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TRANSFUSIONS TODAY:

TRANSFUSIONS TODAY:. Tips and Trends. Antigens & Antibodies. Incompatible Match. Incompatible Match. Antigens & Antibodies. Compatible Match. Quick Blood Type Review. Group A: Antigen “A” on the red cell; Antibody “B” in the plasma Group B:

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TRANSFUSIONS TODAY:

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  1. TRANSFUSIONS TODAY: Tips and Trends

  2. Antigens & Antibodies Incompatible Match Incompatible Match

  3. Antigens & Antibodies Compatible Match

  4. Quick Blood Type Review • Group A: Antigen “A” on the red cell; Antibody “B” in the plasma • Group B: Antigen “B” on the red cell; Antibody “A” in the plasma

  5. Quick Blood Type Review • Group AB: Antigens “A” and “B” on the red cell; no corresponding Antibodies in the plasma • Group O: No Antigens on the red cell; Both Antibodies “A” and “B” in the plasma

  6. Antigens & Antibodies Antigens • Found on the Red Blood Cell (RBC) surface • Are inherited • Are glycolipid or glycoprotein in nature • Can invoke the immune system to react

  7. Antigens & Antibodies Antibodies • Also called agglutinins • They are proteins found in plasma • They react to specific antigens found on the RBC, causing agglutination • Are inherited OR acquired

  8. Rh Antigens • There are approx. 50 known Rh (Rhesus) Antigens • Antigen “D” (Rh Factor) is considered in Transfusion Therapy • Rh “Positive”: Antigen “D” is found on the RBC • Rh “Negative”: No Antigen “D” on the RBC

  9. Rh Antigens • There are no Antibodies to Antigen “D” in the RhNegative plasma unless……… .........this plasma is introduced to Rh Positive RBC Hence………….RhoGAM®

  10. Blood Donation Procedures • Direct vein phlebotomy of a unit (500 ml) of WB • Hematological Pheresis with the removal of ONLY the product required.

  11. Types of Transfusion Products • Whole Blood (WB): -The patient seldom needs all the components in whole blood. -Must always deliver Type Specific WB • Red Blood Cells (RBC): -Obtained by spinning down WB -Used for dealing with low H & H -Should be Type Specific if at all possible

  12. Types of Transfusion Products • Fresh Frozen Plasma: -Obtained by spinning down WB -Used for its rich source of Clotting Factors -Must be Type Specific • Platelets: -Obtained by spinning down Plasma -Used to treat thrombocytopenia -Should be Type Specific

  13. Types of Transfusion Products • Cryoprecipitate: -Obtained by spinning down Plasma -Used for its rich source of Factor VIII, von Willebrand’s Factor, and Factor XIII

  14. Blood Bank Testing • ABO Blood Grouping • Rh Factor • Non-reactive to Antibodies for to: -HIV -HCV

  15. Blood Bank Testing -Human T-cell lymphotropic virus (HTLV-I/II) -Hepatitis B surface antigen (HBsAg) -Hepatitis B core antigen (HBc) -HCV on the RNA -HIV-1 on the RNA -West Nile Virus (WNV)

  16. Blood Bank Testing -Syphilis -Several antigens that are known to be common in many people: Kell, Duffy, Kidd • Fewer tests are run for “Autologous” labeled blood until that status changes

  17. Transfusion Caveats • Transfusion Nurse will be familiar with the patient’s transfusion history • Signed, Informed Consent must be obtained prior to any transfusion • The PHYSICIAN (LIP) is responsible for the above!

  18. Transfusion Caveats • General patient education is provided by the Transfusion Nurse • Transfusion Nurse will establish catheter patency prior to obtaining the blood product from the Blood Bank (BB) • ONLY 0.9% Sodium Chloride will be used with the transfusion

  19. Transfusion Caveats • The proper filter and administration set for the blood product will be used • Transfusion Nurse will record all Vital Signs prior to obtaining the blood product from the BB • Transfusion Nurse and a BB official will co-sign the release of the product from the BB

  20. Transfusion Caveats • The use of an Electronic Infusion Device (EID) should be considered as preferable • All BB instructions for the use of a Blood Warmer, will be followed • The blood product will be matched to the patient by 2 (two) nurses, with both signing

  21. Transfusion Caveats • The transfusion will be started within 30 minutes of the blood product leaving the controlled environment (BB) • A single unit of RBC should be completely infused within a 4-hour period • Each blood product has its own recommended administration time

  22. Transfusion Reactions ACUTE (Immediate) Hemolytic: • Cause: “Donor” RBC being incompatible with “Recipient’s” Plasma • Potential fatality may occur with as little as 10 – 15 ml of incompatible blood

  23. Transfusion Reactions • Prevention: -Proper patient ID -Proper labeling of blood sample drawn -Verification of ABO/Rh compatibility between donor and recipient before transfusion started

  24. Transfusion Reactions • Signs and Symptoms: -Fever -Hypotension -Lumbar Pain -Hemoglobinemia -Hemoglobinuria -Dyspnea -Shock -Oliguria/Anuria -Abnormal Bleeding

  25. Transfusion Reactions • Interventions: -Stop transfusion -Change administration set -Infuse 0.9% NS to maintain patency of vascular access -Notify MD/LIP -Institute your Transfusion Reaction Protocol -Initiate treatment(s) to reverse symptoms -Empty urimeter and clamp catheter!!!

