Blood Components & Products SV PDF

Blood Components and Products Nursing 488 Fall 2024 Catherine Fox MN, RN, CON(C) Lesson Objectives By the end of this lesson, you will be able to: Differentiate indications of various blood components/products. Review steps required for checking blood components/products. Review procedure for...

Blood Components and Products Nursing 488 Fall 2024 Catherine Fox MN, RN, CON(C) Lesson Objectives By the end of this lesson, you will be able to: Differentiate indications of various blood components/products. Review steps required for checking blood components/products. Review procedure for safe administration and monitoring of blood components/products. Identify complications/reactions of blood transfusions and the correct interventions for reaction management. Definitions Blood Components: Specific parts of whole blood used directly for transfusions. Includes: Red blood cells, plasma, platelets, cryoprecipitate. Blood Products: Derived from blood components with additional processing. Includes: Albumin, immunoglobulins, clotting factors. Blood Components Red Blood Cells (RBCs) Platelets Plasma Cryoprecipitate RBCs Indications Increase the oxygen-carrying capacity of the blood  indicated in patients with anemia who have evidence of impaired oxygen delivery Examples: Acute blood loss Chronic anemia and cardiopulmonary compromise Disease or medication effects associated with bone marrow suppression (Canadian Blood Services, 2020, 2023) Credit: Colourbox RBCs: Dose and Storage Dose Storage One unit of blood will typically increase Improper storage increases risk of bacterial hemoglobin concentration by approximately contamination and the efficacy of the product. 10g/l in an average, non-bleeding adult. Once on the unit and spiked you only have four hours to administer. (Canadian Blood Services, 2023) RBCs: ABO Compatibility ABO Compatibility A can receive from A or O. B can receive from B or O. AB can receive from A, B, AB, or O. O can receive only from O. Rh Factor (+/-) Positive goes with positive, but negative can go both ways Universal Donor = O-negative Universal Recipient = AB-positive  Blood Components: Platelets Smallest of the blood cells Main function is to mediate primary hemostasis Credit: Colourbox  Platelets Indication Bleeding, decreased platelet production or functionally abnormal platelets. May be given prophylactically if platelet count is falling.  Platelets Indication Prophylaxis for severe thrombocytopenia (e.g., chemotherapy, bone PLT < 10 x 10⁹/L marrow failure). PLT < 50 x 10⁹/L Active bleeding, surgery, or invasive procedures High-risk procedures or critical bleeding areas (e.g., brain, spinal cord). PLT < 100 x 10⁹/L Special conditions like ECMO or severe microvascular bleeding. Life-Threatening Transfusion required regardless of PLT count for severe cases in ITP or if Bleeding unresponsive to desmopressin.  Platelet Preparations Types Description Pooled Pooled Platelets are from four different donors with the same ABO blood group Apheresis Apheresis platelets are from a single donor. They offer the advantage of providing matched platelet products for specific indications. Apheresis platelet (left) and pooled platelet (right)  Platelets: ABO Compatibility & Storage ABO Compatibility Platelets have A and B antigens on their cell surface but do not express the Rh antigens. ABO identical or compatible platelets may not always be available. Storage Issued platelets must be infused immediately and must be maintained at Credit: Canadian Blood Services, 2017 room temperature (20–24°C ). Platelets must not be refrigerated. (AHS, Platelet Monograph, 2019)  Blood Components: Plasma Plasma is the liquid component of blood, rich in proteins and clotting factors, and plays a crucial role in managing various bleeding disorders. Contains clotting factors (e.g., Factors II, V, VII, IX, X), albumin, and immunoglobulins. Indications: Coagulation disorders (e.g., liver disease, massive transfusions). Warfarin reversal when bleeding or urgent surgery is required. Massive hemorrhage protocols in trauma or surgery. ABO compatibility is essential when transfusing plasma to prevent hemolytic reactions. Administered as fresh frozen plasma (FFP), which is thawed before use.  