Blood Transfusion

Blood Transfusion
Types of Blood Components:
2. Whole blood
3. Packed Red Blood Cells
4. Platelet concentrate
5. Fresh Frozen Plasma (FFP)
6. Cryoprecipitates
7. Granulocytes
8. Albumin
9. Intravenous Gamma Globulin
Whole Blood is rarely given to patients because it is wasteful
and sometimes harmful to give blood components that are
not needed. Whole blood transfusions are necessary when
very large amounts of blood have been lost, otherwise blood
components are given.
 RedBlood Cells carry oxygen and are needed by
surgical patients or those with anemia or kidney
disease

 PlateletConcentrates are fragile blood cells

needed by leukemia and other cancer patients to
control bleeding.

 FreshFrozen Plasma must be processed and

frozen within eight hours of the whole blood
donation to preserve the less stable clotting
proteins. It is used mainly for people with
bleeding complications. Plasma is the yellow liquid
portion of blood. It is also a source of proteins
that stop bleeding by forming blood clots.
 Cryoprecipitate,a part of the plasma, contains two
important clotting factors found in whole blood. It is
used to treat two common clotting disorders.

 Albumin - used in the treatment of certain kidney and

liver diseases. Because of the relative simplicity of
storage and administration, it is also used for
emergency cases, such as accident or shock victims,
particularly where facilities for administering blood
are not available or where time does not permit its
use.

 Gamma Globulin - contains the antibodies in plasma

and is able to modify or prevent measles and other
infectious diseases, such as some varieties of
hepatitis.
BT: General Precautions
No solution other than NORMAL SALINE
should be added to blood components.
Medications are NEVER added to blood
components or piggybacked into a blood
transfusion.
Infusions (1 unit) should not exceed 4
hours.
CHECK: expiration date, leaks, abnormal
color, clots, and bubbles.
Administer blood ASAP (w/in 20-30 mins)
from its being received from the blood
bank.
BT: General Precautions
NEVER refrigerate blood in
refrigerators other than those used in
blood banks.
Assess vital signs and lung sounds:
- before the transfusion
- 15 mins after start of transfusion
- then every hour until transfusion is
completed
- 1 hour after completion of transfusion
7. Assess for any cultural or religious
beliefs regarding blood transfusions.
BT: General Precautions
Ensure that an informed consent has
been obtained.
Determine whether the client has ever
experienced any previous reactions to
blood before.
Special manual pressure cuffs may be
used provided pressure does not exceed
300 mmHg.
Blood warmers may be used. Do not
warm products in a microwave or in hot
water.
BT: Reactions
1. If a transfusion reaction occurs:
- STOP the transfusion
- change the IV tubing
- keep IV line open with normal saline
- notify physician & blood bank
- return blood bag and tubing to the
blood bank
7. Do not leave the client alone.
8. Monitor the client for any life-
threatening symptoms.
BT: Complications
 Transfusion reactions
 Circulatory overload
 Septicemia (Septicemia is the presence of bacteria in
the blood (bacteremia) and is often associated with severe
disease.)
 Iron overload
 Disease transmission
 Hypocalcemia and citrate intoxication(toxic
condition that may develop during massive
replacement therapy with transfused blood that contains
citrate as an anticoagulant; the citrate combines with calcium
ions and may result in tetany.)
 Hyperkalemia (will affect acid base balance)
Polycythemia
o Literal Meaning: “too many cells in the
blood”
o DESCRIPTION: ↑ in both the # of
circulating RBCs & the concentration of
Hgb within the blood

o Classified as a myeloproliferative
disorder (bone marrow overgrowth)

o Cause: UNKNOWN
Polycythemia
CHARACTERISTIC MANIFESTATIONS:
 Plethora - ruddy complexion/flushed skin due to
increased blood volume or from increase blood viscosity
 generalized pruritus – caused by histamine
release due to increased number of basophils
 erythromelalgia – burning sensation in the
fingers and toes
 ↑ blood volume, blood viscosity, &
severe congestion of all tissues and
organs
Polycythemia
DIAGNOSTIC FINDINGS:
CBC: ↑ RBC, WBC, & platelets; ↑
Hct
BMA: ↑ in immature cells forms
Liver Enzymes: ↑
Uric acid: ↑( due to massive
destruction of blood cells resulting in
release of electrolytes and fluids w/in
the circulation)
 Polycythemia
INTERVENTIONS:
2. Force fluids
3. Prevent bleeding and infection
4. Medications:
- Radioactive phosphorus
- chemo agents: Hydrea, chlorambucil
- allopurinol (Zyloprim)
- dipyridamole (Persantine)
 Polycythemia
 Radioactive Phosphorous and Chemo
Agents – both suppresses marrow
functions.
 Allopurinol – prevents gouty attack in
patient with elevated uric acid
concentration.
 Dipyridamole – anticoagulant/platelet
adhesion inhibitor.
Polycythemia
INTERVENTIONS:
2. Phlebotomy
 Important part of therapy that involves
removing enough blood (initially 500 mL
once or 2x weekly) to diminish blood
viscosity and to deplete the patients
iron stores, thereby rendering patient
iron deficient and inadequately unable
to manufacture RBC excessively.
White Blood Cells

