Hi! Today we're going to talk about blood and
blood products. My name is Jill
Beavers-Kirby.The objectives of blood
transfusion are to increase circulating
blood volume, increase the number of red blood
cells, or RBCs, to maintain haemoglobin
levels, and to provide selected cellular
component such as platelets or clotting
factors. First, we'll talk about the ABO system.
This is the presence or absence of a
specific antigen on the surface of the red
blood cells to determine your blood
type. If you have the presence of type A
antigens, then you have blood type A.
If you have the presence of type B antigens,
then you have blood type B. If neither
type A nor type B antigen is present,
then you have blood type O.
Another system used to classify blood
products is the Rh system. The Rh
factor is an inherited protein. If the
Rh factor is present on your cells,
then you have Rh-positive blood. So for
example, the presence of an A antigen
is noted, the presence of Rh factor is
noted, so you have blood type A positive.
If the Rh factor is not present, then you
have Rh-negative. So for example, if
if you have neither type A nor type B
noted on your cells, and the Rh factor is
negative, then you have blood type O negative.
So, what are packed red blood
cells? These are indicated for acute blood loss,
and these are also given because
there is less damage of fluid overload. First
in red blood cells are prepared from
red blood cells using glycerol for protection,
and then these are frozen.
The deglycerolization process removes the
glycerol, the white blood cells, and the
plasma. The frozen red blood cells are then thawed
and they must be used within
These are often used as an autologous donation.
For example, when you're having
a planned surgery, you give a unit of blood.
It's frozen. It's thawed out within
24 hours of its use during
your surgery. Platelets. Platelets are indicated
for thrombocytopenia, also
known as low platelet counts. A single donor
platelet has an approximate blood
volume of 200 millilitres. Pooled donor
platelets can be from one, two, three,
or four patients, and has an approximate
blood volume of 300
millilitres. The bag should be mixed periodically.
Fresh frozen plasma is the
liquid portion of the blood that is separated
from the cells and then frozen.
One unit of fresh frozen plasma or FFP
contains all the body's coagulation
factors. Fats, carbohydrates, and minerals
are also present in concentrations
similar to those in the body circulation.
FFP is given for replacement
of isolated factor deficiencies, a reversal
of warfarin, massive blood transfusions
antithrombin III deficiencies, and treatment
of thrombotic thrombocytopenic
purpura, also known as TTP. Albumin comes from
the plasma, and it's available as a 5%
solution or 25% solution. Five percent solutions
are used to restore plasma
volumes. Twenty-five percent solutions are used
to raise oncotic pressures. You'll see albumin
given when there is hypertension and shock.
Cryoprecipitate is prepared
from fresh frozen plasma. Each unit of cryoprecipitate
contains fibrinogen, Factor VIII,
von Willebrand Factor, and Factor XIII.
Cryoprecipitate is given to patients with
haemophilia, von Willebrand's disease,
or disseminated intravascular coagulopathy,
also known as DIC. So, what are transfusion
reactions? We'll start with the most serious one
first. Acute haemolysis is caused by
incompatibility. For example, giving
an A positive patient B positive blood. The patient
will have chills, fever, low back
flushing, fast heart rate, low blood pressures.
If this isn't treated
aggressively and immediately, this can proceed
to acute renal failure,
shock, and cardiac arrest. So, what do you do
if you suspect this? You stop the
transfusion, change the blood tubing, give the
patient IV normal saline, treat
for shock as if it's present. You'll draw blood
samples to assess for transfusion
reaction, monitor the patient's hourly urine
output to make sure they're not
in renal failure,
and give diuretics as prescribed. An allergic
reaction to blood, also known as
a sensitivity, is due to hypersensitivity
antibodies in the donor's blood.
You'll see this commonly with patients who have
gotten a lot of blood products in
their past. The patient will complain
of hives, also known as urticaria,
itching, fever, and if this is left to go on,
anaphylactic shock. So, what
the nurse will do? You'll stop the transfusion.
You'll provide supportive care
such as oxygen, diphenhydramine, and airway
management. Febrile reactions are the most
common type of reactions. When you start the
blood in 15 to 20 minutes, your
patient may have a low-grade fever. You'll also
see this in patients who have had
multiple blood transfusions. Then the patient
will complain of fever, chills, nausea,
sometimes a headache, high blood pressure,
or they'll feel like their heart is
jumping around in their chest, also known as
palpitations. So, what does the
nurse do? Stop the transfusion and provide
supportive care, such as aspirin,
acetaminophen, or diphenhydramine. And
bacterial reactions. These are caused
from blood products that are contaminated.
These are very rarely seen
but need to be observed for. You'll note
the patient will have an increase in his
heart rate, low blood pressure,
fever, chills, and if left
untreated can proceed to shock. The nursing
intervention, you want to stop the blood,
obtain a blood culture, start antibiotics
start IV fluids, and possible vasopressors
which are medications to help
raise a person's blood pressure, and
steroids if needed. Thank you.