Anemias
(3) important labs for recognizing anemia.
What are RBCs, hemoglobin, and hematocrit?
Platelet count indicative of thrombocytopenia.
What is < 100,000/mcL?
Clotting disorders are usually diagnosed in this stage of life.
What is childhood?
The amount of time in which the transfusion must begin after receiving blood from the blood bank.
What is 30 minutes?
You are assigned a 57-year-old female on the Med-Surg floor who is on day 3 of her post-op recovery. The patient has a PMH of colon cancer and underwent a partial colectomy. During report, the previous nurse tells you that she was told the patient is A&O x4 and ambulates to the restroom with supervision, but the patient did not feel well yesterday and has been using a bedside commode. When you introduce yourself to the patient, she complains of dizziness and having no energy today.
VS:
HR - 105 bpm
BP - 107/88
RR - 20 breaths/min
SPO2 - 92% RA
T - 98.1 F
RECOGNIZE CUES: What pieces of information from the situation are concerning or require further investigation?
- 3 days post-op; partial colectomy
- not feeling well
- dizziness
- no energy (fatigue)
- HR 105 bpm (tachycardia)
A total gastrectomy increases the risk of developing this type of anemia.
What is pernicious anemia?
The underlying (2) causes of decreased platelet production in general thrombocytopenia.
What are bone marrow and liver problems?
Common sites for spontaneous bleeds, without trauma.
What are the joints?
Necessary information collected by the nurse, after informed consent for the transfusion is given and before baseline assessments occur.
What is transfusion history?
You complete a focused head to toe assessment and note >3 seconds capillary refill, pale nail beds, and a small amount of sanguineous drainage on the disposable bed pad. You ask the patient about their bleeding and she says it is less than what she had yesterday. After reporting the findings to the provider, he orders a STAT CBC.
ANALYZE CUES: What components of the CBC are you most concerned about?
RBCs, hemoglobin, and hematocrit.
Chemotherapy, medication, and autoimmune diseases are some causes of dysfunctional bone marrow, leading to this.
What is aplastic anemia?
Neutralizes heparin to reduce the effects of HIT.
What is protamine sulfate?
The specific clotting factor that will be given to treat a hospitalized patient with Hemophilia A.
What is factor VIII?
The initial amount of administered blood which should be supervised by the RN to determine whether or not a transfusion reaction is occurring.
What is 50 mL?
After reviewing the lab results:
WBC: 10,200 /mcL
RBC: 3.5 million /mcL
Hgb: 7.3 g/dL
Hct: 30 %
Platelets: 99,000 /mcL
MCH: 20.9 pg
MCV: 84 fL
Reticulocyte: 0.9 %
PRIORITIZE HYPOTHESIS: With all information gathered so far, what do you suspect the patient is experiencing?
Post-operative anemia and thrombocytopenia (due to rapid consumption of platelets.)
*OB CROSSOVER*
________________ between a mother and her baby causes erythroblastosis fetalis; this results in ____________ jaundice for the newborn and increases the mother's future risk for _________________ transfusion reactions.
Rh incompatibility ; pathologic jaundice ; febrile non-hemolytic
The total number of circulating platelets is greatly reduced in this disorder, despite bone marrow production being normal.
What is Immune/Idiopathic Thrombocytopenic Purpura (ITP)?
(2) places to monitor these patients for bleeds which may not be visibly apparent upon physical assessment.
What are the brain and GI system?
At-risk patients (e.g. older adults, patients with kidney or left ventricular dysfunction) require close monitoring for this type of reaction, especially after the transfusion is completed.
What is Transfusion-Associated Circulatory Overload (TACO)?
GENERATE SOLUTIONS & TAKE ACTION: Which of the following interventions/provider orders would be most appropriate? Select all that apply.
1. Transfuse the prescribed unit(s) of PRBCs.
2. Administer Epogen (epoitin alfa) to achieve the desired therapeutic effect.
3. Transfuse the prescribed unit(s) of platelets.
4. Give the patient their tray and encourage them to drink orange juice with their meal.
5. Rush the patient to the OR for emergency surgery.
1. Transfuse the prescribed unit(s) of PRBCs.
Staying warm, reducing one's infection risk, and maintaining hydration can effectively reduce the occurrence and severity of this medical emergency.
What is sickle cell crisis?
(3) infections thought to lead to the development of ITP.
What are H. pylori, hepatitis, and HIV?
Emergent medication given resulting in a temporary rise in factors VII, VIII, and IX.
What is desmopressin (a vasopressor)?
The telltale sign of the most dangerous and potentially life-threatening transfusion reaction. Hint: the most common cause is from blood bank labeling errors.
What is low back pain?
You follow the appropriate protocols for beginning the PRBC transfusion. In obtaining the patient's transfusion history, she revealed that her last infusion immediately following her surgery caused a transient fever.
EVALUATE OUTCOMES: After initiating the blood replacement therapy, indicate whether the following outcomes are: expected, improving, or worsening.
1. RBCs, hemoglobin, and hematocrit increase upon the next lab draw.
2. BP and SPO2 decrease.
3. RR increases.
4. T increases.
5. Platelet count remains 99,000/mcL.
1. Improving
2. Worsening
3. Worsening
4. Expected
5. Expected