Ex.

Varicosities
Deep Vein Thromboplehbities
Ex.
Aneurysm
Buergers Disease
Raynauds Disease
Plasma CHONs (Liver)

1. Albumin - largest, most abundant plasma

Fx: Maintains osmotic pressure preventing edema,
If decrease albumin- Ascites
Promotes skin integrity

2. Globulins

a. Alpha Transports steroids, hormones & bilirubin
b. - Transports iron & copper
c. Gamma Transport immunoglobulins or antibodies

3. Prothrombin (CF2) Fibrinogen (CF1)
Clotting factor to prevent bleeding
- Spleen life span = 120 days
Cellular Components:

1. RBC (Erythrocytes)
- largest
(Normal: 4 6 M/mm3)

- Anucleated (no nucleus)
- Biconcave discs
- Has molecules of Hgb (red cell pigment)
- Transports & carries O2

Hgb:
F = 12-14 gms%
M = 14-16 gms %


Hct : 3x Hgb
F = 36-42 %
M = 42-48 %
Average = 42 %
HEMATOLOGICAL SYSTEMS


Overview:


I . BLOOD-FORMING ORGANS

1.Thymus removed myasthenia gravis
2. Liver largest gland (occupies most of the right hypochondriac region)
3. Lymph nodes
4. Lymphoid organs Payers Patches (located between the small intestine- site of salmonella thypi)
5. Bone marrow
6. Spleen



II. BLOOD VESSELS

1. Veins SVC, IVC, Jugular vein, superficial blood towards the heart

2. Artery deep seated, carries blood away from the
- 2 largest artery : Aorta, carotid

3. Capillaries





III. BLOOD

Blood

Formed Elements 45 % 55% Plasma & Serum



























CLOTTING FACTOR 1-13

CF 1 = Fibrinogen From

CF 2 = Prothombin Pakistan

CF 3 = Thrombin To

CF 4 = Ca # China

CF 5/6 = Proaccelerin - Labile factor People

CF 7 = Procenvertion - Stable Factor Power

CF 8 = Anti- HFA Against

CF 9 = Christmas Factor/ Anti-hemophilia Communism

CF 10 = Stuart-Prower Start

CF 11 = Plasma Thromboplastin Peace

CF 12 = Hageman Hate

CF 13 = Fibrin Stabilizing Factor Fire


COAGULATION PATHWAY/CASCADE


Intrinsic Factor Stage 1 Extrinsic Factor

EF TF TF (CF3)
CF 12
CF 9 F
CF 11

CF 9--------------------------------------------------CF 10 ------------------------------------------ CFS


Creates------Prothrombinase----------------- CF 2 Stage 2
Product of Stage 1

Thrombin
Stage 3

CF 1

Fibrin


Clot -------- --Clot dissolved

Tissue Plasminogen Activator

Plasminogen

Plasmin Stage 4




1
st
Sign of ANEMIA:

Weakness & Fatigue


Hallmark & Basis of Anemia
All symptoms cause by this


Lesions at the
corner of the mouth

D/T compensation of the
body

D/T decreased
RBC

D/T decreased Hgb that
gives color to skin
KOILONYCHIA
d/t atrophy of epidermal
cells
Life span of RBC
8-120 days
I. DISORDERS OF THE BLOOD



Pathophysiology:

BLOOD DYSCRASIA



Production of blood cells Production of both normal Spleen Disorder Defect in Coagulation
(PANCYTOPENIA) & defective cells Mechanism





1. ANEMIA
- A condition in which the hemoglobin concentration is lower than normal

- Results from :
1. Decreased Erythropoiesis (Formation-maturation process of RBC)
2. Increased Hemolysis
3. Bone Marrow Depression
4. Blood loss




Pathophysiology: Hgb Count


Reduction in the O2 carrying capacity of the blood

TISSUE HYPOXIA



Brain Restlessness Heart Respiratory GIT Skin
Headache, Irritability Anginal Pain RR Anorexia Mucus Membrane
Syncope, Vertigo PR Dyspnea Angular Cheilosis

Fatigability
Palpitation




Pallor


Brittle nails & hair

(Spoon-shaped nails)



