Escolar Documentos
Profissional Documentos
Cultura Documentos
A. Types
1. Type A--has A antigens and anti-B antibodies; If receives B or AB blood, the
anti-B antibodies will react with the B antigen present in the B blood and
cause agglutination. Can receive type A and type O.
2. Type B--has B antigens and anti-A antibodies; Can receive type B and type O.
3. Type AB--has A and B antigens and no antibodies. Can receive A, B, AB, and
O (universal recipient)
4. Type O--has neither A nor B antigens (no antigens) but anti-A and anti-B
antibodies. (Universal donor but can receive only type O.)
2. Packed RBCs
3. Granulocytes
4. Platelets
7. Albumin
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
1. Acute Reactions
a. Febrile, non-hemolytic
3
1. Most common--Not life threatening
2. Chills and fever within 2 hours of start of transfusion; Administer
antipyretics as needed
3. Client's antibodies react to WBCs in the donor blood; happens most
often in people who have had previous transfusions and developed
antibodies
4. Leukocyte poor blood can be used if client known to have this problem
previously; Also, special in-line filters can be used
b. Acute hemolytic
1. Life-threatening
2. Occurs when donor blood is incompatible with recipient (from errors
in matching and patient identification before giving); Antibodies in
recipient combine with antigens on donor erythrocytes causing
agglutination and hemolysis.
3. Chills, fever, low back pain, nausea, dyspnea, anxiety, blood in
urine; Hypotension, bronchospasm and anaphylaxis possible
4. Must be prevented. Must be recognized quickly and transfusion
stopped. Take down all tubing. Hang new tubing and infuse NS
slowly. Thorough assessment. Notify MD. Obtain required blood and
urine specimens (hemolysis). Document!
c. Allergic
1. Usually because of sensitivity to a plasma protein in the blood
2. Itching, flushing
3. Stop transfusion, infuse NS. Notify MD. Usually antihistamines
(Benadryl) resolve the problem and the blood can be resumed.
4. If severe, blood will not be restarted. Epinephrine and steroids may
be needed.
5. In the future, this client should get antihistamine before
transfusion.
d. Circulatory overload
1. Usually happens because client is sensitive to overload, such as in
CHF, or if nurse allows blood to infuse too rapidly.
2. PRBCs better than whole blood unless volume needed.
3. Diuretic may be given after transfusion or between two units.
4. S&S: dyspnea, tachycardia, anxiety, crackles, pink, frothy sputum
5. Nurse should place client upright, feet down. Stop blood. Infuse NS
at KVO rate. Notify MD. May need oxygen, diuretics.
a. Delayed hemolytic
1. Usually mild and requires no intervention.
2. Usually will occur within 2 weeks of transfusion--takes this long for
antibodies to get strong enough to do damage to donor blood.
Client usually home by this time and doesn't recognize the problem.
4
2. Cells are hemolyzed per RES and is gradual
3. Fever, anemia, increased bilirubin, level possible jaundice.
Subsequent transfusions could be acute hemolytic.
c. Iron overload
1. Occurs with clients who get frequent transfusions
2. Can cause severe organ damage
3. Requires iron chelation therapy
d. Graft-versus-host disease
B. Diagnostic studies
1. Lab Tests
a. CBC
1. CBC with diff--RBC, Platelets, and WBCs with the different types ID'd
2. Peripheral blood smear --sizes and shapes of cells identified
b. ESR--erythrocyte sedimentation rate; indicates inflammation
c. Clotting Studies
d. Iron studies
e. Blood typing and Rh factor
f. Bence Jones protein--random urine specimen (negative normal, positive usually
means multiple myeloma)
2. Radiologic Tests
a. Lymphangiography (dye)
b. Scans (Bone Scan, Liver/Spleen Scan)
3. Biopsies
a. Bone Marrow aspiration and biopsy
1. Posterior and anterior iliac crest or sternum
2. Informed consent
5
3. Premedicate for pain—will be sore for several days
4. Assess platelet count before
5. Must empty bladder before and be very still
6. Hold pressure 5 – 10 minutes or longer and stay in bed for about 2 hours
Stem cell>>>erythroblast>>>reticulocyte>>erythrocyte
B. Low RBCs: anemia (The more rapid onset, the more severe symptoms; the more
chronic, the less severe)
1. Overall S&S with low RBCs (There are some specific S&S
particular to different anemias)
1. Lack of stimulation
1. Aplastic anemia/Pancytopenia
8
Even person who only has the trait can have some
symptoms in extreme situations of hypoxia and FVD.
