Administration of blood and blood products: RN,NCLEX

ADMINISTRATION OF BLOOD 

Types of blood components 

1. Packed red blood cells 

• Red blood cells are a blood product used to replace erythrocytes. 
• Each unit increases the haemoglobin level by 1 g/dL and hematocrit by 2% to 3% ; the change in laboratory values takes 4 to 6 hours after completion of the blood transfusion.
• Evaluation of an effective response is based on the resolution of the symptoms of anaemia and an increase in the erythrocytes count. 

2. Platelets 

• Platelets are used to treat thrombocytopenia and platelet dysfunctions. 
• Crossmatching is not required but usually is done ( platelet concentrates contain few blood cells). 
• The volume in a unit of platelets may vary; always check the bag for the volume of the blood component ( in millilitres). 
• Platelets are administered immediately on receipt from the blood bank and are given rapidly,  usually over 15 to 30 minutes. 
• Evaluation of an effective response is based on improvement in the platelet count,  and platelet counts normally are elevated 1 hour and 18 to 24 hours after the transfusion. 

3 Fresh frozen plasma 

• Fresh frozen plasma may be used to provide clotting factors or volume expansion; it contains no platelets. 
• Fresh frozen plasma is infused within 2 hours of thawing,  while clotting factors are still viable, and is infused as rapidly as possible. 
• Rh compatibility and ABO compatibility are required for the transfusion of the plasma products. 
• Evaluation of an effective response is assessed by monitoring coagulation studies, particularly the prothrombin time and the partial thromboplastin time,  and resolution of hypovolemia. 

4. Albumin

• Albumin is prepared from the plasma and can be stored for 5 years. 
• It is used to treat hypovolemic shock or hypoalbuminemia. 
• Albumin, 25g/100 mL, is equal to 500 mL of plasma. 

5. Cryoprecipitates

• Prepared from fresh frozen plasma and can be stored for 1 year; once thawed, the product must be used.
• Used to replace clotting factors, especially factor Vlll and fibrinogen.

Types of blood donations 

A. Autologous 

• A donation of the clients own blood before a scheduled procedure is autologous; it reduces the risk of disease transmission and potential transfusion complications. 
• Autologous donation is not an option for a client with leukaemia or bacteremia. 
• A donation can be made every 3 days as long as the haemoglobin remains within a safe range.
• Donation should begin within 5 weeks of the transfusion date and end at least 3 days before the date of donation. 

B. Blood salvage 

• Blood salvage is an autologous donation that involves suctioning blood from body cavities, joint spaces, or other closed body sites.
• Blood may need to be "washed" a special process that removes tissue debris before reinfusion. 

C. Designated donor

• Designated donation occurs when recipients select their own compatible donors. 
• Donation does not reduce the risk of contracting infections transmitted by the blood; however, recipients feel more comfortable identifying their donors. 

Compatibility chart for Red blood cell transfusions 

                           ........Recipient..............

Donor:              A          B        AB       O

  A                       x          -           x         -

  B                        -          x          x         -

  AB                     -                      x         -

  O                      x          x          x         x

Compatibility 

• Client ( the recipient ) blood sample are drawn and labelled at the client's bedside at the time the blood sample is drawn; the client is asked to state his or her name, which is compared with the name on the client's identification band or bracelet. 
• The recipient ABO type and Rh type are identified.
• An antibody screen is done to determine the presence of antibodies other than anti-A and anti-B.
• Crossmatching is done, in which donor red blood cells are combined with the recipient's serum and coomb's serum; the cross math is compatible if no red blood cell agglutination occurs.
• The universal red blood cell donors are O negative; the universal recipient is AB positive. 

Transfusion reaction 

Description 

• A transfusion reaction is an adverse reaction that occurs as a result of receiving a blood transfusion. 
• Type of transfusion reaction includes hemolytic, allergic, febrile or bacterial reactions, circulatory overload, or transfusion-associated graft-versus-host disease. 

Signs of an immediate transfusion reaction 

• Chills and diaphoresis
• Muscle aches, back pain, or chest pain
• Rashes, hives, itching, and swelling 
• Rapid, thready pulse
• Dyspnea, cough or wheezing 
• Pallor and cyanosis
• Apprehension 
• Tingling and numbness 
• Headache
• Nausea, vomiting, abdominal cramping, and diarrhoea 

Signs of transfusion reaction in an unconscious client 

• Weak pulse
• Fever
• Tachycardia or bradycardia 
• Hypotension 
• Visible hemoglobinuria 
• Oliguria or anuria

Delayed transfusion reactions 

• Reaction can occur days to years after a transfusion 
• Signs include fever, mild jaundice, and a decreased hematocrit level.

Intervention -+

• Stop the transfusion 
• Keep the intravenous line open with 0.9% normal saline.
• Notify the physician and blood bank.
• Remain with the client, observing signs and symptoms and monitoring vital signs as often as every 5 minutes.
• Prepare to administer emergency medication such as antihistamines, vasopressors, fluids and corticosteroids as prescribed. 
• Obtain a urine specimen for laboratory studies.