Intolerance to Cold


Normal shape of nails = Biconcave & 180

Substances Needed For Maturation Of RBC:

1. CHON formation of all tructure/membrane
2. Iron/Fe - formation of pigment hemoglobin
3. Vit. B 12 - responsible for synthesis of nucleic acid
4. Folic Acid - matures the cell
5. Vit. C - catalyst for iron/absorption of iron
6. Vit. B6
7. Intrinsic Factor
Common:
Suicide - common in teenager
Poisoning common in children (aspirin)
Aspiration common in infant
Accidents common in adults
Choking common in toddler
SIDS common in infant in US

Bleeding:
Hematemesis vomiting of blood
Melena passage of dark stool
- Bleeding in Upper GIT
- Doudenal Cancer
Hematochezia passage of fresh blood
- Bleeding in Lower GIT
- large intestine
Nsg Dx:
Activity Intolerance

Decreased O2

Atrophy of cells

Cerebral Hypoxia

PICA






CAUSES:

I. DECREASED ERYTHROPOIESIS

Production maturation of RBC


Absence of any one of the factors
For RBC maturation will cause


Type I:


A. IRON DEFECIENCY ANEMIA

- Cells are microcytic (small) & hypochronic d/t inadequate absorption of iron leading to hypoxemic injury
HYPOCHROMIC ANEMIA HYPOPROLIFERATIVE ANEMIA

Pathophysiology: The body stores of iron decrease, leading to depletion of hemoglobin synthesis

Incidence Rate:

1. Common in developed country d/t high cereal intake & accidents
2. Common in tropical countries blood sucking insects
3. Women 15 45 y/o of reproductive yrs
4. Common among the poor d/t poor nutritional intake

Predisposing Factors:

1. Chronic blood loss- most common cause
a. Trauma
b. Menstruation
c. GIT bleeding

2. Inadequate intake of food rich in iron

3. Inadequate absorption or iron d/t :
a. Chronic diarrhea (Metabolic Acidosis)
b. Malabsorption syndrome (Celiac Disease)
c. High cereal intake with low animal CHON ingestion
d. Subtotal gastrectomy
4. Improper cooking of food/ Alcoholism

S/Sx:

1. Asymptomatic
2. General body malaise
3. All Sx of Anemia + PICA abnormal appetite or craving for non-edible food Ex. Chalk

+ PLUMMER VINSONS SYNDROME Atropic Glossitis inflammation of tongue
Stomatitis mouth sores
Dysphagia
Dx :
1. RBC
2. Hgb
3. Reticulocyte
4. Hct
5. Iron
IRON-RICH FOOD:
1
ST
: organ meat, liver
2
nd
: eggyolk
3
rd
: raisins, legumes
dried fruits
nuts
4
th
: green leafy vegetables

IRON Side-Effects:
Anorexia
N/V
Abdominal Pain
Diarrhea/ Constipation
Melena
6. Ferritin
7. Bone Marrow Aspiration = Most Definitive

Tx:
1. Blood Transfusion = Packed RBC
Nsg Mgt:

1. Monitor signs of bleeding of all hematologic test including urine, stool & GIT
2. Complete bed rest dont overtire pt
3. Encourage iron rich food
4. Instruct the pt to avoid taking tea (Tannates - impairs iron absorption)
5. Administer meds: Hematinic Agents or drugs that will increase blood heme

a.) Oral iron preparation
Ferrous SO4
Fe gluconate 300 mg OD
Fe Fumarate
Fortifier
Fergon, Feorol, Iberet
*Liquid Preparations: W/ brassy taste, disguise by chilling

Nsg Mgt Of Oral Iron Medication:

1. Administer w/ meals to lessen GIT irritation/or 0ne hours before meals
2. If diluting in iron liquid prep administer w/ straw
3. Give Orange juice for absorption
4. Monitor & inform pts S/E

5. If pt cant tolerate oral iron preparation
Administer parenteral iron preparation
1. Iron dextran (IV, IM)
2. Sorbitex (IM only)
3. Inferon, Jectofer


Nsg Mgt Parenteral Iron Preparation:

