Types of Blood Components

Whole Blood
To replace blood volume and O2
carrying capacity in
Treat hemorrhage and shock
Contains PRBC, plasma proteins,
clotting factors and plasma
(few platelets & granulocytes)
Volume = 500ml/unit

Blood Administration

__________________
Packed Red cells (PRBCs)
Treat anemia, replace blood volume
(ordered when Hgb 8-9 & HCT 24-27)
1 unit PRBC = Hgb by 1/HCT by 3
From whole blood (2/3 of plasma
removed)
Only RBCs used

O2 carrying capacity in slow

bleeding, anemia, leukemia, surgery
Volume = 250-300ml/unit

Risks & Benefits

Possible incompatibility issues
Circulatory overload
Deficient in some clotting
factors
Rarely used
Use Lasix to prevent overload

________________

Risks & Benefits

Use leukocyte poor red cells or
leukocyte filter if history of
febrile reaction
No viable platelets or
granulocytes
Incompatibility may cause
hemolytic reaction
Less chance of fluid overload
Takes 4-6 hours for Hgb & HCT
to change
Most commonly used!!

Leukocyte reduction prior to storage

More effective than previous washing
process
Packed RBCs are removed from plasma
Removal of most WBCs and Plasma
reduces the risk of reactions
Drawback bacterial growth if
contaminated during collection/processing

Platelets

To control or prevent bleeding in

platelet deficiencies, i.e.
thrombocytopenia
(ordered when platelets count
<10-20,000)
From whole fresh blood
Expected platelet 10,000/unit
Measure at 1hr & 18-24 hr post
admin
Volume = 30-60ml/unit
________________________

Albumin (plasma derivative)

To expand blood volume or replace
protein
Used to treat shock from trauma,
infection, 3rd spacing, hypovolemia,
and in surgery
Available in 5% -25% solution
Volume 25g/100ml = 500ml of plasma

Frozen RBCs
Rarely used
Successive washing with
saline solution removes
majority of WBCs and
plasma proteins
________________________

Fresh Frozen Plasma (FFP)

To treat DIC, reverse effects
of Coumadin, treat liver
failure pts
Contains clotting factors
Improves coagulation, PT &
PTT
Volume = 200-250ml/unit

Risks and Benefits

- Can be stored for 3 years
- Use within 24hrs of
thawing
- No WBCs
___________________
Risks & Benefits
Rich in clotting factors
No platelets
Good for volume expansion
to restore clotting factors in
hypovolemic shock
Risk for vascular overload
Hypersensitivity reaction
Hemolytic reactions

Risks & Benefits

Not a substitute for whole blood

May form antibodies
Hypersensitivity reaction

____________

Risks & Benefits

Vascular overload
Hyperosmolar solution moves
water from extravascular space
to intravascular space
Outcome: adequate BP &
volume
Hypersensitivity reaction
Can be stored for 5 years

Types of Blood Components

Contd

Types of Blood Components contd

Types of Blood Components

Cont

Current Blood Preparation

Prothrombin Complex Prothrombin,

Factors VII, IX, X, and part of XI
Used to treat clients with specific clotting factor
deficiencies
Prepared from FFP
Store for 1 year, once thawed, must be used

Cryoprecipitate Clotting Factors VIII,

XIII, von Willebrands factor, & fibrinogen
from plasma
Used to treat clients with specific clotting factor
deficiencies
May cause ABO incompatibilities

Preparation
for
Blood Administration

RBC & Plasma Transfusions

Physicians order
Verify signed consent
Obtain IV acess, large bore catheter (18-20 gauge), 2 lines if possible
T&C done? Blood on hold?
*Get client ready for transfusion prior to getting blood from the lab
*Staff signs for and obtains blood (only one client & 1 unit a time!)
Routine compatibility testing takes about 1 hour to identify recipient ABO
and Rh type; in emergency O-negative RBCs can be safely given to most
clients without serologic testing.
Why can O-neg blood be safely given?
*Universal RBC donor is O negative; universal recipient is AB positive
Blood must be completed within 3-4 hours after receipt from blood bank!

