Blood and Blood Products

Whole Blood n Contents –RBC’s –WBC’s –Platelets –Plasma –Clotting factors

Whole Blood n Indications –Acute loss of whole blood

Packed Cells n Contents –RBC’s –20% Plasma n Indications –Replace O 2 carrying capacity with less volume –Severe anemia, slow blood loss, CHF

GranulocytesGranulocytes n Contents –WBC’s –20% Plasma n Indications –Life-threatening decreases in WBC count

PlateletsPlatelets n Contents –Platelets –WBC’s –Plasma n Indications –Low platelet counts

PlasmaPlasma n Contents –Clotting factors –Fibrinogen –Prothrombin –Albumin –Globulins

PlasmaPlasma n Indications –Clotting factor deficiency –Volume expansion

Plasma Protein Fraction n Contents –5% Albumin/Globin in saline n Indications –Expand volume in burns –Hemorrhage –Hypoproteinemia

AlbuminAlbumin n Contents –5% or 25% albumin n Indications –Replace volume in shock –Burns –Hypoproteinemia

CryoprecipitateCryoprecipitate n Contents –Factors VIII and XIII, Fibrinogen n Indications –Hemophilia A –Fibrinogen deficiency –Factor XIII deficiency

ProthrombinProthrombin n Contents –Factors II, VII, IX, and X n Indications –Hemophilia B –Liver disease

Blood Transfusion

n Blood must be typed prior to administration

Blood Transfusion n ABO Antigens –A Antigen Type A –B Antigens Type B –A and B Antigens Type AB –No Antigens Type O

Blood Transfusions n Plasma Antibodies Agglutinate (Clump) Cells of other Types

Blood Transfusions n Type A = B Antibodies –(Clumps B or AB) n Type B = A Antibodies –(Clumps A or AB)

Blood Transfusions n Type AB = No Antibodies –(Clumps Nothing) n Type O = A and B Antibodies –(Clumps everything except O)

Blood Transfusions n O Negative = Universal Donor n AB Positive = Universal Recipient

Blood Transfusions n Rh Factor –85% of Population »Rh Positive –15% of Population »Rh Negative

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

Blood Transfusions n 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

Blood Transfusions n Erythroblastosis Fetalis –Prevented by administration of Rhogam to mother

Transfusion Complications

FeverFever n Most common reaction n Donor WBC incompatabilities n Antipyretics

Allergic Reactions n Signs/Symptoms –Itching –Uticaria –Chills –Fever –Facial edema –Wheezing –Anaphylactic shock

Allergic Reactions n Management –Oxygen –IV fluids –Epinephrine –Antihistamines

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

Hemolytic Reaction n Management –Stop transfusion –Treat shock –Volume replacement –Mannitol

Volume Overload n Signs/Symptoms –Cough –Chest pain –Dyspnea –Distended neck veins –Rales –Frothy sputum

Volume Overload n Management –Slow infusion –Diuretics –Vasodilators

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

Transfusion Complications n Acid/Base Imbalances –Banked blood gradually acidifies n Poor tissue Oxygenation –Loss of 2,3 DPG

Transfusion Complications n Hypothermia –Inadequate warming during transfusion n Viral Hepatitis –Risk rises with each unit

Blood Transfusion n IV catheter 18g or larger n No fluid other than saline –D 5 W lyses RBC’s –LR contains calcium/triggers clotting n Two persons confirm ABO/Rh n Blood filter in administration set

Blood Transfusion n Infusion pumps –Excessive pressure can cause hemolysis n Rewarming above 38 0 C can cause hemolysis n Never add medications directly