1. Administer using Z tract method to prevent discomfort, discoloration leakage to tissues.
2. Dont massage injection site. Ambulate to facilitate absorption.
3. Monitor S/E:
a.) Pain at injury site
b.) Localized abscess (nana)
c.) Lymphadenopathy
d.) Fever/ chills
e.) Urticaria itchiness
f.) If (+) to Hypotension ------------Anaphylactic shock


Give epinephrine (SNS Effect)













Largest part of GIT = Large Intestine
Widest part of GIT = Stomach
B. FOLATE DEFICIENCY ANEMIA

- Cell is macrocytic, hypochromic anemia
- A form of MEGALOBLASTIC ANEMIA
- Anemias characterized by abnormal large RBC 2
nd
to impaired DNA synthesis d/t deficiency of Folic acid

Pathophysiology:
Folic acid impaired DNA synthesis in the bone marrow impaired RBC development, impaired nuclear
maturation but cytoplasmic maturation continues large size

Causative Factors:
1. Alcoholism
2. Mal-absorption
3. Diet deficient in uncooked vegetables

Sx: All symptoms of Anemia



C. PERNICIOUS ANEMIA

- A megaloblastic chronic anemia characterized by deficiency of intrinsic factor secreted by the parietal cells
leading to Hypochlorhydria---------decrease Hcl acid secretion
- A Vit. B12 deficiency

Predisposing Factors:
1. Subtotal Gastrectomy partial removal of the stomach
2. Atrophy of gastric mucosa (elderly) ------ # 1 cause
3. Hereditary
4. Inflammatory disorder of ileum
5. Autoimmune
6. Strict vegetarian diet
7. Gastrointestinal malabsorption----Crohns Disease/ Cancer of stomach


Pathophysiology: STOMACH (composed of different cells)

Parietal or ergentaffen Oxyntic cells

Function: Produce Intrinsic Factor Function: Secrets Hcl acid

INTRINSIC FACTOR HYDROCHLORIC ACID

Binds w/ Vit. B12 to promote absorption Aids in digestion

For maturation of RBC Decreased Digestion ----- Dyspepsia & Weight Loss

Disorder in the Process
Diet: High caloric Intake to correct Wt loss
Immature RBC

Killed by Spleen

Heme----Globin

Ferroes------------Ferretin = Bilirubin ----- Jaundice





Common Route: Dorso-gluteal
Ventro-gluteal
S/Sx:
1. All Sx of Anemia +
2. GIT changes
a. RED BEEFY TONGUE = PATHOGNOMONIC SIGN
b. Dyspepsia indigestion
c. Wt loss, mild diarrhea
d. Jaundice
3. CNS Most dangerous anemia d/t neurologic involvement d/t deficiency in Vit. B 12
a. Tingling sensation
b. Paresthesia (numbness) in extremities
c. (+) Rombergs test = Ataxia
d. Psychosis
Dx:
1. Peripheral Blood Smear = shows giant RBCs, WBCs w/ giant hypersegmented nuclei
2. Very High MCV
3. Shillings Test = reveals inadequate absorption of Vit. B 12
4. Intrinsic Factor Antibody Test
Tx:
1. Vit. Supplementation : Folic Acid 1 mg daily
2. Diet Supplementation
3. Lifetime monthly injection of IM Vit. B 12 as ordered -----not oral---pt. may developed drug toleranceNo S/E
Nsg Mgt :
1. Enforce CBR
2. Diet high calorie or CHO----Increase CHON, iron & Vit C
3. Avoid irritating mouthwashes. Use of soft bristled toothbrush is encourage
4. Avoid applying electric heating pads can lead to burns
II. INCREASE HEMOLYSIS/ HEMOLYTIC ANEMIA

- Destruction of RBC greater than the rate of formation
----all + Hyperbilirubinemia-----JAUNDICE + TEA-COLORED URINE
Causes:
1. Post-viral injection
2. Exposure to ionizing radiation
3. Prolong use of toxic drugs & medications (penicillin, chloramphenicol)

Type II:

A. SICKLE CELL ANEMIA
- A severe chronic incurable hemolytic anemia that results from heritance of the sickle hemoglobin gene.

