1. Blood Transfusions

2. 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

3. 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

4. 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

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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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%

20. 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

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

22. 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

23. 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

24. 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

25. 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