Blood and Blood Products

1. Blood and Blood Products

2. Whole Blood • Contents • RBC’s • WBC’s • Platelets • Plasma • Clotting factors

3. Whole Blood • Indications • Acute loss of whole blood

4. Packed Cells • Contents • RBC’s • 20% Plasma • Indications • Replace O2 carrying capacity with less volume • Severe anemia, slow blood loss, CHF

5. Granulocytes • Contents • WBC’s • 20% Plasma • Indications • Life-threatening decreases in WBC count

6. Platelets • Contents • Platelets • WBC’s • Plasma • Indications • Low platelet counts

7. Plasma • Contents • Clotting factors • Fibrinogen • Prothrombin • Albumin • Globulins

8. Plasma • Indications • Clotting factor deficiency • Volume expansion

9. Plasma Protein Fraction • Contents • 5% Albumin/Globin in saline • Indications • Expand volume in burns • Hemorrhage • Hypoproteinemia

10. Albumin • Contents • 5% or 25% albumin • Indications • Replace volume in shock • Burns • Hypoproteinemia

11. Cryoprecipitate • Contents • Factors VIII and XIII, Fibrinogen • Indications • Hemophilia A • Fibrinogen deficiency • Factor XIII deficiency

12. Prothrombin • Contents • Factors II, VII, IX, and X • Indications • Hemophilia B • Liver disease

13. Blood Transfusion

14. Blood Transfusion • Blood must be typed prior to administration

15. Blood Transfusion • ABO Antigens • A Antigen Type A • B Antigens Type B • A and B Antigens Type AB • No Antigens Type O

16. Blood Transfusions • Plasma Antibodies Agglutinate (Clump) Cells of other Types

17. Blood Transfusions • Type A = B Antibodies • (Clumps B or AB) • Type B = A Antibodies • (Clumps A or AB)

18. Blood Transfusions • Type AB = No Antibodies • (Clumps Nothing) • Type O = A and B Antibodies • (Clumps everything except O)

19. Blood Transfusions • O Negative = Universal Donor • AB Positive = Universal Recipient

20. Blood Transfusions • Rh Factor • 85% of Population • Rh Positive • 15% of Population • Rh Negative

21. Blood Transfusions Rh Negative patients produce Rh antibodies only if exposed to Rh Positive blood

22. 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

23. Blood Transfusions • Erythroblastosis Fetalis • Prevented by administration of Rhogam to mother

24. Transfusion Complications

25. Fever • Most common reaction • Donor WBC incompatabilities • Antipyretics

26. Allergic Reactions • Signs/Symptoms • Itching • Uticaria • Chills • Fever • Facial edema • Wheezing • Anaphylactic shock

27. Allergic Reactions • Management • Oxygen • IV fluids • Epinephrine • Antihistamines

28. Hemolytic Reaction • Signs/Symptoms • Chills, fever • Low back pain • Headache • Chest pain • Dyspnea • Cyanosis • Restlessness, anxiety • Hypotension • Red urine

29. Hemolytic Reaction • Management • Stop transfusion • Treat shock • Volume replacement • Mannitol

30. Volume Overload • Signs/Symptoms • Cough • Chest pain • Dyspnea • Distended neck veins • Rales • Frothy sputum

31. Volume Overload • Management • Slow infusion • Diuretics • Vasodilators

32. Transfusion Complications • Coagulation Disturbances • Platelet/Clotting factor deterioration • Citrate Intoxication • Hypocalcemia • Metabolic Alkalosis • Hyperkalemia • RBC’s Lyse/Release K+

33. Transfusion Complications • Acid/Base Imbalances • Banked blood gradually acidifies • Poor tissue Oxygenation • Loss of 2,3 DPG

34. Transfusion Complications • Hypothermia • Inadequate warming during transfusion • Viral Hepatitis • Risk rises with each unit

35. 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

36. Blood Transfusion • Infusion pumps • Excessive pressure can cause hemolysis • Rewarming above 380C can cause hemolysis • Never add medications directly