TABLE 11-4 Transfusion with Blood or Blood Products

Blood or Blood Product Indications Asessment: Side effects Nursing Care Plan/Implementation
Whole blood
  1. Acute hemorrhage
  2. Hypovolemic shock
  1. Hemolytic reaction
  2. Fluid overload
  3. Febrile reaction
  4. Pyrogenic reaction
  5. Allergic reaction
  1. See Unit 7, Table 7—22 (pp. 508-509), for complete discussion of nursing responsibilities
  2. Protocol for checking blood before transfusion is begun varies with each institution; however, at least two RNs must verify that the unit of blood has been crossmatched for a specific patient
See whole blood
Red blood cells, packed
  1. Acute anemia with hypoxia
  2. Aplastic anemia
  3. Bone marrow failure due to malignancy
  4. Patients who need red blood cells but not volume
See Whole Blood See Whole Blood
Red blood cells, frozen
  1. See Red blood cells, packed
  2. Patients sensitized by previous transfusions
  1. Less likely to cause antigen reaction
  2. Decreased possibility of transmitting hepatitis
See Whole Blood
White blood cells (leukocytes) Currently being used in severe leukopenia with infection (research still being done)
  1. Elevated temperature
  2. Graft-versus-host disease
  1. Careful monitoring of temperature
  2. Must be given as soon as collected
Platelet concentrate
  1. Severe deficiency
  2. Patients who have thrombocytopenia and are bleeding, with platelet counts below 10,000/p.L
  1. Fever, chills
  2. Hives
  3. Development of antibodies that will destroy platelets in future transfusions
Contraindications:
  1. Idiopathic thrombocytopenic purpura
  2. Disseminated intravascular coagulation (DIG)
Monitor temperature
See Single-donor fresh plasma
  1. Clotting deficiency or concentrates not available or deficiency not fully diagnosed
  2. Shock
  1. Side effects rare
  2. Heart failure
  3. Possible hepatitis
Use sterile, pyrogen-free filters
Plasma removed from whole blood (up to 5 days after expiration date, which is 21 days)
  1. Shock due to loss of plasma
  2. Burns
  3. Peritoneal injury
  4. Hemorrhage
  5. While awaiting blood crossmatch results
See Single-donor fresh plasma See Single-donor fresh plasma
Freeze-dried plasma See Plasma removed from whole blood Single-donor fresh-frozen plasma
  1. Notify blood bank to thaw about 30 min before administration
  2. Give immediately
Cryoprecipitate concentrate (factor VIII—antihemophilic factor) For hemophilia:
  1. Prevention
  2. Preoperatively
  3. During bleeding episodes
Rare 0.55 mL of cryoprecipitate concentrate has same effect on serum level as 1600 mL of fresh-frozen plasma
Factors II, VII, IX, and X compiled Specific deficiencies HepatitisCommercially prepared Commercially prepared
Continued