Blood transfusion reactions are common within the hospital setting because so many blood products are given. Transfusing blood products that are lacking or actively being lost (i.e. GI bleed) is literally life-saving treatment. Show
In this article, we will talk about the different blood products, why they are given, and then dive into each type of blood transfusion reaction, what causes them, their signs and symptoms, and how to manage them as the nurse. What are blood products?There are multiple different blood products that are transfused within the hospital, and each one can have adverse reactions called blood transfusion reactions. Packed Red Blood Cells (PRBCs)Packed Red Blood Cells or PRBCs are given to patients when their hemoglobin levels are low. This is called anemia. Some common causes of anemia that may need a transfusion include:
PRBCs are usually ordered when hemoglobin levels drop below 7g/dL, but it depends on the nature of the patient’s anemia as well as their medical history and their hemodynamic stability (are their vital signs normal?) 1 to 2 units will be ordered of PRBCs depending on how low the patient’s hemoglobin level is, as well as if there is active blood loss. Each unit of PRBCs should increase the hemoglobin by about 1g/dL. Before blood products are given, a type and screen is done to verify the patient’s blood type and screen for any antibodies that may require special blood. The exception is if the patient has significant ongoing hemorrhage and the patient needs emergent blood. In this case, O Negative blood is given as they are the universal donor. Each unit of blood will take about 2 hours to transfuse, but the maximum amount of time is 4 hours when the blood will expire. In emergencies, blood can be run as fast as needed, often with pressure bags. Fresh Frozen Plasma (FFP)Fresh Frozen Plasma or just Plasma is the portion of whole blood that doesn’t include the red blood cells, which contains clotting factors. Some reasons FFP may be ordered for your patient include:
In massive transfusions, you replace 1 unit of FFP for every unit of PRBCs replaced (along with 1 unit of platelets). PlateletsPlatelets are a blood product that help the body form blood clots and prevent bleeding. These can often become low from various autoimmune disorders, cancers and chemotherapies, medication reactions, and liver disease. Platelets are replaced when platelet levels are low, termed thrombocytopenia. Platelets are usually ordered for:
Most platelets that are given are obtained by “apheresis”. One apheresis unit is equal to 4-6 “pooled random donor units”. 1 unit of platelets by apheresis should increase the platelets by about 30K. Why are Blood products Given?Blood products are given whenever the blood levels are too low, or when there is acute bleeding. While this will depend on each specific patient and clinician, blood products are generally given when:
Blood Transfusion ReactionsAs with any medication or fluid, there are possible adverse reactions that can occur and that you need to monitor for. Because we are infusing blood products from a donor, this adds an increased risk of adverse reactions to occur. Because of this, nurses must monitor their patients very closely during blood product transfusions. The nurse must stay with the patient the first 15 minutes of a blood transfusion (may change depending on specific facility protocol), and frequently check vital signs. There are common blood reactions, and then there are more rare and severe reactions that can occur. Acute Hemolytic Transfusion ReactionAn acute hemolytic transfusion reaction is a rare life-threatening blood transfusion reaction to receiving blood, specifically PRBCs. This happens when incompatible blood is accidentally infused with the patient. This is why the patient’s blood type is checked in the first place so that an appropriate donor can be given. Compatible blood is outlined below: When having a true acute hemolytic reaction, the patient will quickly experience:
This is a severe reaction as the patient’s own immune system and the donor’s immune system attack each other, destroying blood products and causing damage in the process. The patient may experience hemodynamic instability including life-threatening hypotension. If this reaction occurs, the nurse should: Acute Hemolytic Reaction: Nursing StepsIf an acute hemolytic reaction is suspected, the nurse should:
The Provider should guide treatment, but these are serious reactions and would likely need monitoring in the ICU. Your facility should have a specific protocol in the event of significant blood transfusion reactions, which often involves re-testing the patient as well as re-testing the blood unit itself. Anaphylactic Transfusion ReactionAn anaphylactic transfusion reaction is a severe allergic reaction to something within the blood product. These are rare, with an estimated 1 in 20-50K transfusions. This reaction occurs seconds to minutes after starting the transfusion. The recipient is severely allergic to something within the donor blood, which they may have antibodies against, specifically those who are IgA deficient or haptoglobin deficient. Signs of an anaphylatic reaction include:
Treatment involves immediately stopping the transfusion, and then treatment with standard anaphylactic medications. These medications include:
More significant interventions may be needed, including:
The blood cannot be restarted, and additional testing will need to be performed, and blood from another donor will have to be given. Urticarial Transfusion ReactionAn urticarial transfusion reaction is a less severe allergic reaction to a component within the blood products, but much more common, occurring in 1-3% of blood transfusions. This is an antigen-antibody interaction, usually with donor serum proteins. Patients with this blood transfusion reaction will develop urticaria (hives) with no other allergic signs/symptoms such as wheezing, angioedema, or hypotension. When an urticarial transfusion reaction occurs:
When an urticarial transfusion reaction is diagnosed, stop the blood for 15-30 minutes, give IV antihistamine like Benadryl, and then restart the infusion once hives resolve but slowly and cautiously. Check your specific facility’s protocol. Which complication involves the entry of an intravenous solution?However, there are complications associated with IV access, including IV infiltration, hematoma, an air embolism, phlebitis, extravascular drug administration, and intra-arterial injection.
Which complication involves the entry of an intravenous solution containing a Vesicant drug into the subcutaneous?Extravasation occurs when vesicant solution (medication) is administered and inadvertently leaks into surrounding tissue, causing damage to surrounding tissue.
Which electrolyte influences excitability?Potassium (K+) The magnitude of the potassium gradient across cell membranes determines excitability of nerve and muscle cells, including the myocardium. Rapid or significant changes in the serum potassium concentration can have life-threatening consequences.
Which therapy would be prescribed for a patient with circulatory overload?Diuretic therapy
Diuretics, especially loop diuretics, remain a valid therapeutic alternative for relieving symptoms and improving pathophysiological states of fluid overload such as congestive heart failure and in patients with AKI.
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Which would the nurse administer to manage a mild allergic reaction during a blood transfusion
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