Transfusion Therapy Principles of IV Therapy BSN336

Basic Immunohematology  The science that deals with antigens of the blood and their antibodies Genetically inherited Atigens on the RBC’s are  A, B, AB, and the absence of Antigens, O

Basic Immunohematology  Antigens on the RBC’s are:  A, B, AB, and the absence of Antigens, O  Rh system: 2 nd most important RBC antigen is the D antigen 5 principle antigens are:  D, C, E, c, and e  Presence of the D antigen = Rh positive  Absence of the D antigen = Rh negative

Basic Immunohematology  HLA antigen Present on most cells in the body Important in patients with transplants or multiple transfusions and paternity typing Possible cause of hemolytic transfusion reactions Implicated along with granulocyte and platelet specific antibodies in nonhemolytic transfusion reactions.

Basic Immunohematology  Antibodies (Agglutinins) Agglutinins in that particulate antigens, such as other cells, adhere to one another in response to a specific antigen  Anti-A, Anti-B, Develop within the first 3 months of life. Produced spontaneously  Naturally occurring antibodies that agglutinate erythrocytes containing corresponding antigens in a saline solution  Naturally occurring antibodies in the blood or immunoglobulin

Blood Donor Testing  ABO group and Rh type As well as other RBC antibodies  Specific screening tests: Hepatitis B surface antiben(HBxHg) Hepatitis B core antibody (anti-HBc) Hepatitis C virus antibody (anti-HCv) HIV-1 and HIV-2 antibody (anti-HIV-1 and anti- HTV-2) Serology for syphilis Nucleic aid amplification testing (NAT)for HIV-1 and HCV NAT for West Nile Virus (WNV)

Blood Donor Testing  Recipients tested for ABO and Rh Antibody screening and compatibility testing Blood bank has 2 objectives  Prevent antigen-antibody reactions in the body  Identify antibody that the recipient may have and to supply blood that lacks the corresponding antigen

Blood Donor Collections Methods  Homologous: someone other than the recipient  Autologous: the patients own blood No age limits Underweight patients not excluded Drawn a week prior to need

Blood Donor Collections Methods  Types: Predeposit or Preoperative Acute Normovolemic Memodilution Intraoperative Blood Salvage Postoperative Salvage  Designated

Blood Component Therapy

 Whole Blood RBC’s, Plasma, WBC’s and platelets 500 mL, 200mL RBC’s. 300mL plasma No longer necessary

Blood Component Therapy  Red Blood Cells Packed RBC volume of approximately 300mL Advantages:  Decreased plasma volume  Decreased risk of circulatory overload  Less citrate, potassium, ammonia, and other metabolic by products are transfused

Blood Component Therapy  Leukocyte-Reduced Red Blood Cells Modified blood products Filtered with a special filter Prevention of febrile, nonhemolytic transfusion reactions  Deglycerolized Red Blood Cells Allows for freezing for long term storage  Rare units  Autologous donor units

Blood Component Therapy  Irradiated Blood Products Donor lymphocytes become incapable of replication  Prevention of graft-versus-host disease (GVHD)  Acute leukemia and lymphoma  Bone marrow or stem cell transplant  Immunodeficiency disorders  Neonates and low-birth weight infants

Blood Component Therapy  Granulocytes Replaced by neupogen  Platelets Random-donor concentrates or single-donor concentrates  Plasma and Fresh Frozen Plasma Liquid used to replace plasma proteins lost from injury FFPlasma provide replacement coagulation factors

Blood Component Therapy  Cryoprecipitate Hypofibrinogenemia  Massive transfusion  Congenital deficiency  Acquired deficiency (DIC) Factor VIII deficiency Uremia with bleeding Dysfunctional fibrinogen

Blood Component Therapy  Albumin Plasma protein supplies 80% of plasma’s osmotic activity  Plasma Protein Fraction (PPF)

Administration of Blood Components 1.Verifying the Physician’s Order 2.Blood typing and Crossmatching the Recipient 3.Selecting and Preparing the Equipment 1.Catheters 2.Solution 3.Administration Set 4.Special Filters 5.Fluid/Blood Warmers

Administration of Blood Components 5.Preparing the patient 6.Obtaining blood product from the blood bank 7.Preparing for Administration 8.Initiating transfusion 9.Monitoring the Transfusion 10.Discontinuing the Transfusion

Complications  Acute Hemolytic Reaction Acute or delayed Result of clerical errors,  Incorrect labeling of the blood specimen  Not identifying the right patient  Delayed Hemolytic Reaction  Nonhemolytic Febrile Reaction  Allergic Reaction: Mild  Allergic Reaction: Sever, Anaphylactic Reaction

Complications  Alloimmunization and Refractoriness  Graft-Versus-Host Disease  Non immune Reactions Circulatory Overload Potassium Toxicity (Hyperkalemia) Hypothermia Citrate Toxicity: Hypocalcemia Bacterial Contamination

Transfusion-Transmitted Diseases  Hepatitis  Cytomegalovirus (CMV)  Human Immunodeficiency Virus  West Nile Virus  Creutzfeldt-Jakob Disease  Variant Creutzfeldt-Jakob Disease Mad Cow disease  Severe Acute Respiratory Syndrome  Smallpox  Parasitic infections Parasitic infections

Phlebotomy Technique 1.Preparation of the healthcare worker 2.Assessing the patient’s physical disposition 3.Identifying the patient 4.Approaching the patient 5.Selecting a puncture site 6.Selecting and preparing equipment and supplies

Phlebotomy technique (cont) 7. Preparing the puncture site 8. Choosing a venipuncture method 9. Collecting the samples in the appropriate tubes and in the correct order 10. Labeling the samples 11. Assessing the patient after withdrawal of the blood specimen

Phlebotomy technique (cont) 10. Labeling the samples 11. Assessing the patient after withdrawal of the blood specimen 12. Considering any special circumstances that occurred during the phlebotomy procedures 13. Assessing criteria for sample recollection or rejection 14. Prioritizing patients and sample tubes.

Test Requisitions  Patients full name  Patient’s identification or medical record number  Patients date of birth  Types of test to be performend  Date of test  Room number and bed (if applicable)  Physician’s name and/or code

Test Requisitions  Test Status (timed, stat, fasting, etc.)  Billing information (optional)  Special precautions (potential bleeder, faints easily, HIV, HepB or C