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Questions and Answers
Why is a large-bore IV catheter (18-20 gauge) preferred for blood product transfusions?
Why is a large-bore IV catheter (18-20 gauge) preferred for blood product transfusions?
- To reduce the risk of graft-versus-host disease.
- To ensure appropriate flow rate of the blood product. (correct)
- To minimize the risk of allergic reactions.
- To prevent iron overload during the transfusion.
A patient with type O blood can receive blood from any ABO blood type due to being a universal recipient.
A patient with type O blood can receive blood from any ABO blood type due to being a universal recipient.
False (B)
Match the following blood products with their primary indication:
Match the following blood products with their primary indication:
Platelets = Treatment of thrombocytopenia Plasma (FFP) = Correction of coagulation disorders Cryoprecipitate = Treatment of hemophilia or von Willebrand disease Albumin = Volume expansion in hypoalbuminemia
A patient receiving a blood transfusion develops a rash and itching. What is the most appropriate immediate action?
A patient receiving a blood transfusion develops a rash and itching. What is the most appropriate immediate action?
Autologous blood transfusion involves receiving blood from a compatible donor.
Autologous blood transfusion involves receiving blood from a compatible donor.
Match the following transfusion reactions with their primary symptoms:
Match the following transfusion reactions with their primary symptoms:
Which blood type is considered the universal recipient?
Which blood type is considered the universal recipient?
Rh-positive patients can only receive Rh-positive blood.
Rh-positive patients can only receive Rh-positive blood.
Name two vital signs that should be monitored during and after a blood transfusion.
Name two vital signs that should be monitored during and after a blood transfusion.
__________ is a late complication of multiple blood transfusions, leading to organ damage due to excess iron accumulation.
__________ is a late complication of multiple blood transfusions, leading to organ damage due to excess iron accumulation.
Match the management strategies with the corresponding transfusion reaction:
Match the management strategies with the corresponding transfusion reaction:
An Rh-negative female patient of childbearing age requires a blood transfusion. Which type of blood product is MOST appropriate to administer?
An Rh-negative female patient of childbearing age requires a blood transfusion. Which type of blood product is MOST appropriate to administer?
Prior to initiating a blood transfusion, which of the following actions is MOST critical for the nurse to perform to ensure patient safety?
Prior to initiating a blood transfusion, which of the following actions is MOST critical for the nurse to perform to ensure patient safety?
Which of the following is the MOST appropriate intervention for a patient experiencing circulatory overload during a blood transfusion?
Which of the following is the MOST appropriate intervention for a patient experiencing circulatory overload during a blood transfusion?
A patient with a history of severe allergic reactions requires a blood transfusion. What specific action should the nurse and provider consider to minimize the risk of an allergic reaction?
A patient with a history of severe allergic reactions requires a blood transfusion. What specific action should the nurse and provider consider to minimize the risk of an allergic reaction?
A patient undergoing chemotherapy has a critically low platelet count. Which blood product is MOST likely to be administered?
A patient undergoing chemotherapy has a critically low platelet count. Which blood product is MOST likely to be administered?
Following a traumatic injury, a patient has experienced significant blood loss and requires a transfusion to increase their oxygen-carrying capacity. Which blood product is MOST appropriate?
Following a traumatic injury, a patient has experienced significant blood loss and requires a transfusion to increase their oxygen-carrying capacity. Which blood product is MOST appropriate?
A patient receiving long-term blood transfusions for a chronic condition is at risk for iron overload. Which intervention is MOST important to monitor and manage this complication?
A patient receiving long-term blood transfusions for a chronic condition is at risk for iron overload. Which intervention is MOST important to monitor and manage this complication?
A patient exhibits sudden respiratory distress, severe hypoxemia, and bilateral pulmonary infiltrates during a blood transfusion. What transfusion reaction is MOST likely occurring?
A patient exhibits sudden respiratory distress, severe hypoxemia, and bilateral pulmonary infiltrates during a blood transfusion. What transfusion reaction is MOST likely occurring?
