician or Physician
Assistant must be present on the unit during autologous HPC re-
inIusion with emergency equipment available at the bedside.
Maximum time Irom
thaw to inIusion
HPC products must be inIused within 15 minutes oI thawing.
They cannot be stored since the cryoprotective agent DMSO is
toxic to cells at 4 C.
Storage temperature oI
stems cells that are not
Room temperature or iI the inIusion cannot be initiated
immediately aIter processing is complete, the marrow may be
stored in the Blood Bank at 4 C Ior no more than 24 hours
Compatible IV solution Isotonic (0.9) saline is the only solution compatible with stem
cell products
Irradiation Stem cell products are not irradiated
InIusion equipment Administer through a central venous catheter. Use a standard 170
to 210 micron Iilter. Do not ad2inister through a
2icroaggregate filter
Documentation oI Vital
Vital signs must be documented aIter the Iirst 15 minutes oI the
inIusion, at halI hour intervals during an allogeneic inIusion,
every 15 minutes during an autologous inIusion and then every
30 minutes Ior one-hour post inIusion.
Adverse Reactions Adverse reactions associated with any blood component
transIusion apply to HPC. . In addition, reactions due to the
cryopreservative DMSO and the lack oI an inIusion Iilter may
also occur.
Monitor the patient closely Ior symptoms such as hypertension,
dyspnea, pulmonary edema, chest pain, bronchospasm,
abdominal cramping, hypoxia, headache, nausea, vomiting, Iever,
chills, hypertension, hemoglobinuria and urticaria.
II a reaction occurs II symptoms develop, slow the inIusion. NotiIy the patient's
physician and the Blood Bank physician on-call.
stem cell products
Patients receiving a major ABO-incompatible HPC product will
likely develop an acute hemolytic reaction depending on the
volume oI ABO incompatible cells inIused. See chapter 7.
Red discoloration oI the
A red discoloration oI the urine commonly occurs up to 24 hours
aIter the inIusion oI cryopreserved HPC as a result oI the dye in
the processing media. This occurrence does not need to be
reported as a transIusion reaction.