Blood Components: Cryoprecipitate Cryoprecipitate is a blood component rich in specific clotting factors, primarily used to manage bleeding in patients with coagulation disorders. Indications: Fibrinogen deficiencies Utilized in trauma or surgical settings to manage bleeding when fibrinogen levels are critically low. While ABO compatibility is preferable, especially for neonates and minor children, cryoprecipitate can be transfused with any ABO group when necessary. Cryoprecipitate is pooled from multiple donors to achieve an adequate dose for the patient. Blood Products Albumin Immunoglobulin Products Factor Concentrates  Used to restore and maintain circulating blood volume when Albumin using a colloid is clinically appropriate. Indications Hypoalbuminemia (e.g., chronic liver disease, malnutrition, or nephrotic syndrome) Burns and Trauma Hypovolemic Shock Cirrhosis and Ascites Dialysis-Related Hypotension Immunoglobulin Immunoglobulins are used to support or Products modify immune function. Indications Immunodeficiency: Replacement therapy Autoimmune Disorders: Modulates immune response Alloimmune Disorders: Prevents or treats conditions where the immune system reacts to foreign antigens. Factor Factor concentrates replace specific clotting factors, commonly Factor VIII Concentrates or IX, and are often genetically engineered. Indications: Hemophilia A and B: Replaces Factor VIII (Hemophilia A) or Factor IX (Hemophilia B) to prevent or control bleeding. Other Clotting Disorders: Used in rare clotting factor deficiencies based on the specific factor that is deficient. Transfusion Process  Pre-Transfusion Process What do you need prior to initiating a transfusion? Informed Consent Order Assessment Type and Screen/Crossmatch Baseline Vitals  Pre-Transfusion Process: Equipment For Administration IV access Filters: 170-260 micron for blood & platelets & vented unfiltered infusion set for bottled products Infusion line without med ports Y piece Normal Saline reaction line **Exception: for Intravenous Immune Globulin (IVIG) refer to the Transfusion Medicine Blood Product Information Sheets Vital signs machine & thermometer Emergency medications Emergency equipment Adult filtered infusion set  Steps for Checking Blood Confirm prior to or at bedside: Confirm at bedside: - patient identification on transfusion - Patient’s identification order matches patient identification - patient’s identification matches on component/product transfusion tag - blood component/product received - TSIN number on the tag matches is consistent with transfusion order the TSIN number on the band - Component/product number on container matches component/ product number on the tag - component/product is not expired - no abnormalities exist (leaks, hemolysis, particulates etc.) For blood components: - ABO-Rh on the component label matches the tag - ABO-Rh of the component is compatible with the patient ABO-Rh - Any special requirements (e.g. irradiated) (AHS, Transfusion of Blood Components and Products (Policy), 2021)  Patient Education and Monitoring Symptoms to report: Required Monitoring - hives or itching - feeling feverish or chills - difficulty in breathing - back pain or pain at the infusion site - any feeling different from usual Credit: AHS Blood Administration Procedure, 2022  Monitoring (Adult) Baseline vitals (must be within 15 minutes of initiating transfusion) For the first 15 minutes: Start initially with a slow rate AHS policy of 50 millilitres per hour (mL/h) Monitor your patient closely –remain at the bedside for the first 5 minutes After the first 15 minutes: Reassess your patient and repeat vital signs Increase flow to the prescribed rate if no reaction is observed Credit: Colourbox Returning Blood Components and Products Blood components (RBC, Plasma, Platelets, Cyroprecipitate) must be promptly returned to Transfusion Medicine/Lab if the infusion is not started within 60 minutes of delivery. Blood products must be returned to Transfusion Medicine/Lab as soon as possible in the event that the patient no longer requires the blood product.  Post Transfusion (Adults) 1. Complete transfusion within 4 hours of removal from controlled storage. 2. Flush IV line with normal saline to ensure full transfusion. 3. Disconnect blood tubing after transfusion. 4. Check and document end-of-transfusion vital signs. 5. Dispose of empty component and tubing per IPC policy or consult transfusion medicine if a reaction is suspected. 6. Document in the transfusion administration flowsheet. 7. An MPR should be completed with any patient education and/or adverse reactions and interventions (if any). Credit: Colourbox Overview of Transfusion Reactions Febrile Non-Hemolytic Reaction (FNHTR) Acute Hemolytic Transfusion Reaction (AHTR) Allergic Reactions (mild and severe) Transfusion-Related Acute Lung Injury (TRALI) Transfusion-Associated Circulatory Overload (TACO) Febrile and Hemolytic Reactions Reaction Signs and Symptoms Immediate Actions Management Febrile Non-Hemolytic Fever (38°C to 39°C) Stop transfusion Acetaminophen for Reaction (FNHTR) without other Notify transfusion fever symptoms medicine Premed with Recheck patient ID antipyretics if recurrent Acute Hemolytic Fever, pain, Stop transfusion Labs: CBC, electrolytes, Transfusion Reaction tachycardia, Notify transfusion coagulation (AHTR) hypotension, medicine Support renal function hemoglobinuria Monitor closely Allergic Reactions Reaction