  26. Transfusion Reactions Febrile nonhemolytic: • Cause: White Blood Cell (WBC) antigen- antibody reaction • Prevention: Premed, use leukocyte-reduced blood products

  27. Transfusion Reactions • Signs and Symptoms: -Increase in temp of 2°F or more with no other explanation (immediate or hours later) -Chills -Rigors -General malaise

  28. Transfusion Reactions Allergic: • Cause: Sensitivity reaction to foreign plasma protein in transfused product • Signs and Symptoms: -Urticaria -Hives -Local Erythema

  29. Transfusion Reactions • Interventions are based on the severity of the reaction: -Severe: Stop transfusion, notify MD, treat s/s -Mild: Interrupt transfusion, give anithistamines, possibly resume • Prevention: Premedication

  30. Transfusion Reactions Anaphylaxis: • Cause: Generally unknown (same as Allergic) • Sign and Symptoms: -Respiratory Distress -Bronchospasm -Abdominal Cramps -N/V/D -Shock, loss of consciousness, death

  31. Transfusion Reactions • Interventions: (same as prior) • Prevention: Use deglycerolized RBC ORAutologous blood in the future Transfusion Associated Circulatory Overload (TACO) • Cause: Too rapid infusion for pulmonary compromised patient (a cardiogenic issue)

  32. Transfusion Reactions • Signs and Symptoms: -Pulmonary Edema -Dyspnea -Cyanosis -Severe Headache -Hypertension

  33. Transfusion Reactions -CHF -Chest Film shows: White out Normal to increased heart size Vascular congestion Pleural effusions -EKG abnormal

  34. Transfusion Reactions • Interventions: - Same as above -Place patient in sitting or Hi-Fowlers position -Give Diuretics and Oxygen (possibly vented) • Prevention: -Appropriate infusion rates -Pre/Post med with diuretics -Split Units from BB

  35. Transfusion Reactions Transfusion-Related Acute Lung Injury (TRALI) • Cause: Unknown (non-cardiogenic issue) Hypothesis – “Donor” antibodies reacting to “Recipient” white cell antigens (HLA or HNA), allowing the filling of the alveoli with proteins, causing lung injury A diagnosis of “Exclusion” – must be no symptoms prior to transfusion

  36. Transfusion Reactions -Most commonly reported cause of transfusion-related death in U.S. • Signs and Symptoms: -Onset of hypoxemia during or within 6 hours of the transfusion -Presence of bilateral lung infiltrates not present prior to transfusion -No Dx of TACO

  37. Transfusion Reactions -Chest Film shows: White out Normal heart size No vascular congestion -EKG normal • Prevention: -Screening donations for the presence of extremely high levels of HLA antibodies

  38. Transfusion Reactions • Interventions: -Immediate oxygen -Possible intubation with mechanical vent -Possible fluids to treat hypotension -Monitor for conversion to ARDS -Pulmonary Artery Wedge Pressure measurements (risky) -Alveoli tapping

  39. Transfusion Reactions Hypothermia: • Cause: Rapid infusion of very cold blood product • Signs and Symptoms: -Shaking chills -Hypotension -Cardiac arrhythmias

  40. Transfusion Reactions • Interventions: -Initiate measures to warm blood product -Comfort measures to control symptoms ie. warm blankets • Prevention: -Know patient history -Use blood warmer at out set

  41. Transfusion Reactions Citrate Toxicity: • Cause: Multiple transfusions in a patient with liver impairment • Signs and Symptoms: -Circumoral tingling -Hypotension -N/V -Cardiac arrhythmias (low Ca; low K)

  42. Transfusion Reactions • Interventions: -Slow or discontinue transfusion -Monitor serum Ca and K levels • Prevention: -Ascertain patient history of liver impairment -Limit transfusions as much as possible

  43. Transfusion Reactions DELAYED • Delayed Hemolytic • Bacterial Sepsis • “Primary” and “Secondary” Alloimmunization • PosttransfusionPurpura (PTP) • Transfusion-associated graft-vs-host disease (TA-GVHD) Activation of T-Lymphocytes

  44. Transfusion Reactions • Hepatitis B and/or C • Creutzfeldt-Jakob Disease (CJD) or (vCJD) • HIV • Cytomegalovirus (CMV) (Human Herpesvirus-5)

  45. Thank You!!! Gweneth E. Cole, RN, CRNI® PICC a little…TALK a little! www.piccalittle.com gwen@piccalittle.com gcole@ptcins.org 207-873-3558

  46. References/Bibliography • www.seabb.org/presentations/doc_download/10-taco-vs-trali • INS Standards of Practice; J/F 2011; Vol.34, No.1S; 66. Transfusion Therapy; pp S93-S95. • INS Clinical Competency Validation Program; 3rd Edition; Procedure 5.1: Administration of Blood and Blood Components; pp 76-79.

  47. References/Bibliography • www.aabb.org/marketplace “General Information for Whole Blood and All Blood Products” “Side Effects and Hazards for Whole Blood and All Blood Products” • AABB Technical Manual; 17th Edition

  48. References/Bibliography • INS Core Curriculum for Infusion Nursing; 3rd Edition; pp. 299-316. • http://www.ninds.nih.gov/disorders/cjd/detail_cjd.htm

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