Transfusion Therapy

Principles of IV TherapyBSN336

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: 2nd 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

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 Order2. Blood typing and Crossmatching the

Recipient3. Selecting and Preparing the Equipment

1. Catheters2. Solution3. Administration Set4. Special Filters5. Fluid/Blood Warmers

Administration of Blood Components

5. Preparing the patient6. Obtaining blood product from the

blood bank7. Preparing for Administration8. Initiating transfusion9. Monitoring the Transfusion10. 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 worker2. Assessing the patient’s physical

disposition3. Identifying the patient4. Approaching the patient5. Selecting a puncture site6. Selecting and preparing equipment

and supplies

Phlebotomy technique (cont)

7. Preparing the puncture site8. Choosing a venipuncture method9. Collecting the samples in the

appropriate tubes and in the correct order

10. Labeling the samples11. Assessing the patient after

withdrawal of the blood specimen

Phlebotomy technique (cont)

10. Labeling the samples11. Assessing the patient after withdrawal of

the blood specimen12. 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