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Friday, September 25, 2020

Administration of blood and blood products: RN,NCLEX


Types of blood components 

1. Packed red blood cells 

  • Red blood cells are a blood product used to replace erythrocytes. 
  • Each unit increases the haemoglobin level by 1 g/dL and hematocrit by 2% to 3% ; the change in laboratory values takes 4 to 6 hours after completion of the blood transfusion.
  • Evaluation of an effective response is based on the resolution of the symptoms of anaemia and an increase in the erythrocytes count. 
2. Platelets 

  • Platelets are used to treat thrombocytopenia and platelet dysfunctions. 
  • Crossmatching is not required but usually is done ( platelet concentrates contain few blood cells). 
  • The volume in a unit of platelets may vary; always check the bag for the volume of the blood component ( in millilitres). 
  • Platelets are administered immediately on receipt from the blood bank and are given rapidly,  usually over 15 to 30 minutes. 
  • Evaluation of an effective response is based on improvement in the platelet count,  and platelet counts normally are elevated 1 hour and 18 to 24 hours after the transfusion. 
3 Fresh frozen plasma 

  • Fresh frozen plasma may be used to provide clotting factors or volume expansion; it contains no platelets. 
  • Fresh frozen plasma is infused within 2 hours of thawing,  while clotting factors are still viable, and is infused as rapidly as possible. 
  • Rh compatibility and ABO compatibility are required for the transfusion of the plasma products. 
  • Evaluation of an effective response is assessed by monitoring coagulation studies, particularly the prothrombin time and the partial thromboplastin time,  and resolution of hypovolemia. 
4. Albumin

  • Albumin is prepared from the plasma and can be stored for 5 years. 
  • It is used to treat hypovolemic shock or hypoalbuminemia. 
  • Albumin, 25g/100 mL, is equal to 500 mL of plasma. 
5. Cryoprecipitates

  • Prepared from fresh frozen plasma and can be stored for 1 year; once thawed, the product must be used.
  • Used to replace clotting factors, especially factor Vlll and fibrinogen.
Types of blood donations 

A. Autologous 

  • A donation of the clients own blood before a scheduled procedure is autologous; it reduces the risk of disease transmission and potential transfusion complications. 
  • Autologous donation is not an option for a client with leukaemia or bacteremia. 
  • A donation can be made every 3 days as long as the haemoglobin remains within a safe range.
  • Donation should begin within 5 weeks of the transfusion date and end at least 3 days before the date of donation. 
B. Blood salvage 

  • Blood salvage is an autologous donation that involves suctioning blood from body cavities, joint spaces, or other closed body sites.
  • Blood may need to be "washed" a special process that removes tissue debris before reinfusion. 
C. Designated donor

  • Designated donation occurs when recipients select their own compatible donors. 
  • Donation does not reduce the risk of contracting infections transmitted by the blood; however, recipients feel more comfortable identifying their donors. 

Compatibility chart for Red blood cell transfusions 


Donor:              A          B        AB       O

  A                       x          -           x         -

  B                        -          x          x         -

  AB                     -                      x         -

  O                      x          x          x         x


  • Client ( the recipient ) blood sample are drawn and labelled at the client's bedside at the time the blood sample is drawn; the client is asked to state his or her name, which is compared with the name on the client's identification band or bracelet. 
  • The recipient ABO type and Rh type are identified.
  • An antibody screen is done to determine the presence of antibodies other than anti-A and anti-B.
  • Crossmatching is done, in which donor red blood cells are combined with the recipient's serum and coomb's serum; the cross math is compatible if no red blood cell agglutination occurs.
  • The universal red blood cell donors are O negative; the universal recipient is AB positive. 
Transfusion reaction 

  • A transfusion reaction is an adverse reaction that occurs as a result of receiving a blood transfusion. 
  • Type of transfusion reaction includes hemolytic, allergic, febrile or bacterial reactions, circulatory overload, or transfusion-associated graft-versus-host disease. 
Signs of an immediate transfusion reaction 
  • Chills and diaphoresis
  • Muscle aches, back pain, or chest pain
  • Rashes, hives, itching, and swelling 
  • Rapid, thready pulse
  • Dyspnea, cough or wheezing 
  • Pallor and cyanosis
  • Apprehension 
  • Tingling and numbness 
  • Headache
  • Nausea, vomiting, abdominal cramping, and diarrhoea 
Signs of transfusion reaction in an unconscious client 
  • Weak pulse
  • Fever
  • Tachycardia or bradycardia 
  • Hypotension 
  • Visible hemoglobinuria 
  • Oliguria or anuria
Delayed transfusion reactions 
  • Reaction can occur days to years after a transfusion 
  • Signs include fever, mild jaundice, and a decreased hematocrit level.
Intervention -+
  • Stop the transfusion 
  • Keep the intravenous line open with 0.9% normal saline.
  • Notify the physician and blood bank.
  • Remain with the client, observing signs and symptoms and monitoring vital signs as often as every 5 minutes.
  • Prepare to administer emergency medication such as antihistamines, vasopressors, fluids and corticosteroids as prescribed. 
  • Obtain a urine specimen for laboratory studies. 

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