Transfusion

Giving of blood: the transfer of whole blood, blood components, or bone marrow from a healthy donor into the bloodstream of somebody who has lost blood or who has a blood disorder

Setting a. free standing infusion centers b. ambulatory care clinics c. physicians offices d. Patients Home

Pretransfusion Assessment History should include a. type of reaction b. its manifestation c. interventions required d. whether any preventive measures were used e. Assess the number of pregnancies a woman has

Physical Assessment a. vital signs b.careful auscultation of the lungs c.Patients use of accessory muscle d.Skin should be observed for rashes, petechiae and ecchymoses e.Sclera should be examined for icterus

Signs and Symptoms of reaction

Fever Chills Respiratory distress Low back pain Nausea Pain at the IV site Or anything unusual

COMMON POTENTIALLY SEVERE TRANSFUSIONRELATED COMPLICATION

Febrile Nonhemolytic Reactions Acute Hemolytic Reaction Allergic Reaction Circulatory Overload Transfusion-Related Acute Lung Injury (TRALI) Delayed Hemolytic Reaction Disease Acquisition

COMMON POTENTIALLY SEVERE TRANSFUSION-RELaTED COMPLICATION

1.) Febrile Nonhemolytic Reaction Most common type of transfusion reaction (90%) Frequently occurs to patient with previous transfusion Rh-negative woman who have borne Rh-positive babies Caused by antibodies to donor leukocytes that remain in the unit of blood or blood components s/s Chills(minimal to severe) Fever elevation(more than 1C elevation) Fever typically begins within 2 hours

Medical Intervention Leukocyte reduction filterAntipyretics Routine premedication is not advised because it can mask the beginning of a more serious transfusion reaction

LEUKOCYTE REDUCTION FILTER

Blood Bag System with in-line Leukocyte Reduction Filter and Diversion Blood Sampling Arm

COMMON POTENTIALLY SEVERE TRANSFUSION-RELaTED COMPLICATION

2.)Acute Hemolytic Reaction Most Life-threatening type of transfusion reaction Occurs when the donor blood is incompatible with that of the recipient Occurs when: Errors in blood component labeling and Patient identification that result in the administration of an ABO-incompatible transfusion Erythrocytes are hemolyzed (destroyed) in the circulation Reaction can occur after transfusion of as little 10ml of PRBCs

s/s Fever Chills Low back pain Nausea Chest tightness Dyspnea Anxiety Hemoglobinuria(erythrocytes are destroyed, hemoglobin is released from the cells and excreted by the kidneys) Hypotension Bronchospasm Vascular collapse may result Diminished renal perfusion result in acute renal failure

COMMON POTENTIALLY SEVERE TRANSFUSION-RELaTED COMPLICATION

Management Reaction must be recognized promptly transfusion discontinued immediately Blood and urine specimen must be obtained and analyzed for evidenced of hemolysis Treatment Goal: Maintaining blood volume and renal perfusion and preventing and managing DIC

COMMON POTENTIALLY SEVERE TRANSFUSION-RELaTED COMPLICATION 3.)Allergic Reaction

Some pt. develop urticaria(hives) or generalized itching during transfusion Caused: Sensitivity reaction to plasma protein Symptoms of allergic reaction: Urticaria, itching, and flushing The reactions are usually mild and respond to antihistamines
Medical Management Antihistamine before the transfusion Diphenhydramine Benadryl Epinephrine, corticosteroid, pressor support is administered if allergic reaction is severe For severe reactions, future blood components are washed to remove any remaining plasma protein Leukocyte filters

COMMON POTENTIALLY SEVERE TRANSFUSION-RELaTED COMPLICATION

4.)Circulatory Overload If too much blood is infused too quickly hypervolemia can occur PRBCS are safer to use than whole blood Diuretics are administered after the transfusion or between units of PRBCs Patients receiving fresh frozen plasma may develop circulatory overload Signs of Circulatory overload include, dyspnea, orthopnea,tachycardia and sudden anxiety Jugular Vein distention, crackles at the base of the lungs, increased in BP

COMMON POTENTIALLY SEVERE TRANSFUSION-RELaTED COMPLICATION E.)Bacterial Contamination

Administration of contaminated products puts the patients at greater risk Contamination can occur at any point during procurement or processing but is usually due to organisms in the donors skin Many bacteria cannot survive in the cold temperatures used to store PRBCs Preventive Measures Meticulous care in the processing of blood components When PRBCs or whole blood is transfused, it should be administered within 4hour period, because warm temperature promotes bacterial growth Fluids and broad-spectrum antibiotics Septicimia is treated with IV fluids and antibiotics Signs of Bacterial Contamination Fever Chills Hypotension

Diseases Transmitted by Blood Transfusion

Hepatitis

Greater risk from pooled blood products and blood of paid donors than from volunteer donors

(Viral Hepatitis B,C)

AIDS (HIV and HTL)

People with high risk behaviour (multiple sex partners, anal sex, IV injection drug use) People with s/s that suggest AIDS should not donate blood