Blood Transfusion Process And Complications Case Study

Blood transfusion process and complications case study analysis

Mary Vanderhoef MSN, ARNP Revised by Octavia Mercado, BSN, RN, CCRN SEPT 2015 Blood transfusion is the process of transferring blood or blood-based products from one person to another Can be life saving as in massive blood loss due to trauma Treatment for severe anemia Thrombocytopenia First fully documented human blood transfusion by Dr. Jean-Baptiste Denis, physician to King Louis XIV of France in 1667. Transfusion of blood from a sheep into a 15 year old boy that survived Dr. James Blundell, British Obstetrician, performed the first successful blood transfusion of human blood in 1818 for treatment of post partum hemorrhage. Used the blood of the patient’s husband and directly infused into the patient. In the 1910’s it was discovered that by adding anticoagualnt and refrigerating the blood, it was possible to store the blood for several days..

First non-direct transfusion was performed in 1914 Dr. Luis Agote (2nd from right) overseeing one of the first safe and effective blood transfusions in 1914 In the 1930’s and 1940’s Dr Charles Drew’s research led to discovery that blood could be separated into plasma and red blood cells. Indications for blood transfusion ANEMIA: A decrease in red blood cells (rbc’s) secondary to blood loss or deficient production Normal Hgb Levels Males: 14-18 g/dl Females 12-16 g /dl Hematocrit is the proportion of rbc’s in total volume of blood Males: 40-54% Females 38-48% Transfusions are generally ordered when Hgb 8 g/dl or less OR If patient is symptomatic Effects of Anemia and decreased O2 delivery: Tachycardia, dyspnea, palpitations, fatigue, weakness, light headedness If severe, anemia could lead to: CVA, or MI secondary to decreased perfusion to heart and brain Causes of Anemia Sudden blood loss Chronic bleeding Phlebotomy in critically ill patients (increases with blood draws 3 x greater in ICU patients) Whole Blood Packed Red Blood Cells (prbc’s) Platelets Fresh Frozen Plasma (FFP) Cryoprecipitate Rarely used in the US Restores fluid volume and circulation Contains rbc’s, wbc’s plasma and platelets Most common transfusion Restores blood’s ability to carry O2 Contains few platelets and wbc’s Generally mls per unit Transfuse over 2-4 hours: based on pts need to receive blood and pts other issues Shorter transfusion time: symptomatic Longer transfusion time: CHF, ESRD Increases the Hgb 1 g/Hct 3-4 % Shelf life 42 days Platelets are thrombocytes Restores clotting ability Usual dose is 5-10 units OK for rapid transfusion (1 unit over 10 min) Increases platelet count by 5000 per one unit 4-5 day shelf life Unconcentrated source of all clotting factors and proteins from a single unit of blood (contains albumin, fibrinogen, and antibodies) Treats bleeding caused by factor deficiencies and for Liver failure, DIC, and reversal of coumadin/warfarin therapy Is frozen and can be stored for up to 1 year Notify blood bank 30 minutes prior to when needed in order for them to thaw the FFP After thawing by blood blank must infuse within 6 hours Generally ml per unit ordered OK for rapid transfusion (1 unit over 10 min) Generally used for patients with specific bleeding disorders such as hemophilia, von Willebrand’s disease. Storage and usage same as for FFP A+ B+ AB+ O+ A- B- AB- 0- Universal Donor O- (only 6.6% of the population) Universal Recipient AB+ Most prevalent blood type O+ (37% of the population) Rh typing Looks at 8 different genes Rh present (positive) Rh absent (negative) Typing is done to prevent complications from giving incompatible blood If transfusion reaction suspected STOP the transfusion Notify Physician Give supportive treatment (per orders/protocol): Normal saline fluids Antipyretics antihistamines Viral is the most common transfusion-transmitted infection Hepatitis B Hepatitis C HIV (most feared) Long period for seroconversion (25-45 days) CMV which belongs to the herpes group (transmitted by whole blood and rbc’s) Can cause immunosuppression leading to risk of pneumonia, gastroenteritis, and hepatitis particularly in the critically ill Stored units can become contaminated with bacteria and cause infection to recipient Mortaility rate from bacteremia = 50% Causes: Inadequate skin prep at phlebotomy site, small leaks in blood containers, contaminated containers, asymptomatic bacteremia at time of donation Whole Blood ~ 35 days PRBC’s ~ 42 days (after this there is a decline in the quality with an increase in inflammatory mediator release) Can be frozen up to 10 years WBC’s ~ Autologous Allogenic/Homologous Cell Saver Safest Giving pt their own blood Can donate 72 hours before the scheduled surgery Limiting factors: Hgb All other donated blood, other than the patients own blood. Collects, Washes and spins blood that has been suctioned from patient during surgery Debris and hemolytic by products removed Reinfused into patient Malignancy Sepsis Enteric contamination Coagulopathy Pulmonary infection Impaired renal function Excessive hemolysis HIV – 1: 2 million Hepatitis B - 1: 200,000 Hepatitis C – 1: 1-2 million Creuzfeldt-Jacob disease – very rare * Blood Reaction Signs and Symptoms Allergic reaction Rash, hives (urticaria), pruitus, laryngeal edema, hypotension, anaphylactic shock Febrile non-hemolytic reaction Chills, fever increase of >1˸ଉ C or >2˸ଉ F, nausea, vomiting, back or leg pain, dyspnea Hemolytic transfusion reaction Anxiety, chills, fever, back pain, shock, dyspnea, abnormal bleeding, red or dark brown urine (hemoglobinuria) Transfusion associated circulatory overload (TACO Coughing, cyanosis, difficulty in breathing, rapid incr ease in systolic blood pressure Transfusion – associated sepsis severe rigors, high fever > 40˸ଉ C, shock, hemoglobinuria, DIC, renal failure Transfusion – related acute lung injury (TRALI) Coughing, cyanosis, difficulty in breathing Blood Transfusion Case Study Name: _____________________________ Date: _____________________ Class: NUR 438 Brief Patient History Mr.