Blood Product
Administration

Blood Product Administration

Compare all labels second time

Check vital signs and record
Initial vitals before admin.
Vitals 15 minutes after admin. (stay with pt 1st
15mins)
Vitals q30min after that until transfusion complete
Vitals post admin. and then in 1hr

IV 18-20 gauge adult, 23-child

0.9% Sodium Chloride (NS) only!!!
Invert unit to mix cells
Prime Y-type blood tubing with NS, before
admin.
Spike blood bag, clamp off NS
Squeeze tubing to cover blood filter with blood

Use appropriate filters

Use blood administration
set no more than 4 hours
infusion must be complete
in 4 hours
Check facility policy re: #
units per administration set
May give blood on a pumpuse pump tubing

Use appropriate filters

Product Features:

Patient protection against leukocyte-related

transfusion complications

Primes directly with red cells quickly and

conveniently
Patented filtration media and minimal hold-up
volume provides minimal loss of red cells

No saline prime or flush required

For intraoperatively
salvaged washed
blood

Reduces leukocytes
Decreases fat globules

Reduces microaggregates

Blood to cover filter

Use appropriate filters

for Platelets

Product Features:
Patient protection against leukocyte-related transfusion
complications
Primes directly with platelets quickly and conveniently
High platelet recovery achieved without saline flush

Critical Points

Critical Points

Client indentification & blood compatability

Drip rate no higher than 2 cc per minute X 15
minutes (30 cc per 15 minutes or 120 cc/hr.)
Seton etc. set pump at 75 to 80 cc/hr. for 15 min.
Remain with pt for first 15 minutes
Vital signs prior to administration, in 15 minutes, then
q 30 minutes, until transfusion complete--then X 2hr
No meds or fluid other than NS to be given in line
with blood!!!
CHECK POLICY AND PROCEDURE of facility!!

Monitor for signs of transfusion reaction

Infuse over period specified (2-4 hours)
Blood cannot be out of refrigerator more than
30 minutes prior to administration PLAN
AHEAD!!
BE READY TO START BEFORE GETTING
BLOOD!!
Allow blood to hang no longer than 4 hours
If multiple units to be given for replacement
of rapid blood loss, may be given under
pressure and warmed prior to administration
(only agency approved warming device)

Febrile

Transfusion Reactions/Complications

pyrogenic /non-hemolytic

Febrile (most common)

Sensitization to donor WBC, platelets, plasma
proteins
Allergic (hypersensitivity to donor plasma proteins)
Mild allergic to severe (anaphylactic)
Hemolytic (life-threatening!)
Acute hemolytic: ABO incompatible; red cell
destruction (wrong blood type given to pt)
*Circulatory overload
Fluid given too fast & too much
Iron overload- delayed reaction
Hypocalcemia- citrate in blood binds with calcium &
is excreted
Bacterial (pyrogenic or sepsis) (not in text)

Caused by leukocyte
incompatibility; sudden
onset: usually within first
15 minutes of transfusion!
(usually a reaction to donor WBCs or
plasma proteins)

Fever/chills (^1 degree)

Sensations of Cold
Flushed skin, abdominal pain,
vomiting and diarrhea
Hypotension/Shock

Prevent by use of leukocyte

poor blood!
Stop infusion/antipyretics

Transfusion of bacterially infected components

Allergic Reactions
(Hypersensitivity reactions)
Antibodies in patients blood react
against proteins, such as
immunoglobulin A in donor blood
May occur during or after the
transfusion
Can occur quickly, within 50mls of
blood administered
Mild and transient: stop infusion,
possibly restart, give antihistamine
prophylactically, use washed RBCs
Severe: stop infusion, keep line open
with new saline tubing; CPR &
epinephrine (if indicated)
DO NOT RESTART TRANSFUSION

to febrile; due to bacterial

contamination of blood:
see S & S above

Hemolytic/Transfusion Reaction!
Most dangerous!
Develops within first 15 minutes of
transfusion: free hemoglobin in blood and
urine specimens provide evidence of acute
hemolytic reaction; delayed at 2-14 days

Mild (initially) (1% of pts.)