Causative Factor:

1. Genetic inheritance of the sickle gene- HbS gene

Pathophysiology:
Decreased O2, Cold, Vasoconstriction can precipitate sickling process

Factors cause defective Hgb to acquire a rigid, crystal-like C-shaped configuration

Sickled RBCs adhere to endothelium pile up & plug the vessels ischemia results pain, swelling & fever

Sx:
1. Jaundice
2. Enlarged skull & facial bones
3. Tachycardia, murmurs & cardiomegaly
Primary sites of thrombotic occlusion: spleen, lungs & CNS
4. Chest pain, dyspnea

Complications:

1. Sickle Cell Crises = Results from tissue hypoxia & necrosis
2. Acute Chest Syndrome = Manifested by a rapidly falling Hgb level, tachycardia, fever & chest infiltrates in the CXR
3 Nursing Priority:

1. A/W Avoid deoxygenating activities
- High altitude is bad
2. Fluid Deficit Promote hydration
3. Pain & Comfort
POLYCYTHEMIA
Earliest Sign : Headache
Late Sign: Pruritus

Complication: Stroke, Thrombosis

Tx:
1. Bone marrow transplant
2. Hydroxyurea = Increases the Hgb
3. Long term RBC transfusion = Packed RBC
Surgery For Hemolytic anemia = Spleenectomy
Nsg Mngt:

1. Manage the pain
Support & elevate acutely inflamed joint
Relaxation techniques
Analgesics
2. Prevent and manage infection
Monitor status of patient
Initiate prompt antibiotic therapy
3. Promote coping skills
Provide accurate information
Allow patient to verbalize her concerns about medication, prognosis & future pregnancy
4. Monitor and prevent potential complications
Provide always adequate hydration
Avoid cold, temperature that may cause vasoconstriction
5. Monitor and prevent potential complications
Leg ulcer
Aseptic technique
Priapism = Sudden painful erection
Instruct patient to empty bladder, then take a warm bath


B. POLYCYTHEMIA


- Refers to an INCREASE volume of RBCs -----reverse of sickle cell anemia
- The hematocrit is ELEVATED to more than 55%


Classified as Primary or Secondary


1. POLYCYTHEMIA VERA
- Primary Polycythemia
- A proliferative disorder in which the myeloid stem cells become uncontrolled


Causative Factor: Unknown


Pathophysiology:
The stem cells grow uncontrollably
The bone marrow becomes HYPERcellular & all the blood cells are increased in number
The spleen resumes its function of hematopoiesis and enlarges
Blood becomes thick & viscous causing sluggish circulation
Overtime, the bone marrow becomes fibrotic

Sx:
1. Skin is ruddy
2. Splenomegaly
3. Dizziness, blurred vision, HA
5. Angina, dyspnea & thrombophlebitis



Dx:
1. CBC- shows elevated RBC mass
2. Normal oxygen saturation
3 Elevated WBC & Platelets

Complications:

1. Increased risk for thrombophlebitis, CVA MI
2. Bleeding d/t dysfunctional blood cells

Tx:
1. To reduce the high blood cell mass- PHLEBOTOMY
2. Allopurinol
3. Dipyridamole
4. Chemotherapy to suppress bone marrow

Nsg Mngt:
1. Primary role of the nurse is EDUCATOR

2. Regularly assess for the development of complications

3. Assist in weekly phlebotomy

4. Advise to avoid alcohol & aspirin

5. Advise tepid sponge bath or cool water to manage pruritus




III. BONE MARROW DEPRESSION/ HYPOPLASTIC ANEMIA

- Inadequate abnormal cells-------Hypoplastic anemia/Aplastic Anemia
- All Sx + decreased WBC --------------Leukopenia ----------risk for infection

+ decreased PLATELETS--- Thrombocytopenia----- bleeding



when all 3 are present ----- PANCYTOPENIA

WBC
(Leucocytes 5,000 10,000/mm3)


GRANULOCYTES
3 Types:
1. Polymorphonuclearneutrophils (PMNs)

- Most abundant 60-70% WBC
- Lifespan of 24-48 hrs.
Function: Short-term Phagocytosis
For acute inflammation

2. Polymorphous Basophils (PMBa)

-Involved in Parasitic infection
- Release of chemical mediator for inflammation
(Serotonin, Histamine, Prostaglandin, Bradykinins)
-Absorbs large fat particles after ingestion of high fat meal


