BLOOD PRODUCTS &

TRANSFUSION REACTIONS

Sherry Knowles, RN, CCRN, CRNI 2008

Blood Group

Antigens Antibodies Can give blood to

Can receive

blood from

AB A and B None AB AB, A, B, 0

A A B A and AB A and 0

B B A B and AB B and 0

0 None A and B AB, A, B, 0 0

Blood Types

Blood Types

Type O blood is called the “universal donor” because it can be donated to people of

any blood type.

Type AB blood is called the “universal recipient” because people with this type

can receive any blood type.

Rh Factor

The Rh factor (Rhesus factor) is a red cell surface antigen also known as the D

antigen.

Approximately 85% of Americans have Rh+ blood.

Rh Factor

Rh-negative individuals may develop antibodies to the Rh factor if they are exposed to Rh-positive cells through transfusion or if cells from an Rh-positive fetus cross the placenta into an Rh-negative mother.

Subsequent administration of Rh-positive blood to such an Rh-negative individual who has developed anti-Rh antibodies would result in hemolysis of the donor cells and could be fatal.

Whole blood

Whole blood is occasionally used for massive transfusion in circumstances in which rapid correction of acidosis, hypothermia or coagulopathy is required.

Packed Red Blood Cells (PRBC’s)

RBCs are the component of choice used to increase Hb.

Packed Red Blood Cells consist of erythrocyte concentrated from whole blood.

RBC’s are anticoagulated with citrate and may have one or more preservatives added.

Washed Red Blood Cells (PRBC’s)

Washed Red Blood Cells are red blood cells washed with normal saline to remove most of the plasma.

Washed Red Blood Cells are not leukoreduced.

Washed Red Cells are used for patients who have had repeated hypersensitivity reactions to blood products despite prophylactic administration of antihistamines.

Leukoreduced Red Blood Cells (PRBC’s)

Leukoreduced Red Blood Cells contain leukocytes in reduced amounts.

Leukoreduced Red Blood Cells are used for patients who have experienced multiple non- hemolytic febrile transfusion reactions.

Irradiated Blood Products

Radiation inactivates lymphocytes

Irradiated blood products are used to prevent graft-vs-host disease in patients at risk.

Platelets

                      

                      

Given for:

stable patients with platelet counts <10,000/m L

patients with bleeding, fever or splenomegaly with platelet counts <20,000/m L

patients with significant bleeding or undergoing an invasive procedure

patients with documented platelet function abnormalities

Fresh Frozen Plasma (FFP)

FFP contains all coagulation factors in normal amounts and is free of red cells, leukocytes and platelets.

FFP is indicated for patients with documented coagulation factor deficiencies who are actively bleeding or who are about to undergo an invasive procedure.

FFP may also be used to reverse anticoagulating effects of warfarin.

Plasma must be ABO-compatible with the red cells of the recipient.

Granulocytes (WBC’s)

WBC’s may be transfused in the presence of sepsis with profound persistent neutropenia that is unresponsive to antibiotics.

Must be ABO Compatible

Clotting Factors

Factor VIII

Factor VIIIa

Factor IX

Factor XIII

von Willebrand factor

And Many more!

Cryoprecipitate

Cryoprecipitate is a concentrate prepared from FFP.

A single bag of Cryo contains factor VIII, von Willebrand factor, fibrinogen and fibronectin.

No compatibility testing is required and ABO-Rh type is not relevant.

Immunoglobulin

Intravenous immunoglobulin is used in the treatment of immuno-thrombocytopenia, Guillain Barre syndrome and autoimmune hemolytic anemias.

RhD immunoglobulin is used to prevent exposure to D-positive red cells in D negative patients. (usually given in pregnancy and immediately after birth).

Activated Protein C

Anti clotting

Anti Inflammation

Used early in Sepsis

Must watch for bleeding

Synthetic Blood

Hemoglobin based oxygen carriers (HBOCs)

Perflurocarbon based products (PFCs)

 

Transfusion Reactions

Can Be Life

Threatening!

Hemolytic Transfusion Reaction

This reaction results from incompatibility of donor and recipient blood.

Results in the accelerated destruction of red blood cells

Signs include fever, chills, headache, hematuria, low back or flank pain, chest tightness, acute sense of doom, shock and DIC

Much more subtle!

Occurs in 3-14 days following transfusion

Signs include unexplained drop in hemoglobin and/or rise in bilirubin, jaundice

Delayed Hemolytic Transfusion Reaction

Allergic Transfusion Reaction

Characterized by intense itchy with welts (hives)

Usually involves stopping the transfusion for a short period of time and treating the symptoms (usually with an antihistamine)

With appropriate monitoring a transfusion may be restarted at a slower rate

Anaphalatic Transfusion Reaction

Classic severe reaction with bronchospasm, shortness of breath, respiratory distress and hypotension

Onset is sudden, within a few mL of blood infusion

Febrile Transfusion Reaction

Any elevation of temperature > than 1 degree

C

suggests that a blood product being infused

may

be bacterially contaminated, especially if the

fever

is accompanied by intense shivering (rigors)

May include muscle cramps, nausea, flushing, headache, tachycardia, chills, and rigors

Maintain comfort, anti-pyretic medication and Meperidine (Demerol) for rigors

Citrate Toxicity Reaction

Citrate is the anticoagulant added to blood

Following multiple blood transfusions citrate may depress ionized calcium levels

Following multiple blood transfusions watch for signs of hypocalcemia (muscle irritability & cardiac arrhythmias)

Type of Reaction Symptoms Possible Causes

Acute Hemolytic

Reaction

Chills / Rigors, Headaches, Back / Loin Pain, Restlessness / Anxiety, Tachycardia, Shock, Hematuria,

Oliguria – Anuria

Rapid onset of Circulatory Collapse, Fever

Major Blood Group Incompatibility

   

Bacterial Contamination

Anaphylactic

Reaction

Respiratory and Cardiovascular Collapse, Dyspnea, Wheezing and

Chest Tightness, Tachycardia, Hypotension, Nausea, Vomiting,

Abdominal Pain, Itching

Reaction due to a hypersensitivity to proteins present in the donor blood

Allergic Reaction Skin Rashes / Bronchospasm Allergic Response to Elements in Donor Blood

Febrile Reaction Fever / Chills, Headache / Flushing, Tachycardia

Leucocyte Antibody Reaction of White cells in Donor Blood

Transfusion Related Acute Lung Injury

Acute Respiratory Distress, Bilateral Pulmonary Infiltrates

Anti-Leucocytes Antibodies in patient or donation

Transfusion Reaction Summary

Assess patient VS’s and symptoms

Stop the blood, start NS and obtain blood and urine samples for testing

Notify physician and follow instructions for treatment of symptoms

Notify the Transfusion Service and obtain a Transfusion Reaction Form

Complete all procedures for managing a transfusion reaction

Management ofTransfusion Reaction

The End

Transfusion Reactions

Can be Fatal!