*Urticaria
Pruritis
Itching
Severe (Anaphylactic)
Anxiety
Wheezing & Chest tightness
Dyspnea
Bronchospasm
Hypotension
Tachycardia
Swelling of tongue, face
Loss of consciousness
Shock, pulmonary edema

**Bacterial (pyrogenic): similar

Occurs in 1:25,000
Usually occurs after 50-100 ml blood
infused! (possibly 200mls)

ABO/Blood incompatibility
*RBCs clump (lysis of RBCc), block
capillaries, decrease blood flow to organs.
Hgb released (myogloburia), blocks renal
tubules > acute renal failure=ATN (acute
tubular necrosis)
Potassium released

Fever/chills
SOB/dyspnea/wheezing
Apprehension
Headache/low back pain
Chest pain/chest
tightness
Urticaria
Tachycardia
N&V
*Hematuria
Burning at IV site

Hemolytic/Transfusion Reaction!

Hemolytic Reactions

If hemolytic reaction occurs:

Stop transfusion, keep IV line open
with new tubing, saline, colloid
solution to maintain BP; monitor

Key Indicators:

Notify MD of patient signs and symptoms

Treat shock (anaphylactic) if present

(epinephrine, oxygen, antihistamines,
vasopressors, fluids, corticosteroids)

Draw blood samples for serologic

testing; send urine to
lab and return blood tubing to
blood bank for free Hgb testing
Prevent acute renal failure: give
diuretic, fluid challenge

Stop the blood, send tubing and

remaining blood to lab; urine to lab!

Follow facility policy and procedure

for administering blood, blood
products and transfusion reaction!

*Circulatory overload
Fluid given too fast & too much
Note cough, dyspnea, lung sounds, HTN etc
Slow infusion, elevate HOB, treat overload,
phlebotomy
Iron overload
Delayed reaction
Vomiting diarrhea, hypotension, altered
hematological values
Administer deferoxamine (Desferal) Iv to remove
accumulated iron via the kidneys (urine red)
Hypocalcemia
Citrate in blood binds with calcium & is excreted
Check lab values
Also hyperkalemia: stored blood liberates potassium
through hemolysis (older blood greater risk for
hemolysis)

Acute-usually occurs after

50 ml. infused

Nursing actions if reaction

occurs

Stop transfusion immediately

Continue N/S IV with new tubing
Provide appropriate care for client
Notify physician of clients signs and
symptoms
Follow facility policy and procedure
Obtain urine specimen for free
hemoglobin test

Autologous transfusion

Fever/chills
Burning at IV site
Low back pain
Hypotension

Lewis can occur within infusion of as little as 10mls

Reactions/Complications

Apprehension
Headache
Chest pain
Tachycardia
Urticaria
N/V

Autotransfusion

What are the benefits of Autologous transfusion?

Indications

Blood you receive should definitely match yours.

Risk of getting any allergic reaction will be very

low.
Blood will be available if you have a rare blood
type.
No infectious diseases - hepatitis, syphilis, AIDS,
etc.
Safe and well-tested procedure.

Used in surgery & emergency

settings
Autologous blood-collection of
own blood prior to scheduled
surgery or in emergency
situation (blood salvage; cell
saver)

Risks and Benefits

Requires special
equipment
No T&C needed
If pre-donation, begin
collection within 5
weeks of transfusion
date end at least 3
days prior to
transfusion need

Cell-saver" technology collects blood

lost during surgery, cleanses it, and

places it back in the patient's body, all in
a continuous loop.