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Table 6-15. Common Blood Products and Their Clinical Indications and Omcomes

Product

Content

Clinicallndications

Outcome

Whole blood

Blood cells and

Acme major blood loss in setting of

Resolution of signs and symptoms of

plasma

hypotension, tachycardia, tachypnea,

hypovolemic shock or anemia.

pallor, and decreased Hct and Hgb.

Hct should increase 3% in a non bleeding

To treat oxygen-catrying deficit (RBC) and

adult (per unit transfused).

volume expansion (plasma).

Whole blood is rarely used.

Red blood cells

RBCs only

Acute or chronic blood loss.

Resolution of signs and symptoms of

(RBCs)

To treat oxygen-carrying deficit in sccring

anemia.

of tachycardia, tachypnea, pallor,

Hct should increase 3% in a nonbleeding

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faeigue, and decreased Hct and Hgb.

adult (per unit transfused).

Anemia without need for volume

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expansion.

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Plaeelets (Pits)

Concentrated Pits

To restore clotting function associatcd

Resolution of thrombocytopenia.

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in plasma

with or a&er blood loss.

Prevention or resolution of bleeding.

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To increase Pit coune in a bleeding patient

Pit should increase 5,000 in a lO-kg adult

with Pit < 1 00,000, in advance of a pro

(per unie).

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cedure with Pit <50,000, or prophylacti

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cally wieh Pic <10,000.

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Table 6-15. Continued

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Product

Content

Clinical Indications

Outcome

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Fresh-frozen

All plasma

To replace or increase coagulation factor

Improved or adequate coagulation lev-

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plasma (FFP)

components,

levels.

els or factor assays.

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namely blood

Acute disseminated intravascular coagu-

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factors and pro-

lopathy.

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tein

Thrombotic thrombocytopenic purpura.

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Factor Xl deficiency.

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0

Rapid reversal of warfarin therapy.

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Albumin

Albumin cells

Volume expansion in situations when crys-

Acquire and maintain adequate blood

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with few globu-

ralloid (saline or Ringers lactate) is inad-

pressure and volume support.

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lins and other

equate such as shock, major hemor-

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proteins

rhage, or plasma exchange.

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Acute liver failure.

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Burn injury.

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Plasma protein

Albumin,

See Albumin, above.

See Albumin, above.

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fraction

globulins, and

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(PPF)

plasma proreins

Cryoprecipitate

Factors VIII and

Rcplacemenr of these factor deficiencies.

Correction of these faeror or fibrinogen

XlII, von WiUe

Replacement of fibrinogen when an

deficiencies.

brand's factOr,

increase in volume would not be toler

Cessation of bleeding in uremic patients.

and fibrinogen

ared with FFP.

in plasma

Bleeding associated with uremia.

Her = hematocrit, Hgb = hemoglobin.

Sources: Data from National Blood Resource Education Programs Transfusion Therapy Guidelines for Nurses. US Depanmem of Health and Human Services, National Institutes of Health, September 1990; and adapted from WH Churchill. Transfusion Therapy. New York: Sciemific American Medicine, 2001 ;4.

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Table 6-16. Acute Adverse Blood Reactions

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Reaction

Cause

Signs and Symptoms

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Febrile reaction

Patienr's blood (antileukocyte antibod

Low-grade fever, headache, chills, flushed

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ies) is sensitive to transfused plasma

skin, muscle pain, anxiety (mild)

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protein, platelets, or white blood

Hypotension, tachycardia, tachypnea,

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cells.

cough (severe)

Onset: during transfusion or up to 24 hrs

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post transfusion

13

Allergic reaction

Patient's blood (lgE, IgG, or both) is sen11

Hives, flushed or itchy skin, and bronchial

sitive

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[0 transfused plasma protein.

wheezing (mild)

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Tachypnea, chest pain, cardiac arrest

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(severe)

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Onset: within minutes of transfusion

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Septic reaction

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Transfused blood components arc con

Rapid onset of high fever, hypotension,

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taminated with bacteria.

chills, emesis, diarrhea, abdominal

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cramps, renal failure, shock

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Onset: within minutes ro 30 mins after

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transfusion

Acute hemolytic reaction

Patient's blood and transfused blood

Tachycardia, hypotension, tachypnea,

are not compatible, resulting in red

cyanosis, chest pain, fever, chills,

blood cell destruction.

head- or backache, acute renal failure, cardiac arrest

Onset: within minutes to hours afrer

transfusion

Anaphylacric reaction

Patient is deficient in IgA and develops

Hives (mild)

IgA antibody to transfused compo

Wheezing or bronchospasm, an.xiery,

nents.

cyanosis, nausea, emesis, bloody

diarrhea, abdominal cramps, shock,

cardiac arrest (severe)

Onset: within a few seconds after exposure

Ig = immunoglobulin.

Sources: Adapted from B Kozier, G Erb, K Blais, JM Wilkinson (cds). Fundamentals of Nursing: Concepts, Process and Practice (5rh cd).

Redwood Cit)', CA. Benjamin-Cummings, 1995;110; and data from PJ Larison, LO Cook. Adverse Effects of Blood Transfusion. In OM

Harmening (cd), Modern Blood Banking and Transfusion Practices. Philadelphia: FA DavIs, 1999; and Narional Blood Resource Education Programs Transfusion Therapy Guidelines for Nurses. US Department of J-Iealrh and Human Services, Nadonal lnsritures of Health.

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Seprember 1990.

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