S is a 75-year-old man who has a long history of chronic atrial fibrillation treated with warfarin, CHF, ESRD, and DM II. Over the past week, Mr. S has experienced intermittent epigastric pain and black stools. He is now dizzy and weak. Clinical Assessment Mr. S is admitted to the intensive care unit from the emergency department. He recently began taking ciprofloxacin for a urinary tract infection. He also has been taking an aspirin each day because he heard it was good for you. Also, he recently began taking over-the-counter ibuprofen for his stomach pain and general aches. Diagnostic Procedures Mr. S’s admission laboratory work reveals a hemoglobin level of 7 g/dL and an international normalized ratio (INR) of 7. His baseline vital signs include the following: blood pressure of 80/60 mm Hg, heart rate of 150 beats/min (atrial fibrillation), respiratory rate of 30 breaths/min, SPO2 92%, and temperature of 37.3 degrees Celsius. Medical Diagnosis Diagnosis is acute gastrointestinal bleeding Nursing Actions You have started and finished the FFP, and are currently transfusing the allogenic PRBCs. Ten minutes after starting the PRBC transfusion, Mr. S begins to C/O back pain, chills, and SOB.

After taking his oral temperature you note it is now 38.8 degrees Celsius. He appears anxious, and is pulling at his lines and tubes. 1. What is this patient’s mean arterial pressure (MAP)? Is his MAP adequate, and why? Please show your work for the math equation. 2. What signs and symptoms may Mr. S exhibit secondary to his low H&H laboratory values? 3. What is the importance of administering the FFP prior to the PRBC’s in Mr. S’s case? 4. What should the length of time be to transfuse Mr. S’s PRBC’s, and why? 5. Mr. S is O positive blood type. What blood types can he receive, and what blood types can receive his blood type? 6. What is the importance of Rh factor when considered which type of blood to administer to patients? 7. What does allogenic mean? What does autologous mean? 8. What do you think is occurring with Mr. S? 9. What should be your immediate actions/interventions? 10. What nursing diagnoses should you give for this patient? 11. What education can be provided to this patient upon discharge?