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Table 8-2

Blood or Blood ProductIndicationsAssessment: Side EffectsNursing Care Plan/Implementation
Whole blood
  1. Acute hemorrhage
  2. Hypovolemic shock
  1. Hemolytic reaction
  2. Fluid overload
  3. Febrile reaction
  4. Pyrogenic reaction
  5. Allergic reaction
  1. See Chapter 6. Physiological Integrity, Table 6.9. Postoperative Complications (The Perioperative Experience), for complete discussion of nursing responsibilities
  2. Protocol for checking blood before transfusion is begun varies with each institution; however, at least two RNs must verify that the unit of blood has been crossmatched for a specific client
Red blood cells, packed
  1. Acute anemia with hypoxia
  2. Aplastic anemia
  3. Bone marrow failure due to malignancy
  4. Clients who need red blood cells but not volume
See Whole bloodSee Whole blood
Red blood cells, frozen
  1. See Red blood cells, packed
  2. Clients sensitized by previous transfusions
  1. Less likely to cause antigen reaction
  2. Decreased possibility of transmitting hepatitis
See Whole blood
White blood cells (leukocytes)Currently being used in severe leukopenia with infection (research still being done)
  1. Elevated temperature
  2. Graft-versus-host disease
  1. Careful monitoring of temperature
  2. Must be given as soon as collected
Platelet concentrate
  1. Severe deficiency
  2. Clients who have thrombocytopenia and are bleeding, with platelet counts below 10,000/mm3
  1. Fever, chills
  2. Hives
  3. Development of antibodies that will destroy platelets in future transfusions
Contraindications:
  1. Idiopathic thrombocytopenic purpura
  2. Disseminated intravascular coagulation (DIC)
Monitor temperature
Single-donor fresh plasma
  1. Clotting deficiency or concentrates not available or deficiency not fully diagnosed
  2. Shock
  1. Side effects rare
  2. Heart failure
  3. Possible hepatitis
Use sterile, pyrogen-free filters
Plasma removed from whole blood (up to 5 days after expiration date, which is 21 days)
  1. Shock due to loss of plasma
  2. Burns
  3. Peritoneal injury
  4. Hemorrhage
  5. While awaiting blood crossmatch results
See Single-donor fresh plasmaSee Single-donor fresh plasma
Freeze-dried plasmaSee Plasma removed from whole bloodSee Single-donor fresh plasmaMust be reconstituted with sterile water before use
Single-donor fresh frozen plasma
  1. See Single-donor fresh plasma
  2. Inherited or acquired disorders of coagulation
  3. Preoperatively for hemophilia
See Single-donor fresh plasma
  1. Notify blood bank to thaw about 30 min before administration
  2. Give immediately
Cryoprecipitate concentrate (factor VIII—antihemophilic factor)For hemophilia:
  1. Prevention
  2. Preoperatively
  3. During bleeding episodes
Rare0.55 mL of cryoprecipitate concentrate has same effect on serum level as 1,600 mL of fresh frozen plasma
Factors II, VII, IX, and X compiledSpecific deficienciesHepatitisCommercially prepared
Fibrinogen (factor I)Fibrinogen deficiencyIncreased risk of hepatitis because the hepatitis virus combines with fibrinogen during fractionation
  1. Reconstitute with sterile water
  2. Do not warm fibrinogen or use hot water to reconstitute
  3. Do not shake
  4. Must be given with a filter
Albumin or salt-poor albumin
  1. Shock due to hemorrhage, trauma, infection, surgery, or burns
  2. Treatment of cerebral edema
  3. Low serum protein levels
None; these are heat-treated productsCommercially prepared