Why is a crossmatch test performed prior to a blood transfusion?
Why is a crossmatch test performed prior to a blood transfusion?
A patient with a known allergy to sulfa drugs is about to receive a blood transfusion. What is the MOST important pre-transfusion assessment to perform?
A patient with a known allergy to sulfa drugs is about to receive a blood transfusion. What is the MOST important pre-transfusion assessment to perform?
During a blood transfusion, a patient develops sudden onset of fever, chills, and flank pain. What is the MOST likely type of transfusion reaction occurring?
During a blood transfusion, a patient develops sudden onset of fever, chills, and flank pain. What is the MOST likely type of transfusion reaction occurring?
Which action is MOST important for the nurse to take when a patient is suspected of experiencing a transfusion reaction?
Which action is MOST important for the nurse to take when a patient is suspected of experiencing a transfusion reaction?
A patient receiving a blood transfusion suddenly develops a cough, shortness of breath, and elevated blood pressure. Which complication is MOST likely?
A patient receiving a blood transfusion suddenly develops a cough, shortness of breath, and elevated blood pressure. Which complication is MOST likely?
What is the primary purpose of using an in-line filter during blood product administration?
What is the primary purpose of using an in-line filter during blood product administration?
Which of the following blood products would be MOST appropriate for a patient undergoing an autologous blood transfusion?
Which of the following blood products would be MOST appropriate for a patient undergoing an autologous blood transfusion?
Irradiated blood products are MOST often used for patients at risk for which of the following transfusion complications?
Irradiated blood products are MOST often used for patients at risk for which of the following transfusion complications?
A patient receiving a blood transfusion develops respiratory distress, severe hypoxia, and bilateral pulmonary infiltrates. Which transfusion reaction is MOST likely occurring
A patient receiving a blood transfusion develops respiratory distress, severe hypoxia, and bilateral pulmonary infiltrates. Which transfusion reaction is MOST likely occurring
Where can Red blood cell be stored
Where can Red blood cell be stored
When is an order for transfusion NOT required
When is an order for transfusion NOT required
You are collecting a pre-transfusion blood sample from the patient. Select
all that are correct.1. The sample tube must be labeled before drawing the blood sample.
2. The sample label must have at least the patient’s name and another
unique identifier.
3. The sample label must be checked against the patient’s chart not the
armband as it might be wrong.
4. When possible the patient should participate in the identification process.
5. The sample must be labeled in the presence of the patient.
You are collecting a pre-transfusion blood sample from the patient. Select all that are correct.1. The sample tube must be labeled before drawing the blood sample. 2. The sample label must have at least the patient’s name and another unique identifier. 3. The sample label must be checked against the patient’s chart not the armband as it might be wrong. 4. When possible the patient should participate in the identification process. 5. The sample must be labeled in the presence of the patient.
A 17 year old female is admitted to Emergency after being hit by a car. She requires
an immediate Red Blood Cell transfusion for active bleeding before her blood
group can be determined. Which blood group is appropriate for this patient?
A 17 year old female is admitted to Emergency after being hit by a car. She requires an immediate Red Blood Cell transfusion for active bleeding before her blood group can be determined. Which blood group is appropriate for this patient?
Serious reactions such as acute hemolytic transfusion reaction usually present more than 6 hours after the completion of the transfusion
Serious reactions such as acute hemolytic transfusion reaction usually present more than 6 hours after the completion of the transfusion
When administering a transfusion, the blood should initially be started slowly to
When administering a transfusion, the blood should initially be started slowly to
You assess Luke white after the first 15 minutes of his transfusion and notice a red rash appearing on his chest and upper arms. What do you do first?
