Blood Transfusions

Blood Transfusion Therapy Verify identity of recipient and of donor’s blood group Monitor vital signs Use appropriate filter Use blood within 30 minutes of arrival Infuse over 4 hours maximum 2

Transfusion Reactions Hemolytic: the most severe, but rare Febrile reactions: fever, chills Allergic reaction: urticaria, pruritus, laryngeal edema Air emboli: may occur when blood is transfused under pressure Hypothermia Electrolyte disturbances: hyperkalemia from massive transfusions or patient with renal problems 3

Delayed Reactions to Blood Transfusion Transmission of infection: Hepatitis, HIV, malaria, syphilis, other Blood banks test vigorously and discard units of infected blood Delayed hemolytic reaction: Destruction of RBCs and fever 5-10 days after transfusion Observe for posttransfusion anemia 4

Apheresis Definition: removal of blood from an individual; separation of the blood into its components Nursing considerations 5

Allogeneic Bone Marrow Transplant (BMT) Involves matching histocompatible donor with recipient Limited by presence of suitable marrow donor 7

Umbilical Cord Blood Stem Cell Transplantation Rich source of hematopoietic stem cells for use in children with cancers Stem cells found with high frequency in circulation of newborns Benefit of umbilical cord blood is blood’s relative immunodeficiency at birth, allowing for partially matched unrelated cord blood transplants to be successful 8

Autologous BMT Uses patient’s own marrow collected from disease-free tissue, frozen, and sometimes treated to remove malignant cells Has been used to treat neuroblastoma, Hodgkin disease, NHL, Wilms tumor, rhabdomyosarcoma, and Ewing sarcoma 9

Peripheral Stem Cell Transplants (PSCT) A type of autologous transplant Different type of collection from patient Stimulate production of high number of stem cells, then collect stem cells by an apheresis machine 10

Peripheral Stem Cell Transplants (PSCT) Stem cells separated from whole blood Remaining blood cells and plasma returned to patient after apheresis Stem cells frozen for later transfusion to patient 11

Family Concerns Difficult decision for HSCT transplant Child faces death without transplant Preparing child for transplant places child at great risk No “rescue” procedure if complications follow HSCT transplants Nursing considerations 12

Administration of Blood and Blood Products Identify the child and verify blood with another nurse Take v/s including blood pressure before administering blood, then q 15 minutes for the first 2 hrs, then q 30 minutes thereafter until infusion is complete

Administration of Blood and Blood Products Administer blood with normal saline on a piggyback setup, through an appropriate filter Use blood within 30 minutes of its arrival form the blood bank Check blood products-products that appear purplish or are bubbling should not be used because of risk of bacterial contamination The rate of infusion of packed RBC’s is approximately 5 ml/kg/hr over not ore than 4 hours

Administration of Blood and Blood Products Run transfusion slowly x first 15 minutes; monitor closely for transfusion reaction during this time period During administration of blood or blood products, the child and parents should be instructed to notify the nurse immediately if the child feels “bad”, or has fever or chills, headache, nausea, pain at he needle site, or difficulty breathing

Administration of Blood and Blood Products In neonates and small infants, auscultate the lungs before and frequently during a transfusion to detect signs of respiratory distress form fluid overload If reaction is suspected, stop the transfusion immediately and infuse normal saline through new tubing, notify MD and continue to monitor v/s and hourly urine output Send samples of child’s blood to lab

Blood Component Therapy Administration Procedure Large bore needle 19 gauge or higher Blood Tubing “Y type” Microaggregate filter Isotonic Solution Normal Saline Strict Identification process

Blood Component Therapy Red Blood Cell Transfusions One unit contains ~ 200 ml red blood cells 100 ml storage solution 30 ml plasma Must be ABO/Rh compatible In dire emergencies O- can be used Do not provide viable platelets nor do they contain significant amounts of coagulation factors

Blood Component Therapy Red Blood Cell Transfusions Indications Pts with symptomatic anemia who are not treatable with specific therapy such as iron, vitamin B12, folic acid or Erythropoietin Therapeutic Effect In 70 kg adult, each unit should increase hematocrit by 3-4%

Blood Component Therapy Platelets Platelet concentrate contains ~: Platelets concentrated by centrifuging whole units of blood 60 ml plasma Small numbers of RBCs and WBCs Pooled platelets Up to 8 units of platelets from separate donors can be pooled into single bag for transfusion Expire 4 hours after pooling

Blood Component Therapy Platelets Platelet Phoresis Collected from a single donor. Equivalent to ~4 pooled units Contains 200-400ml of plasma Expire 4 hours after processing for release Indications Prevent bleeding d/t thrombocytopenia Bleeding Abnormal platelet function

Blood Component Therapy Fresh Frozen Plasma (FFP) One unit of FFP is plasma taken from one unit of whole blood FFP contains all coagulation factors One unit ~ 250 ml Must be ABO compatible, Rh factor is not considered Thawed plasma may be transfuse for 5 days after thawing Indications Documented coagulation factor deficiencies (r/t liver disease, Warfarin, DIC) Active bleeding

Blood Component Therapy Cryoprecipitate (Cryo) Prepared from plasma and contains fibrinogen 1 bag contains ~350 mg Fibrinogen Pooled = 6 bags or 2100 mg Fibrinogen Indications Bleeding Immediately prior to invasive procedures

Blood Component Therapy Blood Transfusion Reactions Acute Transfusion Reactions Acute hemolytic reactions d/t antibodies in ABO antigen system May cause acute renal failure, DIC Treatment: fluids, diuresis, support for bleeding Most errors are clerical or d/t patient misidentification Febrile reactions D/t sensitization on cell components (usually leukocytes) Treatment: leukocyte depleted RBCs

Blood Component Therapy (cont.) Allergic reactions Most common D/t proteins on donor’s plasma Treatment: pre-transfusion treatment with antihistamines or steroids Circulatory overload Sepsis Delayed Transfusion Reactions Autotransfusion