Transfusions 101 - Everything You Need To Know About Blood Transfusions

Ashley Hay, BSN, RN, BSN, RN

Blood Transfusions 101

Everything you need to know about blood products and administration

Many patients require transfusions of blood products for acute or chronic issues. Here, we'll discuss an overview of the products used, possible transfusion related reactions, general administration, and all of the special ways the products can be prepared for patient use.

Types of blood products

Whole blood is what is directly drawn from the bloodstream; made up of many different types of cells including, red blood cells, white blood cells, platelets, and plasma. "There are very few indications for the use of whole blood transfusions. The major indication for whole blood transfusion would be in some cases of cardiac surgery or situations of massive hemorrhage when more than 10 units of red blood cells are required in any 24-hour period. The other rare situation would be in which blood transfusion is required immediately for rapid, life-threatening hemorrhage when red-blood-cell component therapy is not available" (Mitsuyasu, 2004). Blood bank laboratories can separate whole blood into the specific components needed. An alternative to donating whole blood is the process of apheresis. It is a "special kind of blood donation that allows a donor to give specific blood components, such as platelets. During the apheresis procedure, all but the needed blood component are returned to the donor" (Blood & Tissue Services | Donating Platelets, 2017).

Packed red blood cells (PRBC) can be given in emergency settings to replace blood lost in trauma or in more chronic settings for anemia (these can be chronic hematologic diseases such as diamond blackfan anemia, beta thalassemia, iron deficiency or even secondary to myelosuppression due to chemotherapy administration). General symptoms of anemia may include fatigue, pallor, shortness of breath, dizziness and headache. The hemoglobin, iron and oxygen levels should rise post-transfusion and the symptoms above should improve. Administration times may vary depending on the clinical situation, desired volume and patient weight (refer to your hospitals policy). I've seen standard administrations (~10ml/kg) given in both pediatric and adult oncology settings over anywhere from 2-4 hours. Premedications such as Tylenol, Benadryl and Solumedrol (or other steroid) may be required if the patient has experienced a previous transfusion reaction. Vital signs are frequently monitored, usually at baseline (before transfusion or any premeds), 15 minutes into infusion (assess for potential reaction symptoms), and at least every hour thereafter.

Platelets (PLT) play a role in blood clotting. These transfusion are given when the platelet count is low and bleeding symptoms are present (nose bleeds, petechiae, purpura, etc). PLT may be needed in certain cases related to surgery, trauma, thrombocytopenia and in rare cases of some hematologic diseases, such as symptomatic idiopathic thrombocytopenic purpura. These infusions are typically given quickly (less than 30 minutes) and may require premedication if necessary.

Plasma is the clear yellow liquid portion of blood, making up for over half your bloods content. It contains proteins, enzymes and antibodies and can be used in cases of burns, infection, liver failure, treatment for thrombotic thrombocytopenic purpura (TTP), as well as some chronic illnesses related to the immune system or coagulation issues. Fresh frozen plasma (FFP) and Cryoprecipitate (cryo) and even intravenous immune globulin (IVIG) are all specialized portions of plasma that can be used in the different clinical situations listed above. Infusions times vary depending on product used and patient status. Vital signs and general assessment should be performed at regular intervals, as with all blood products listed above.

Transfusion Reactions

It is important to assess your patient for potential transfusion-related reactions during and after treatment. Possible symptoms to be on the lookout for include facial/chest flushing, hives, rash, tachycardia, shortness of breath, back pain and chills. These can be treated quickly with the use of supportive measures (oxygen and IVF bolus) and emergency medications (antihistamines, steroids, epinephrine, etc). It is important to ensure you are prepared to give the patient a transfusion compatible with their blood type.

Compatibility

"There are eight different common blood types, which are determined by the presence or absence of certain antigens - substances that can trigger an immune response if they are foreign to the body. Since some antigens can trigger a patient's immune system to attack the transfused blood, safe blood transfusions depend on careful blood typing and crossmatching" (The American National Red Cross, 2017). While O positive is the most common blood type, O negative is considered a universal donor and can be received by anyone, no matter their blood type. You can find a simple compatibility chart here. Double checking compatibility of the unit (along with other patient identifiers) before starting the transfusion can prevent life-threatening reactions.

Preparation of Units

If you have ever had to check a unit of blood with a co-worker prior to administration, you know there can be lots of transfusional lingo on the bag. Let's break it down.

Washed: This process is done to remove extra proteins that may cause an immune-mediated reaction to the blood product. Typically used for patients with history of certain severe transfusion reactions and those with rare immune deficiencies. These products usually take longer to get from the blood bank and have a much shorter expiration than most units (a few hours).

Leukoreduced: May also be called leukocyte reduced or leukodepleted. This filtration process helps to remove a large portion of leukocytes (white blood cells), needed for many immune suppressed oncology patients, transplant patients and reduces the risk of cytomegalovirus (CMV) transmission. Many units of PRBC and PLT are now marked CMV negative also.

Irradiated: This process involves using radiation to kill leukocytes, also used for those who are immune suppressed, preventing exposure to these leukocytes can minimize future complications like graft versus host disease (GVHD) for these patients.

Antigen Negative: You may see something like "C,E,K Negative" or "phenotypically matched" on the unit you are about to transfuse. This means the unit has been tested for certain antigens. It can be used for patients who have received multiple transfusions and may begin to develop antibodies, causing transfusion reactions. These kinds of units are commonly given to oncology patients and those with sickle cell disease.

Conclusion

Whew! Are you still with me? Now that we've covered all of that, let's bring up one of my favorite topics related to transfusions...donation! If you're able, please consider donating to your local blood bank or plasma center. Being a hem/onc RN I can tell you the number of blood products being given every day is just massive. It seems there is always a shortage of product available and many patients depend on the life-saving gift of donation. Spread the word to your family, co-workers and friends.

References:

Blood Types. (2017). Retrieved February 13, 2017, from Blood Types Chart | Blood Group Information | American Red Cross

Donating Platelets. (2017). Retrieved February 13, 2017, from Blood & Tissue Services | Donating Platelets

Klatt, E. C., MD. (n.d.). Blood Products. Retrieved February 13, 2017, from Blood Products

Mitsuyasu, R. T., MD. (2004, March 23). Use of Whole Fresh Blood for Transfusions. Retrieved February 13, 2017, from Medscape: Medscape Access

Peterson, B. R. (2006). New developments in blood transfusion research. Retrieved February 13, 2017, from Google Books

Types of Blood Transfusions. (n.d.). Retrieved February 13, 2017, from Types of Blood Transfusions | Red Blood Cell, Platelets & Plasma | American Red Cross

Use of fresh frozen plasma. (n.d.). Retrieved February 13, 2017, from https://www.transfusion.com.au/blood_products/components/plasma/use

What Is Plasma? (n.d.). Retrieved February 13, 2017, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=160&ContentID=37

Transfusions 101 - Everything You Need To Know About Blood Transfusions

Blood Transfusions 101

Types of blood products

Transfusion Reactions

Compatibility

Preparation of Units

Conclusion

About Ashley Hay, BSN, RN, BSN, RN

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