You assess Luke white after the first 15 minutes of his transfusion and notice a red rash appearing on his chest and upper arms. What do you do first?
which blood product is used to control significant bleeding in a patient who has been taking daily ASA
which blood product is used to control significant bleeding in a patient who has been taking daily ASA
Which of the following can cause hemolysis of transfused blood? Select all that apply
Which of the following can cause hemolysis of transfused blood? Select all that apply
You began transfusing Bela Lugosi at 11:30 a.m. When should you next assess the
patient and repeat his vital signs?
You began transfusing Bela Lugosi at 11:30 a.m. When should you next assess the patient and repeat his vital signs?
The best way to spike a blood product is to hang it from the IV pole?
The best way to spike a blood product is to hang it from the IV pole?
You began transfusing Mary Bloodworthy at 9:00. It is now 13:00 and Mary’s unit
of blood is ¾ transfused. What do you do?
You began transfusing Mary Bloodworthy at 9:00. It is now 13:00 and Mary’s unit of blood is ¾ transfused. What do you do?
You are checking platelets prior to starting a transfusion. The patient’s name
on the BTL label reads “Joseph White”, but his armband reads “Josef L. White”.
What should you do?
You are checking platelets prior to starting a transfusion. The patient’s name on the BTL label reads “Joseph White”, but his armband reads “Josef L. White”. What should you do?
Which patients should be pre-medicated with an antihistamine prior to
transfusion?
Which patients should be pre-medicated with an antihistamine prior to transfusion?
Which of the following requires transfusion through a blood tubing?
Which of the following requires transfusion through a blood tubing?
Luke White’s platelet transfusion has just finished. Suddenly he says he can’t
breathe and collapses in his chair. Which type of acute transfusion reaction
can present with dyspnea?
Luke White’s platelet transfusion has just finished. Suddenly he says he can’t breathe and collapses in his chair. Which type of acute transfusion reaction can present with dyspnea?
Select all that are CORRECT:
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- Before starting blood check patient armband against BTL label/tag.
Check blood with the patient’s chart in the case of an outpatient transfusion.
Allow the blood to reach room temperature so as not to cause chills.
Blood tubing must be primed with D5W only.
Blood must be started soon after it is received.
Select all that are CORRECT:
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- Before starting blood check patient armband against BTL label/tag. Check blood with the patient’s chart in the case of an outpatient transfusion. Allow the blood to reach room temperature so as not to cause chills. Blood tubing must be primed with D5W only. Blood must be started soon after it is received.
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A 34 year old female requires immediate surgery for a perforated bowel. She has
liver disease and her INR is 3.0. The physician has ordered 3 units of plasma. The
patient’s blood group is B negative. You are checking the first unit of plasma and
the group is B. What is the next step?
A 34 year old female requires immediate surgery for a perforated bowel. She has liver disease and her INR is 3.0. The physician has ordered 3 units of plasma. The patient’s blood group is B negative. You are checking the first unit of plasma and the group is B. What is the next step?
Signs and symptoms that may be associated with a transfusion reaction include: ( Select all that apply
Signs and symptoms that may be associated with a transfusion reaction include: ( Select all that apply
Types of acute reactions
Types of acute reactions
Flashcards
Blood Replacement Products
Blood Replacement Products
Used to replace blood lost due to trauma, surgery, or medical conditions; include whole blood, RBCs, platelets, plasma, cryoprecipitate, and albumin.
Whole Blood
Whole Blood
Contains red blood cells, plasma, platelets, and clotting factors; used for significant blood loss.
Red Blood Cells (RBCs)
Red Blood Cells (RBCs)
Prepared from whole blood by removing plasma; used to increase oxygen-carrying capacity in patients with anemia or significant blood loss.