NON-GRANULOCYTES

A. Monocytes (Macrophage)
-Largest WBC
- Involved in long term phagocytosis
- For chronic inflammation
- Other name macrophage


Macrophage in CNS- Microglia
Macrophage in skin Histiocytes
Macrophage in lungs Alveolar macrophage
Macrophage in Kidneys Kupffer cells

B. Lymphocytes
3 Types:
SIGNS OF PLATELET DYFUNCTION
1. Petecchiae
2. Ecchymosis/bruises
3. Oozing of blood from venipuncture site
HIV
Window Period: 6 months
Incubation: 6 months to 5 yrs.
Sx: Kaposi Sarcoma
Dx Test: Western Blot Test
Drug of Choice:
Zidovudine ( AZT or Retrovir)
Standar Precaution:
Gloves, Gown, Goggles & Mask
3. Polymorphous Eosinophils (PMEo)

- Involved in Allergic reactions

1. B Cell L
Bone marrow or bursa dependent
- Arises from bone marrow

2. T Cell
Devt of immunity
- From thymus
- Target cell of HIV

3. NK Cell
Natural killer cell
-Have both antiviral & anti-tumor properties

C. Platelets (Thrombocytes)
(Normal: 150,000 450, 000/ mm3)
- Promotes homeostasis prevention of blood loss
by activating clotting
- Consists of immature or baby platelets known as
Megakaryocytes Target of Dengue Virus

- Normal lifespan 9 12 days









A. APLASTIC ANEMIA
A condition characterized by decreased number of RBC as well as WBC & platelets
- Common among clients undergoing chemotherapy, Cobalt therapy, Radiation therapy
- Stem cell disorder d/t bone marrow depression leading to pancytopenia all RBC are decreased


Decrease RBC Decrease WBC Decrease platelets
Anemia Leucopenia Thrombocytopenia


Susceptibility to infection No clotting

Fever Bleeding



Petechia Ecchymosis Bruising
(Purpura)
Predisposing Factors :
1. Environmental Toxins & Chemicals Pesticides, Benzene & its derivatives
2. radiation
3. Immunologic injury
4. Certain drugs causes bone marrow depression
a. Chemotherapeutic agents, = Methotrexate, Nitrogen Mustard (anti-metabolite), Vincristine
b. Broad Spectrum antibiotic =Chlorampenicol, Sulfonamides bactrim
(Pt severe isolation)
c. Phenybutazones
5. Heavy Metals

Bone Marrow Transplantation
1. Syngeneic BMT
donor from twins
2. Allogenic BMT
Related or unrelated as long
as compatible (Human leukocyte antigen)
3. Autologous BMT
Own self
- harvest marrow during remission
Pathophysiology:
Toxins cause a direct bone marrow depression acellular bone marrow decreased production of blood elements
Sx:
1. All Sx of Anemia +
2. Leucopenia increase susceptibility to infection
3. Thrombocytopenia
4. Splenomegaly
5. Retinal hemorrhages
Dx:
1. CBC- decreased blood cell numbers
2. Bone marrow aspiration at posterior iliac crest: Confirms the anemia- hypoplastic or acellular marrow replaced by fats
Fatty streaks in bone marrow
Tx:
1. Bone Marrow Transplantation
2. Immunosuppressant drugs
3. Rarely, steroids
4. Blood transfusion = Fresh Whole blood
Nsg Mgt:
1. Removal of underlying cause
2. Blood transfusion as ordered
3. CBR
4. O2 inhalation
5. Reverse isolation d/t leukopenia
6. Monitor signs of infection
7. Avoid SQ, IM or any venipuncture site
8. Use electric razor when shaving to prevent bleeding
9. Administer meds:
Immunosuppressant
Anti lymphocyte globulin (Alg) given via central venous catheter, 6 days 3 weeks to achieve max therapeutic effect of
drug.

IV. BLOOD LOSS
- Cells are normocytic (normal size), normochronic (normal content) but d/t surgery, menstruation------anemia
- All Sx + Hypovolemia
- Blood Transfusion = Fresh Whole blood
OTHER BLOOD RELATED PROBLEMS


1. DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

- Acute hemorrhagic syndrome characterized by wide spread bleeding & thrombosis d/t a deficiency of clotting
factors (Prothrombin & Fibrinogen).