 AKA: Leukocytes
 Primarily protects the body against
infection and in tissue injury.
White Blood Cells
Classification:
2. Granulocytes – presence of granules in
the cytoplasm of cells.
3 Main Groups
a. neutrophils
b. eosinophils
c. basophils
White Blood Cells
Classification:
2. Agranulocytes – granule free
a. monocytes
b. lymphocytes (lymph nodes)
- T cells
- B cells
 White Blood Cells
NEUTROPHILS:

o polymorphonuclear neutrophils (PMNs)

o Predominant form of granulocyte, make
about 60% of WBC.
 They surround and digest invading
organisms and other foreign matter by
phagocytosis.
 WBC: Functions
EOSINOPHILS

 Minor granulocyte
 important in phagocytosis of PARASITES
 neutralize histamine in allergic reactions
 WBC: Functions
BASOPHILS

 produce & store histamine

 participate in delayed allergic reactions.
 also contain Heparin, an anticoagulant.
 White Blood Cells
MONOCYTES:

o Develop into cells called Macrophages that

participates in immunity.
 effective against FUNGI & VIRUSES
 digest aged blood cells (RBCs) w/in the
spleen
WBC: Functions
LYMPHOCYTES
 produce substances that aid in attacking
foreign material
 Occurs mostly in 2 forms (T-cells and B-cells)
 T-cells (cellular immunity): kills foreign cells
directly or releases a variety of
LYMPHOKINES that enhance the activity of
phagocytic cells
- delayed allergic reactions
- rejection of foreign tissue
- destruction of tumor cells
WBC: Functions
LYMPHOCYTES
 B-cells (humoral immunity): capable
into differentiating into PLASMA
CELLS
 Plasma cells: produce
immunoglobulins (Ig) or antibodies
 Functions: bacterial phagocytosis,
bacterial lysis, virus & toxin
neutralization, allergic hay fever &
asthma
WBC: Diagnostic Tests
CBC: WBC count and Differential
Count

WBC 5,000 – 10,000

cells/mm³
Neutrophils 55% – 70%
Eosinophils 1% - 4%
Basophils 0.5% - 1%
Lymphocytes 20% - 40%
Monocytes 2% - 8%
Bone Marrow Aspiration
o Examination of the bone marrow
that reveals the number, size, and
shape of RBCs, WBCs, and platelet
precursors

o Performed by a physician or
specially-trained nurse

o Site: posterior iliac crest, sternum

 Bone Marrow Aspiration
PRE-PROCEDURE: POSTPROCEDURE:

 Explain the purpose of  Apply pressure until

the procedure & what to bleeding stops.
expect.
 Place a small bandage
 Advise the client that
there will be pain during over the site.
the procedure.  Observe the site
 Verify that client has frequently for bleeding.
signed the informed  Administer analgesics if
consent. necessary for pain.
 Provide sedation as
prescribed.
 Neutropenia
 Abnormal decrease in the number of
netrophils in the blood.
 Are essential in preventing and limiting
bacterial infections.
 Neutropenia: Etiology
1. ↓ production of neutrophils
- aplastic anemia
- metastatic cancer, lymphoma, leukemia
- chemotherapy & radiation therapy
5. ↑ destruction of neutrophils
- hypersplenism
- medication-induced
- immunologic disease
- viral disease
- bacterial infections
Neutropenia: Management
1. Reverse Isolation

Neutropenic diet - A neutropenic diet is

sometimes referred to as a "clean diet". This
basically means avoiding foods which are known
to contain a higher level of bacteria.

Medication: Neupogen - used to treat and

prevent neutropenia (low counts of a certain
type of white blood cell known as neutrophils
Leukemia
o Literal meaning: white blood

o Hematopoietic malignancy with unregulated

proliferation of leukocytes

o Types:
 Acute myeloid leukemia (AML)

 Chronic myeloid leukemia (CML)

 Acute lymphocytic leukemia (ALL)

 Chronic lymphocytic leukemia (CLL)

Acute Myeloid Leukemia
 Defect in the stem cells that
differentiate into all myeloid cells:
monocytes, granulocytes,
erythrocytes, and platelets
 Affects all ages with peak incidence
at age 60; M > F 3:2
 SURVIVAL: 1-3 yrs w/ treatment
AML: manifestations

fever and infection

weakness and fatigue
bleeding tendencies: epistaxis,
petechiae
pain from enlarged liver or spleen
hyperplasia of gums
bone pain
AML: Management

2. aggressive chemotherapy: cytosine,

arabinoside & daunorubicin

4. BMT

6. PBSCT

8. Gentuzumab ozogamicin (Mylotarg) – anti-CD33

antigen
Chronic Myeloid Leukemia
 Mutation in myeloid stem cell with
uncontrolled proliferation of cells:
Philadelphia chromosome
 Uncommon in people under 20; incidence
increases with age; mean age is 55 to 60
years; M > F

