Blood Transfusions: An Overview Jassin M. Jouria, MD Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serves as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. Abstract Being able to replace blood and blood components that a patient has lost or that his or her body is not able to produce is a vital part of providing excellent medical care. With the aid of donor blood, or even sometimes the patient’s own blood that has been previously banked, medical professionals have a safe strategy for treatment of patients who have lost blood to illness or injury. This course will explain the different types of blood products, the requirements for performing a transfusion, and how to recognize and respond to complications of the transfusion process. [1] nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com Continuing Nursing Education Course Planners William A. Cook, PhD, Director, Douglas Lawrence, MA, Webmaster, Susan DePasquale, MSN, FPMHNP-BC, Lead Nurse Planner Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 3 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Statement of Learning Need The transfusion of blood and blood products provide life-saving measures and treat various medical conditions. Nurses are required to follow blood transfusion guidelines and protocol to ensure patient safety and wellbeing. Course Purpose To provide nursing professionals with knowledge of blood and blood product indications and administration protocol for safe administration. [2] nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Activity Review Information Reviewed by Susan DePasquale, MSN, FPMHNP-BC Release Date: 1/1/2016 Termination Date: 5/14/2018 Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. [3] nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com 1. GM is a 32-year-old AA female who is typed with B+ blood. As a donor, GM can MOST SAFELY provide packed RBC for which of the following individuals? a. TS, a 21 year old Asian female with AB+ blood b. KT, a 56 year old European male with AB - blood c. PL, a 76 year old white female with A - blood d. MN, a 5-year-old Hispanic male with B+ blood 2. Your patient is an otherwise healthy 46-year-old male with β- thalassemia and is scheduled for a transfusion of packed RBC. You are with him and are explaining some of the risks and benefits of his upcoming transfusion. Which of the following would be true? a. He runs a high risk of graft-versus-host disease along with allergic reactions, a fever, a hemolytic reaction and some very rare reactions but that he will be observed and monitored throughout the transfusion. b. He runs a high risk of Transfusion-Related Acute Lung Injury (TRALI) or Transfusion Associated Circulatory Overload (TACO) but that he will be observed and monitored throughout the transfusion. c. You should counsel him not to get a transfusion, but to get a shot of iron for his iron deficiency anemia. d. The transfusion should be completed within 4 hours and there are some risks associated with an RBC transfusion, including allergic reactions, a fever, a hemolytic reaction and some very rare reactions but that he will be observed and monitored throughout the transfusion. [4] nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com 3. Your patient is typed AB— and is scheduled for an infusion of plasma. Which of the following plasma types is most suitable for your patient? a. AB+ b. O - c. A+ d. B – 4. A patient who is thrombocytopenic is scheduled to receive two units of irradiated platelets from which the leukocytes (WBC) have been removed. You spike the unit with a standard infusion set and get ready to connect directly to her right arm. Something makes you stop—what question do you need to ask yourself? a. Don’t I need to use a standard blood filter? b. Shouldn’t I use another leukocyte reduction filter just to be sure her chances of GVHD are reduced? c. I should probably ask the blood bank if these platelets have been tested for ABO compatibility, shouldn’t I? d. I wonder if her platelet level is low enough to get two units of platelets? 5. An acute hemolytic reaction during a transfusion for acute blood loss is most likely due to: a. ABO incompatibility b. Too rapid infusion c. Rh0D incompatibility d. Massive sepsis [5] nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com Introduction According to a report from the Agency for Healthcare Research and Quality (AHRQ), blood transfusions were the most common hospital procedure in 2010, indicating that 11% of all hospital stays underwent at least one transfusion procedure.1 This represented more than a 126% increase since 1997 and reached across all age groups, except for individuals less than one year old. The American Association of Blood Banks (AABB) estimates that over 9.2 million volunteers donate blood and blood components every year. Approximately 30% of those are first time donors; together, all these donors represent about 15.7 million units of blood and blood components.2 There is, however, significant variability in transfusion outcomes in a number of clinical settings. This variability may reflect deviations from practice guidelines, training differences, differences in recommendations of various medical societies, differences in availability of inventory and disagreements about the validity of the practice guidelines.3 While blood transfusions are generally accepted as being life-saving, this has actually not be tested in any prospective controlled trial.3 While the number of deaths associated with blood transfusions is small and seems to be decreasing,4 blood transfusions still carry significant risk, are expensive, and face potential shortages in emergencies. The American Association of Blood Banks (AABB) has initiated a Patient Blood Management (PBM) program with the goal of optimizing the care of transfusion patients and has produced guidelines for PBM and blood utilization. Blood management can be defined as a “patient-centered standard of care in which strategies and techniques [6] nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com are used to reduce, eliminate, or optimize blood transfusions to improve patient outcomes.”5 The guidelines include:6 Development of guidelines specific to individual facilities and for quality improvement Providing thresholds and assessment strategies for the transfusion review process Both surgical and non-surgical strategies for PBM Procedures for auditing blood utilization Successful PBM programs most often have a committed leader, and this is most often a registered nurse (RN) or an advanced practice registered nurse (APRN). The nursing staff often has the responsibility to implement the PBM programs, assess and manage transfusions and the potential reactions, as well as communicate to the patient and their family the benefits and potential adverse reactions to a blood transfusion. This activity is designed to review basic information about transfusions, provide information on potential complications and the current best practice guidelines, procedures and policies to manage complications and to inform health teams and patients regarding new developments in alternatives to allogeneic blood transfusions, including autologous transfusions, erythropoiesis-stimulating agents