Predisposing Factor:

1. Rapid BT d/t hemolysis
2. Massive trauma
3. Massive burns
4. Septicemia
5. R/T Hemolytic reaction & Anaphylaxis
6. Neoplasia new growth of new tissue (tumor)
7. Pregnancy
8. Septicemia

S/Sx:
1. Petechiae widespread & systemic (lungs, lower & upper trunk)
2. Ecchymosis widespread
3. Oozing of blood from venipunctured site
4. Hemoptysis cough blood
5. Hemorrhage
6. Oliguria---------------LATE SIGN
RBC
Normal Size: 80-94 cu micron
< 80 ---- Microcytic Cell ANISOCYTOSIS
> 94 ----- Macrocytic Cell (abnormal size)

Normal Hgb content of RBC: 22-28 micromicrogram

< 22 >28
Hypochromic Hyperchromic


Dx :

1. CBC reveals decrease platelets
2. Stool for occult blood (+)
Specimen stool
3. Opthalmoscopic exam sub retinal hemorrhage
4. ABG analysis metabolic acidosis

Nsg Mgt:

1. Monitor signs of bleeding All hematologic test + urine, stool, GIT
2. Administer isotonic fluid solution
3. Administer O2 inhalation
4. Administer meds:

a. Vit K aquamephyton
b. Pitressin or vasopressin -----t o conserve H20 & has vasoconstriction effect----Most Common S/E: Chest Pain

5. NGT lavage
- Use iced saline lavage 1
st
to induce vasoconstriction inside the stomach

6. Monitor NGT output
7. Provide heplock
8. Prevent complication: Hypovolemic shock----Early Sign: Restlessness & Cool moist Skin
Late Sign of hypovolemic shock : Anuria
9. Give Heparin-----short-acting




DIAGNOSTIC TEST FOR BLOOD DYSCRASIAS


1. CBC, Hgb, Hct

2. BT, CT, PT

3. ERYTHROCYTE INDEX

MCV = Mean Corpuscolar Volume -----to evaluate size of RBC
MCH = Mean corpuscular Hgb -----------to evaluate the Hgb content of RBC
MCHC = Mean corpuscular Hgb Concentrationto evaluate Hgb content of Pack RBC (in grams /100ml)
(Normal: 30-36 grams/100ml)



4. COOMBS TEST

- To evaluate the presence of immune bodies that adheres to
RBC causing hemolysis/agglutinization of RBC
(Rh Incompatibility, ABO Incompatibility)










POIKILOCYTOSIS = abnormality in shape of RBC
METARUBRICYTE = abnormal RBC w/ nucleated
Packed RBC = 250 ml
Refrigerated = 3-5 days
Platelet = 3-6 days

5. SCHILLING TEST

- To evaluate rate of absorption of Vit. B12 (Cyanocobalamine)
- Use to diagnosed Pernicious Anemia

Procedure: Administer P.O. radioactive Vit. B12 ------24 hr. urine
Check (+) (-) of Vit. B12 ------ if (-) Pernicious Anemia (do not give P.O. give parenterally)
------ if (+) in urine ---normal
Common in Pts. Who undergone gastrectomy/ cancer----they do not have intrinsic factor




6. BONE MARROW ASPIRATION/PUNCTURE/TAP



- To evaluate size, shape, character of RBC cells
- Invasive (consent)
- Local anesthesia (lidocaine 1-2%)
- Sites: Sternum ------ Position: Supine
A & P Iliac Crest ------ Position: Supine (A) & Prone/Lateral (P)
- Pediatric pts. --- use the long bones (femur, humerus)-----as we grow older the # of marrows in long bones decreases
- Apply pressure dressing over site to prevent bleeding




7. LYMPH NODE BIOPSY

- Site : Cervical LN, Axilla LN, Inguinal LN





IV. BLOOD TRANSFUSION:

Objectives:

1. To replace circulating blood volume
2. To increase O2 carrying capacity of blood
3. To combat infection if theres decrease WBC
4. To prevent bleeding if theres platelet deficiency

