706 SECTION 6 Problems of Oxygenation: Transport

temperature for 1 to 5 days. Gentle agitation of the bag is use-ful to prevent the platelets from adhering to the plastic. In a severely immunocompromised patient, these products are also irradiated to further ensure WBC removal and prevent the complication of graft-versus-host disease (see Chapter 14).

Administration ProcedureBlood components are usually administered with at least a 19-gauge needle. Larger needles (e.g., 18 or 16 gauge) may be preferred if rapid transfusions are given. Smaller needles can be used for platelets, albumin, and clotting factor replacement. Whatever type of venous access is used, it is important to verify its patency before requesting the blood component from the blood bank. Most blood product administration tubing is of a Y type with a microaggregate filter (filters out particulate)

with one arm of the Y for the isotonic saline solution and the other arm of the Y for the blood product.

SAFETY ALERT Do not use dextrose solutions or lactated Ringers solution for

administering blood because they will cause RBC hemolysis. Do not give any additives (including medications) via the same tubing

as the blood unless the tubing is cleared with saline solution.

When the blood or blood components have been obtained from the blood bank, positive identification of the donor blood and recipient must be made. Improper product-to-patient iden-tification causes 90% of hemolytic transfusion reactions, thus placing a great responsibility on nursing personnel to carry out the identification procedure appropriately. You must follow the policy and procedures at your place of employment; many institutions have implemented a dual-checking system with two

TABLE 31-32 BLOOD PRODUCTS*

DESCRIPTION SPECIAL CONSIDERATIONS INDICATIONS FOR USE Packed RBCsPacked RBCs are prepared from whole blood

by sedimentation or centrifugation. One unit contains 250-350 mL.

Use of RBCs for treatment allows remaining compo-nents of blood (e.g., platelets, albumin, plasma) to be used for other purposes. There is less danger of fluid overload. Packed RBCs are preferred RBC source because they are more component specific.

Leukocyte depletion (by the blood bank or filter) may be used to reduce hemolytic febrile reactions in patients who receive frequent transfusions.

Severe or symptomatic anemia, acute blood loss. One unit of RBCs can be expected to result in a hemoglobin increase of 1 g/dL or Hct increase of 3% in a typical adult. One unit of RBC can replace a blood loss of 500 mL.

Frozen RBCsFrozen RBCs are prepared from RBCs using

glycerol for protection and frozen. They can be stored for 10 yr at 188.6 F (87 C).

They must be used within 24 hr of thawing. Successive washings with saline solution remove majority of WBCs and plasma proteins.

Autotransfusion; stockpiling or rare donors for patients with alloantibodies. Infrequently used because filters remove most WBCs.

PlateletsPlatelets are prepared from fresh whole blood

within 4 hr after collection. One unit contains 30-60 mL of platelet concentrate.

Multiple units of platelets can be obtained from one donor by plateletpheresis. They can be kept at room temperature for 1-5 days depending on type of collection and storage bag used. Bag should be agitated periodically. Expected increase is 10,000/L/U. Failure to have a rise may be due to fever, sepsis, splenomegaly, or DIC.

For patients who receive frequent transfusions or do not respond to previous platelet transfusions, may give leukocyte reduced, HLA, or type specific to prevent alloimmunization to HLA antigens.

Bleeding caused by thrombocytopenia; may be contraindicated in thrombotic thrombocytopenic purpura and heparin-induced thrombocytopenia except in life-threatening hemorrhage.

Fresh Frozen PlasmaLiquid portion of whole blood is separated from

cells and frozen. One unit contains 200-250 mL. Plasma is rich in clotting factors but contains no platelets. It may be stored for 1 yr. It must be used within 2 hr after thawing.

Use of plasma in treating hypovolemic shock is being replaced by pure preparations such as albumin and plasma expanders.

Bleeding caused by deficiency in clotting factors (e.g., DIC, hemorrhage, massive transfusion, liver disease, vitamin K deficiency, excess warfarin).

AlbuminAlbumin is prepared from plasma. It can be

stored for 5 yr. It is available in 5% or 25% solution.

Albumin 25 g/100 mL is osmotically equal to 500 mL of plasma. Hyperosmolar solution acts by moving water from extravascular to intravascular space. It is heat treated and does not transmit viruses.

Hypovolemic shock, hypoalbuminemia.

Cryoprecipitates and Commercial ConcentratesCryoprecipitate is prepared from fresh frozen

plasma, with 10-20 mL/bag. It can be stored for 1 yr. Once thawed, must be used.

See Table 31-19. Replacement of clotting factors, especially factor VIII, von Willebrands disease, and fibrinogen.

DIC, Disseminated intravascular coagulation; Hct, hematocrit; HLA, human leukocyte antigen; RBCs, red blood cells; WBCs, white blood cells.*Component therapy has replaced the use of whole blood, which accounts for less than 10% of all transfusions. Granulocyte transfusions are not included here because they are rarely used.