Blood Transfusion

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.

 Red

Blood Cells carry oxygen and are needed by surgical patients or those with anemia or kidney disease

 Platelet

Concentrates are fragile blood cells needed by leukemia and other cancer patients to control bleeding.

 Fresh

Frozen 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

7.

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 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.

7. 8.

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 Do not leave the client alone. Monitor the client for any lifethreatening 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 o

Literal Meaning: “too many cells in the blood” 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: 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. o

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: Develop into cells called Macrophages that participates in immunity.  effective against FUNGI & VIRUSES  digest aged blood cells (RBCs) w/in the spleen o

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

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Performed by a physician or specially-trained nurse

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Site: posterior iliac crest, sternum

Bone Marrow Aspiration PRE-PROCEDURE: Explain the purpose of the procedure & what to expect.  Advise the client that there will be pain during the procedure.  Verify that client has signed the informed consent.  Provide sedation as prescribed. 

POSTPROCEDURE: Apply pressure until bleeding stops.  Place a small bandage over the site.  Observe the site frequently for bleeding.  Administer analgesics if necessary for pain. 

Neutropenia Abnormal decrease in the number of netrophils in the blood.  Are essential in preventing and limiting bacterial infections. 

Neutropenia: Etiology 1.

5.

↓ production of neutrophils - aplastic anemia - metastatic cancer, lymphoma, leukemia - chemotherapy & radiation therapy ↑ 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

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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  Uncontrolled

proliferation of immature cells from lymphoid stem cell

 Most

yrs)

common in young children (3-4

 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 leukemic

cell 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  painless

lymph node enlargement (cervical=29%, supraclavicular=41%); firm & movable

 Enlargement  Pruritus B

of the liver & spleen

without rash

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  Malignant

disease 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.