Signs & Symptoms Immediate Actions Management - Pause transfusion - Premed with Mild Allergic Reaction Itching, hives, rash - Administer antihistamine for future antihistamine transfusions if needed - Stop transfusion Hives, airway - Consult Transfusion Severe - Call emergency obstruction, Medicine Allergic/Anaphylactic response if necessary hypotension, - Consider special blood Reaction - Administer epinephrine respiratory distress components if severe Respiratory Complications Reaction Signs & Symptoms Immediate Actions Management - Stop transfusion - Supportive care Transfusion-Related Dyspnea, hypoxemia, - Provide oxygen (oxygen, ventilation) Acute Lung Injury respiratory distress support - Differentiate from (TRALI) within 6 hours - Emergency BACT or AHTR response if needed Transfusion- - Stop transfusion - Consider slower Dyspnea, cyanosis, Associated - Position upright infusion rate or hypertension, Circulatory Overload - Administer diuretics for high-risk pulmonary edema (TACO) diuretics patients Transfusion Reaction Management 1. Immediately stop the transfusion; Call for help! 2. Maintain the vascular access site using a new infusion set and compatible IV solution; 3. Assess vital signs; 4. Recheck patient ID band, TSIN band, and blood label 5. Notify the authorized prescriber (MRHP) and Transfusion Medicine / Laboratory of the suspected transfusion reaction; and 6. Ensure all blood components and blood products, blood tubing, solutions, and transfusion tags are retained until direction is received from Transfusion Medicine / Laboratory. (AHS, 2021)  Transfusion Reactions: Emergency Medications Transfusion-associated anaphylactic shock is rare! Treatment Stop the transfusion! Do not restart. Promptly administer ordered emergency medications Provide ventilatory support as indicated clinically. Emergency Medication  IM epinephrine is the first-line treatment for anaphylaxis as it is the only single medications that works on multiple body systems  Given in the vastus lateralis muscle Adjunct Medications Prevent or delay a biphasic anaphylactic reaction following the use of epinephrine to treat anaphylaxis  Diphenhydramine (decrease or relieve skin symptoms)  Corticosteroids (may be used to prevent or minimize biphasic anaphylactic reactions) Biphasic anaphylactic reaction is anaphylaxis that resolves after epinephrine is administered but  IV Fluids then the patient becomes symptomatic again up to 72 hours later (without further exposure to the allergen). Thank You! Credit: Colourbox  References Alberta Health Services (2020). Anaphylaxis Management: Administration of Intramuscular Epinephrine (Policy). https://extranet.ahsnet.ca/teams/policydocuments/1/clp-anaphylaxis-mgmt- epi-hcs-223.pdf Alberta Health Services (2018). Signs and Symptoms of Anaphylaxis. https://insite.albertahealthservices.ca/main/assets/tms/hpsp/tsm-hpsp-anaphylaxis-signs- symptoms.pdf Alberta Health Services (February 2022). Transfusion of blood components and products (policy). https://extranet.ahsnet.ca/teams/policydocuments/1/clp-prov-transfusion-blood-product-policy- ps-59.pdf Alberta Health Services (n.d.). Blood Component* ABO Compatibility Chart for Red Blood Cells and Plasma. https://www.albertahealthservices.ca/assets/wf/lab/if-lab-clin-tm-aborh-compatibility.pdf Alberta Health Services (2021). Acute Transfusion Reaction Chart. https://www.albertahealthservices.ca/assets/wf/lab/if-lab-clin-tm-trxn-chart.pdf Alberta Health Services (2022). Red Blood Cells, Leukocyte Reduced. https://www.albertahealthservices.ca/assets/wf/lab/if-lab-clin-tm-rbc.pdf Alberta Health Services (2022). Platelets, Leukocyte Reduced. https://www.albertahealthservices.ca/assets/wf/lab/if-lab-clin-tm-platelets.pdf  References Canadian Blood Services (2023). Clinical Guide to Transfusion: Chapter 2: Blood Components. Retrieved from https://professionaleducation.blood.ca/en/transfusion/guide-clinique/blood-components Canadian Blood Services (2020). Clinical Guide to Transfusion: Chapter 9: Blood Administration. Retrieved from https://professionaleducation.blood.ca/en/transfusion/guide-clinique/blood-administration Canadian Blood Services (2022). Clinical Guide to Transfusion: Chapter 10: Transfusion Reactions. https://professionaleducation.blood.ca/en/transfusion/clinical-guide/transfusion-reactions Canadian Blood Services (2021). Clinical Guide to Transfusion: Chapter 15: CMV seronegative, irradiated and washed blood. https://professionaleducation.blood.ca/en/transfusion/clinical-guide/irradiated-washed- and-cmv-seronegative-blood-components Canadian Blood Services (August 2018). Clinical Guide to Transfusion: Chapter 18: Platelet Transfusion, Alloimmunization and Management of Platelet Refractoriness. https://professionaleducation.blood.ca/en/transfusion/guide-clinique/platelet-transfusion-alloimmunization- and-management-platelet