 Life expectancy is 3 to 5 years

Chronic Myeloid Leukemia
A section of DNA is found to be missing or
altered from chromosomes
↓
Philadelphia chromosome (chromosome 22)
↓
Production of abnormal protein
(tyrosine kinase protein)
↓
Overproduction of WBC
CML: manifestations
initially
may be asymptomatic
Malaise & weakness
Anorexia & weight loss
Confusion
shortness of breath
enlarged, tender spleen
enlarged liver
CML: management
imatinib mesylate (Gleevec) –
Tyrosine Kinase Inhibitor

3. Chemotherapy

5. BMT

7. PBSCT
Acute Lymphocytic Leukemia
 Uncontrolledproliferation of
immature cells from lymphoid stem
cell
 Most common in young children (3-4
yrs)
 Prognosis is good for children; 80%
event-free after 5 years, but
survival drops with increased age
Acute Lymphocytic Leukemia
Immature Lymphocytes proliferates in the
marrow
↓
Interferes with dev’t of normal myeloid
cells
↓
Normal hematopoeisis is inhibited
↓
Reduced number of WBC, RBC, Platelets
ALL: manifestations
leukemiccell infiltration is more
common with this leukemia with
symptoms of:
1. meningeal involvement
( headache, vomiting)
2. liver, spleen, and bone marrow
pain
3. chills
ALL: management
1. Chemotherapy: vincristine,
prednisone, methotrexate

3. BMT or PBSCT

5. monoclonal antibody therapy

Chronic Lymphocytic Leukemia
 Malignant B lymphocytes, most of which
are mature, may escape apoptosis,
resulting in excessive accumulation of
cells
 Most common form of leukemia
 More common in older adults (60 yrs &
older) and affects men more often
 Survival varies from 2 to 14 years
depending upon stage
 CLL: manifestations
 Painless lymphadenopathy, hepatomegaly,
splenomegaly;

 anemias and thrombocytopenia

 autoimmune complications with RES

destroying RBCs and platelets may occur

B symptoms: fever, sweats, and weight loss

CLL: management
early stage may require no
treatment

Chemotherapy

monoclonal antibody therapy -

alemtuzumab (Campath); anti
CD52 antigen
Lymphoma
Tumor usually starts in lymph nodes but
can involve lymphoid tissues in the
spleen and GIT (ex. Walls of the
stomach, liver and bone marrow)
Neoplasm of lymph origin:

2 Classifications

a. Hodgkin’s lymphoma

b. Non-Hodgkin’s lymphoma
Hodgkin’s Lymphoma
Unicentric origin
(+)
Reed–Sternberg cell (giant cell
mutations of the T-lympocytes)
Suspected viral etiology; familial
pattern; incidence occurs in early
20s and again after age 50
Excellent cure rate with treatment
HL: manifestations
 painlesslymph node enlargement
(cervical=29%, supraclavicular=41%);
firm & movable

 Enlargement of the liver & spleen

 Pruritus without rash

B symptoms: fever, sweats, and weight

loss
Ann Arbor Staging
I – single lymph node region or an extralymphatic organ
or site (usually in the neck); 90%-98% survival

II – 2 or more lymph node regions on the same side of

diaphragm or localized involvement of an
extralymphatic organ or site; 70%-80% survival

III – lymph node regions on both sides of diaphragm;

50% survival

IV – diffuse or disseminated involvement of one or

more extralymphatic organs with or without
associated lymph node involvement
HL: management

Treatment is determined by stage

of the disease and may include:
- chemotherapy
- radiation therapy
Non-Hodgkin’s Lymphoma
Lymphoid tissues become
infiltrated with malignant cells
that spread unpredictably;
localized disease is rare
Incidence increases with age; the
average age of onset is 50 to 60
Prognosis varies with the type of
NHL
Non-Hodgkin’s Lymphoma
Primary sites:
2. GI tract or nasopharynx (15%-25%)
3. Ovaries
4. Testes
5. Bones
6. CNS
7. Liver
8. Breast
9. Subcutaneous tissues
NHL: management
Treatment is determined by type
and stage of disease and may
include:

- interferon
- chemotherapy
- radiation therapy
- surgery
Multiple Myeloma
 Malignantdisease of plasma cells in
the bone marrow with destruction
of bone

 Median survival is 3 to 5 years;

there is no cure
Multiple Myeloma
 bone pain
 Osteoporosis
 Fractures
 elevated serum protein
 Hypercalcemia
 renal damage, renal failure
 symptoms of anemia, fatigue, weakness
 increased serum viscosity
 increased risk for bleeding and infection
Multiple Myeloma
1. Chemotherapy – primary treatment

3. Corticosteroids - Dexamethasone

5. radiation therapy – useful in

strengthening of the bone along with
chemo.

7. Biphosphonates – strengthens bones.