Blood and Dialysis

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Is it normal practice for a hemodialysis patient w/ 1500 ml fluid restriction to receive orders to have a blood transfussion (2units) in between dialysis sessions. The patient receives dialysis 3 days per week, T,TH,Sat. The order is to receive blood on Friday. It doesn't appear to be the safest method but would appreciate any thoughts or input......

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Specializes in Critical Care and ED.
is it normal practice for a hemodialysis patient w/ 1500 ml fluid restriction to receive orders to have a blood transfussion (2units) in between dialysis sessions. the patient receives dialysis 3 days per week, t,th,sat. the order is to receive blood on friday. it doesn't appear to be the safest method but would appreciate any thoughts or input......

yes it is normal. [color=#333333]anemia is common in people with kidney disease. healthy kidneys produce a hormone called erythropoietin which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen. usually the ordering doctor will make adjustments to the rate of the uf for the next treatment to allow for the fluid volume.

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Thank you for the feedback. I guess I was under the wrong impression that the extra fluid could lead to serious complications for the patient. In defense of the patient I was concerned and felt it would be best to give the blood during dialysis.

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Thank you for the feedback. I guess I was under the wrong impression that the extra fluid could lead to serious complications for the patient. In defense of the patient I was concerned and felt it would be best to give the blood during dialysis.

This is a big pet peeve of mine.

Admistering two units of LRRC's is equivalent to app 700ml. In the dialysis world that's a mere blip on the radar.

If the patient is highly fluid overloaded (symptomatic pulmonary edema, CHF exacerbation, effusions, etc., not just a few "rales" like they all have) and/or hemodynamically unstable, then yes, it is preferable to give the blood during dialysis.

I'm happy to give blood during dialysis as it helps the floor staff, however, I've had them take advantage of it by deferring transfusions in relatively stable patients by as much as 36 hrs in patients with a Hgb of 8.0. That's laziness and unacceptable.

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If you are employed by FMC you are not allowed to transfuse in the outpatient clinic. This is a HUGE issue for our patients because they have to go to the lab to have a T&CM drawn (another needle stick). The patient will have to go the next day to infusion services have an IV started (yet another needle stick) & sit for 4 - 6 hours to receive the blood. Why? because of reimbursement issues. We used to draw the T&CM during dialysis, send the specimen to the lab & if no issues with blood availability we would transfuse that day during treatment or during the next treatment. The hospital would bring us the blood & it was so simple for the patient.

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Specializes in Med-Surg.

I am new to dialysis nursing and still in training - they told us that we really try to stay away from transfusions and work with epo and diligent anemia management as each transfusion increases the risk of building antibodies that can ultimately keep a pt from getting a kidney transplant...has anyone heard this?

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It makes sense in a way.

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I am new to dialysis nursing and still in training - they told us that we really try to stay away from transfusions and work with epo and diligent anemia management as each transfusion increases the risk of building antibodies that can ultimately keep a pt from getting a kidney transplant...has anyone heard this?

Yes. Hence the reason for the widespread use of leukocyte reduced red cell (LRRC's) transfusions in renal failure patients, among other disease processes.

Concise overview article here:

http://www.scbcinfo.org/publications/bulletin_v1_n2.htm

Leukocyte-Reduced Blood Components

Established Indications

  • Reducing recurrent febrile non-hemolytic transfusion reactions to cellular blood components


  • Reducing CMV transmission by cellular blood components


  • Reducing HLA alloimmunization to platelets in patients receiving induction chemotherapy


Indications Under Review

  • Preventing alloimmunization and the refractory state to platelets


  • Reducing tumor recurrence rates after resection


  • Reducing postoperative wound infections and mortality


  • Preventing latent CMV reactivation


  • Preventing latent HIV reactivation


  • Preventing HLA alloimmunization in organ or bone marrow transplant candidates


Indications Under Review

  • Preventing transfusion-associated graft vs. host disease


  • Preventing transfusion-related acute lung injury due to passive administration of anti-leukocyte antibody


  • Preventing anaphylactic (hypersensitivity) transfusion reactions


  • Preventing hemolytic transfusion reactions


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Specializes in Dialysis.

Depends on the strength of the patient's heart. PRBC's are going to act as volume expanders drawing fluid into the vascular space. If this patient has a low cardiac output or a low ejection fraction you could easily be looking at pulmonary edema. I would advocate waiting until dialysis unless the patient is actively bleeding or hypotensive.

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Just curios, CocoaGirl, you mentioned they do this because of reimbursement issues. Reimbursement from the insurance company?

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