IV. WBCs: Main function protect against infection and tissue injury, [5,000 - 10,000]
A. A&P
1. Leukocytes from Myeloid cells
a. Granulocytes--60 - 70% of leukocytes are these
1. Immature granulocytes are called bands. “Shift to left”
2. Mature granulocytes are called Segs.
3. Types of granulocytes
a. Neutrophils--Segmented neutrophils (Segs)
Important for phagocytosis ; Arrive at site of inflammation
very quickly but only live 1 - 2 days in this job
b. Eosinophils--function in hypersensitivity reactions by working to
neutralize histamine
c. Basophils--produce and store histamine and other substances
involved in hypersensitivity reactions
b. Monocytes
1. Only about 5 % of total leukocytes but are the largest
2. Are 2nd to arrive at site of inflammation and continue phagocytosis as
macrophages
3. Produced in bone marrow, circulate briefly and then become
macrophages in various body tissues such as spleen (main site),
liver, lung, and lymph nodes.
2. T lymphocytes
a. Produced in bone marrrow but migrate to and mature in the thymus.
b. Responsible for cellular immunity (cell mediated immunity)
1. Kill foreign cells directly or release substances that enhance
phagocytosis
2. Responsible for delayed allergic reactions, destruction of
tumor cells, and transplant rejection
B. Low WBCs:
1. Terminology
a. Leukopenia: low WBCs in general;
a. Myeloid
1. Acute Myeloid Leukemia-AML
a. Proliferation of all myeloid cells but immature
b. Common in adults
c. Usually poor prognosis
d. S&S b/c of all cells abnormal (anemia, infection, bleeding)
e. Tx: Supportive care (antibiotics, blood, etc) Chemo, Allogenic
bone marrow transplant
b. Lymphoid
1. Acute Lymphocytic Leukemia-ALL
a. Proliferation from lymphoid stem cell
b. Usually occurs in very young children
c. Most survive about 5 years with treatment
d. Immature lymphocytes proliferate and crowd out production
of other cells, thus S&S are of decreased RBCs, platetlets,
and large numbers of immature white cells; Also large
numbers of cells pool in liver and spleen; bone pain common
e. Tx: chemo, radiation, allogenic bone marrow transplant
b.
c.
d.
a. Hodgkin's Lymphoma
1. Malignancy, easily cured in early stages; usually starts in
lymphatic system but can spread outside
b.
c.
b. Non-Hodgkin's Lymphoma
1.
3. Multiple Myeloma
a. Malignancy of the plasma cells (mature form of lymphocyte)
b. Excessive, non-functioning immunoglobulins (remember plasma cells secrete
immunoglobulins which are necessary for antibody production)
c. Diagnosed by:
1.
2.
3.
4.
V. Platelets (thrombocytes)
A. Main function is control of bleeding (hemostasis)
Live about 7 - 10 days; Float around doing nothing, then collect at site of vascular
injury forming a plug (fibrin clot)
B. Normal value is 150,000 - 400,000
C. Low Platelets
1. Overall S&S with low platelets
a. Petechiae
b. Echymosis
c. Easy bleeding
d. Hematuria
e. Heavy menses
f. GI bleeding
g. Intracranial bleed with neurological changes
h. Anemia S&S
3. BLEEDING PRECAUTIONS
a. Assess frequently
• Bleeding
• Decreased BP, tachycardia, restlessness
• Lab values
3. Coumadin therapy
ERYTHROCYTES THROMBOCYTES
RBCs Platelets
NK cells
B LYMPHOCYTES Can attack T LYMPHOCYTES
Mature in bone marrow any target Mature in thymus
LEUKOCYTES Humoral Immunity Cell Mediated Immunity
WBCs
T cytotoxic
EOSINOPHILS Killer cells
Neutralize histamine; defend against parasites
22