Briefly learn about the blood products nurses typically give, the equipment needed to give them, FAQs, and when do you warm blood?
Why are they called packed red blood cells? Come from whole blood, but plasma removed = Packed Red Blood Cells
At what hemoglobin or hematocrit levels are generally PRBCs given? Adults: Hgb< 7 Pediatrics (hematocrit is more often used): <20%
After giving a unit of PRBCs, how should we expect H/H levels to increase? -1 unit should raise the hematocrit of ~3% in an adult -So if H/H does not increase consider serious bleeding, let MD know
How much time should pass after giving PRBCs and drawing a new H/H level? ~1-2 hrs.
Learn about warming blood
When do you warm blood?
For massive transfusions (50% of body blood volume)
When therapy calls for 25% of body blood volume, but the potential exists that more units may be required or that these units may be administered rapidly
When transfusing blood to patients with cold agglutinins (an autoimmune disorder in which a patient has autobodies that attack and destroy RBCs when the patient is in cold environments, or if given cold blood)
How do you warm blood?
USE ONLY a commercial blood warmer
Never use a microwave. Read about a patient death related to microwaving blood here.
Don't let setting up a blood warmer slow you down in times of massive transfusion needs
The first unit or two can be given in a normal fashion while the warmer is set up
When is FFP given? Given when PT/PTT/INR labs tests elevated* (Elevated because of lack of clotting factors) *Vitamin K also commonly given (because Vit K helps the liver produce certain clotting factors)
What is cryo? Contains a special subset of FFP (it is NOT just concentrated FFP, cryo has more specific clotting factors than FFP) Contains: fibrinogen, von Willebrand factor, factor VIII, factor XIII and fibronectin
When is cryo given? Given in von Willebrand disease, or when hypofibrinogenemia present
When are platelets given? Platelets are given when platelet count is approximately <50,000 (cut off value varies greatly) Especially prior to invasive procedure when platelet levels are low
when do you need to use a filter for administration?
Do you need to use a filter with albumin? Most sources say no. In the past, a filter was used for albumin adminsitration
Best advice is to follow your hospital policy and culture.
FAQs when ordering blood products
What does ‘washed red blood cells’ mean? The unit of PRBCs was washed to reduce plasma proteins (like immunoglobulins) The purpose is to reduce allergic reactions, especially if the patient knows they have a blood transfusion related allergy. What does ‘pooled’ mean? Means that the blood component comes from several donors and is put into 1 unit/bag
What does ‘leukocyte reduction’ mean? When RBC units are filtered to remove white blood cells The purpose is to reduce the risk of febrile transfusion reactions What is irradiated vs. non-irradiated blood? Irradiated blood is when RBCs have been exposed to xrays that kill all living white blood cells that could cause graft versus host disease (so, this is needed in organ donation patients)
What is CMV negative blood? Blood that has been tested, and shown to NOT contain the Cytomegalovirus (CMV), a herpes virus.