Blood and Blood Products (Nursing)

00:01 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.

00:42 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.

00:51 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.

01:18 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.

01:52 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 24 hours.

02:04 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.

02:52 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 pain, 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.

05:16 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 as prescribed, start IV fluids, and possible vasopressors which are medications to help raise a person's blood pressure, and steroids if needed. Thank you.