Platelets
Platelets
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Plasma (FFP)
Plasma (FFP)
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Cryoprecipitate
Cryoprecipitate
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Albumin
Albumin
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Transfusion Compatibility Principles
Transfusion Compatibility Principles
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ABO Compatibility
ABO Compatibility
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Rh Factor Compatibility
Rh Factor Compatibility
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Crossmatch
Crossmatch
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Autologous Blood Transfusion
Autologous Blood Transfusion
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Allergic Reactions (Transfusion)
Allergic Reactions (Transfusion)
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Febrile Non-Hemolytic Transfusion Reaction (FNHTR)
Febrile Non-Hemolytic Transfusion Reaction (FNHTR)
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Hemolytic Transfusion Reaction
Hemolytic Transfusion Reaction
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Pre-Transfusion Care
Pre-Transfusion Care
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Administering Blood Products
Administering Blood Products
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Post-Transfusion Assessment
Post-Transfusion Assessment
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Post-Transfusion Documentation
Post-Transfusion Documentation
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Iron Overload
Iron Overload
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Circulatory Overload
Circulatory Overload
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Graft-Versus-Host Disease (GVHD)
Graft-Versus-Host Disease (GVHD)
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Signs of Allergic Reaction
Signs of Allergic Reaction
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Signs of FNHTR Reaction
Signs of FNHTR Reaction
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Signs of Hemolytic Reaction
Signs of Hemolytic Reaction
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TRALI Signs and Response
TRALI Signs and Response
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Study Notes
- Blood replacement products are used to replace blood lost due to trauma, surgery, or medical conditions.
Whole Blood:
- Contains red blood cells, plasma, platelets, and clotting factors.
- Rarely used due to its high volume; primarily for significant blood loss (e.g., trauma, surgery).
Red Blood Cells (RBCs):
- Prepared from whole blood by removing plasma.
- Used to increase oxygen-carrying capacity in patients with anemia or significant blood loss.
- Usually given to patients with hemoglobin levels below a certain threshold.
Platelets:
- Used to treat or prevent thrombocytopenia (low platelet count), usually in conditions like leukemia or after chemotherapy.
- Often given to patients with bleeding risks or active bleeding due to platelet deficiency.
Plasma (Fresh Frozen Plasma - FFP):
- Contains water, electrolytes, proteins, hormones, and waste products.
- Used for coagulation disorders, liver disease, or to replace clotting factors in bleeding patients.
Cryoprecipitate:
- A component of plasma that contains clotting factors, including fibrinogen.
- Used for patients with bleeding disorders, particularly hemophilia or von Willebrand disease.
Albumin:
- A protein derived from plasma.
- Used for volume expansion and to maintain blood pressure in patients with severe hypoalbuminemia (e.g., burns, liver disease).
Transfusion Compatibility Principles
- Compatibility between blood products and the patient’s blood is crucial to prevent harmful reactions.
Blood Typing:
- Blood type is categorized by the ABO system (A, B, AB, or O) and Rh factor (positive or negative).
ABO Compatibility:
- Type A: Can receive A or O.
- Type B: Can receive B or O.
- Type AB: Can receive A, B, AB, or O (universal recipient).
- Type O: Can only receive O (universal donor).
Rh Factor Compatibility:
- If a patient is Rh-positive, they can receive Rh-positive or Rh-negative blood.
- If a patient is Rh-negative, they should receive Rh-negative blood to prevent sensitization, especially in women of childbearing age.
Crossmatch:
- A crossmatch test is done before transfusion to ensure compatibility between donor blood and the recipient’s blood.
- A major crossmatch tests the recipient’s plasma against donor red cells, while a minor crossmatch tests the recipient’s red cells against donor plasma.
Autologous Blood Transfusion:
- The patient donates their own blood before surgery, which is then reinfused during or after the procedure.
- For patients who prefer not to receive donor blood due to religious or personal reasons.
Pre-Transfusion Care:
- Verify orders: Confirm the transfusion order, blood product, and patient’s compatibility.
- Pre-transfusion vital signs: Measure baseline vital signs (temperature, heart rate, blood pressure, respiratory rate).
- Confirm identity: Use two patient identifiers (e.g., name, date of birth) to verify the patient and blood product.
- Assess for allergies: Ensure the patient has no history of reactions to blood products.
- Ensure IV Access: A large-bore IV catheter (18-20 gauge) is preferred for blood product transfusion to ensure appropriate flow.