Nsg Mgt & Principles in Blood Transfusion
1. Proper refrigeration
2. Proper typing & cross matching
Type O universal donor
AB universal recipient
85% of people are RH (+)
3. Aseptically assemble all materials needed:
a.) Filter set
b.) Isotonic or PNSS or .9NaClfor flushing to prevent Hemolysis

Hypotonic solution Cell swells or burst
Hypertonic solution Cell will shrink or crenate
c.) Needle gauge 18 - 19 or large bore needle to prevent hemolysis.
d.) Instruct another RN to recheck the following .
Pts name, blood typing & cross typing expiration date, serial number Most important
e.) Check blood unit for bubbles, cloudiness, dark in color & sediments indicates bacterial contamination.
Return to blood bank, do not dispose
BT REACTIONS:

H - Hemolytic Reaction
A - Allergic Reaction
P - Pyrogenic Reaction
C - Circulatory Reaction
A - Air Embolism
T - Thrombocytopenia
C - Citrate Intoxication
H - Hyperkalemia d/t expired blood

f.) Never warm blood products may destroy vital factors in blood.
- Warming is done if with warming device only in EMERGENCY!
- Within 30 mins room temp only!

g.) Blood transfusion should be completed < 4hrs because blood that is exposed at room temp for > 2h causes blood
deterioration------can lead to bacterial contamination
h.) Avoid mixing or administering drug at BT line leads to hemolysis
i.) Regulate BT 10 12 gtts/min KVO or 100cc/hr to prevent circulatory overload
j.) Monitor VS before, during & after BT especially q15 mins for 1st hour
- Majority of BT reaction occurs within 1h.


BLOOD TRANSFUSION REACTIONS:


1. HEMOLYTIC REACTION

Sx:
Headache
Dizziness
Dyspnea
Palpitation
Lumbar/Sternal flank pain
Hypotension, Flushed Skin---red port wine urine

Nsg Mgt:

1. Stop BT
2. Notify Doc
3. Flush with plain NSS
4. Administer isotonic fluid sol to prevent acute tubular necrosis & counteract shock
5. Send blood unit to blood bank for reexamination
6. Obtain urine & blood samples of pt & send to lab for reexamination
7. Monitor VS & Allergic Rxn


2. ALLERGIC REACTION

S/Sx:

1. Fever/ chills
2. Urticaria/ pruritus
3. Dyspnea
4. Laryngospasm/ bronchospasm
5. Bronchial wheezing

Nsg Mgt:

1. Stop BT
2. Notify Doc
3. Flush with PNSS
4. Administer antihistamine diphenhydramine Hcl (Benadryl)
If (+) Hypotension anaphylactic shock administer epinephrine
5. Send blood unit to blood bank
6. Obtain urine & blood samples send to lab
7. Monitor VS & IO
8. Adm. Antihistamine as ordered for Allergic Rxn, if (+) to hypotension indicates anaphylactic shock
Shock -----administer epinephrine
9. Administer antipyretic & antibiotic for pyrogenic Rxn & TSB


PRIORITY CASES

Hemolytic Reaction = 1
st

d/t Hypotension---attend to destruction of Hgb
------ O2----- Brain Damage

Circulatory Reaction = 2
nd

Allergic Reaction = 3
rd

Pyrogenic Reaction = 4
th


But:
Anaphylactic = 1
st
priority
Hemolytic = 2
nd


3. PYROGENIC REACTION:


S/Sx:

a.) Fever/ chills d.) Tachycardia
b.) Headache e.) Palpitations
c.) Dyspnea f.) Diaphoresis
(Pyrogens -----fever-producing agents)

Nsg Mgt:

1. Stop BT
2. Notify Doc
3. Flush with PNSS
4. Administer antipyretics, antibiotics
5. Send blood unit to blood bank
6. Obtain urine & blood samples send to lab
7. Monitor VS & IO
8. Tepid sponge bath offer hypothermic blanket



4. CIRCULATORY OVERLOAD

Sx:
- Dyspnea
- Orthopnea
- Rales or crackles
- Exertional discomfort

Nsg Mgt:

1. Stop BT
2. Notify Doc
3. Administer diuretics