- Use a blood administration set: Blood products should be administered with an in-line filter to prevent clots from entering the bloodstream.
- Infusion Rate: Start the transfusion slowly, typically over 2 hours, and observe the patient closely during the first 15 minutes.
- Monitor for Reactions: Continuously assess for signs of adverse reactions during transfusion.
Post-Transfusion Care:
- Vital Signs: Measure vital signs at intervals (e.g., 15 minutes after transfusion starts, hourly during transfusion, and at the end).
- Monitor for Reactions: Check the patient for signs of transfusion reactions (e.g., fever, rash, back pain, shortness of breath).
- Assess the IV Site: Check for signs of infiltration or phlebitis.
- Record the type of blood product, amount transfused, start and finish times, and any adverse reactions in the medical record.
Potential Complications of Blood Product Administration
Allergic Reactions:
- Symptoms: Rash, urticaria, fever, itching, or anaphylaxis (severe reactions).
- Management: Stop the transfusion immediately, maintain IV access with saline, and notify the healthcare provider. Antihistamines may be ordered for mild reactions.
Febrile Non-Hemolytic Transfusion Reaction (FNHTR):
- Symptoms: Fever and chills within 1-6 hours after transfusion.
- Cause: Immune response to white blood cells in the transfused blood.
- Management: Slow the transfusion, administer antipyretics, and monitor for further symptoms.
Hemolytic Transfusion Reaction:
- Symptoms: Fever, chills, chest or flank pain, dark urine, hypotension, tachycardia, and hemoglobinuria.
- Cause: ABO incompatibility, where the recipient’s immune system attacks transfused red blood cells.
- Management: Stop the transfusion immediately, maintain IV access with saline, and notify the healthcare provider. Send the blood bag and tubing to the lab for testing.
Iron Overload:
- Symptoms: Seen after multiple transfusions, causing liver damage, heart failure, or diabetes.
- Management: Regular monitoring of iron levels and use of iron chelation therapy if necessary.
Transfusion-Related Acute Lung Injury (TRALI):
- Symptoms: Sudden respiratory distress, hypoxemia, and bilateral pulmonary infiltrates.
- Cause: Immune response to leukocyte antigens in transfused blood.
- Management: Stop the transfusion, provide respiratory support, and notify the healthcare provider.
Graft-Versus-Host Disease (GVHD):
- Symptoms: Rash, fever, diarrhea, liver dysfunction.
- Cause: Donor T lymphocytes attack the recipient’s tissue.
- Management: This is rare but often fatal, and can be prevented by using irradiated blood products for immunocompromised patients.
Circulatory Overload:
- Symptoms: Cough, shortness of breath, hypertension, or pulmonary edema.
- Management: Slow the transfusion rate, monitor oxygen levels, and administer diuretics if necessary.
Recognizing and Responding to Common Transfusion Reactions
Allergic Reactions:
- Signs: Rash, hives, itching, or anaphylaxis.
- Response: Stop the transfusion immediately, maintain IV access with normal saline, notify the healthcare provider, and administer antihistamines or epinephrine as prescribed.
Febrile Non-Hemolytic Transfusion Reaction (FNHTR):
- Signs: Fever, chills, and malaise.
- Response: Slow the transfusion or stop, administer antipyretics, and monitor the patient for worsening symptoms.
Hemolytic Transfusion Reaction:
- Signs: Fever, chills, pain at the infusion site, chest or flank pain, dark urine.
- Response: Stop the transfusion immediately, maintain IV access with normal saline, notify the healthcare provider and send blood to the lab, administer fluids to maintain kidney function.
Transfusion-Related Acute Lung Injury (TRALI):
- Signs: Respiratory distress, hypoxia, bilateral pulmonary infiltrates on imaging.
- Response: Stop the transfusion immediately, provide respiratory support (e.g., oxygen, mechanical ventilation if needed), and notify the healthcare provider.
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