Safe transfusion of blood and blood components

Nurses are integral to the blood transfusion process. This article, which forms part of Nursing Standards clinical skills series, outlines the role of the nurse in evidence-based transfusion practice. Patient assessment, preparation, pre-transfusion checks, documentation and adverse reactions are discussed.     

Guidelines for administering blood and blood components

The Serious Hazards of Transfusion (SHOT) scheme has revealed that many patients have received incorrect blood or blood component. This article reports new national guidelines for ordering, administering and managing blood, blood components and blood transfusion.     

Current viral risks of blood and blood products

A number of viruses may be transmitted by blood transfusion, the most important of these are HIV, human T-cell lymphotrophic retrovirus (HTLV), hepatitis B virus (HBV), and hepatitis C virus (HCV). A series of overlapping safety measures are in place and are being improved and supplemented continuously. As a result, the risk of transmission of these viruses in the USA has been reduced to between one and four per million blood components transfused.     

Understanding the blood group system and blood transfusions

Having a blood transfusion carries risks for patients. To minimise these risks, nurses must be aware of the ABO group system, components of blood and how they should be stored, handled, checked and administered. They must also be aware of possible adverse events during or after transfusion, how to monitor patients and how to deal with adverse events should they occur. All staff involved at any stage must be trained and aware of hospital policy and all actions must be accurately recorded to ensure the process is as safe as possible.     

血脂、血糖与血液流变相关性的探讨

目的 探讨血脂、血糖与血液流变的相关性.方法 对本院2 693例门诊及住院患者进行血脂、血糖、血液流变检测,根据全血黏度结果分为高黏组、正常组、低黏组.结果 血浆黏度、红细胞比容、血沉、胆固醇、低密度脂蛋白各组变化差异均有统计学意义(P＜0.01);三酰甘油、血糖在高黏组与正常组,高黏组与低黏组差异有统计学意义(P＜0.01或P＜0.05).高密度脂蛋白各组差异无统计学意义.结论 血脂、血糖对血液流变指标有直接的影响.     

Transfusion of blood and blood products: indications and complications

Red blood cell transfusions are used to treat hemorrhage and to improve oxygen delivery to tissues. Transfusion of red blood cells should be based on the patient's clinical condition. Indications for transfusion include symptomatic anemia (causing shortness of breath, dizziness, congestive heart failure, and decreased exercise tolerance), acute sickle cell crisis, and acute blood loss of more than 30 percent of blood volume. Fresh frozen plasma infusion can be used for reversal of anticoagulant effects. Platelet transfusion is indicated to prevent hemorrhage in patients with thrombocytopenia or platelet function defects. Cryoprecipitate is used in cases of hypofibrinogenemia, which most often occurs in the setting of massive hemorrhage or consumptive coagulopathy. Transfusion-related infections are less common than noninfectious complications. All noninfectious complications of transfusion are classified as noninfectious serious hazards of transfusion. Acute complications occur within minutes to 24 hours of the transfusion, whereas delayed complications may develop days, months, or even years later.     

献血人群中巨细胞病毒感染与输血安全

巨细胞病毒(CMV)是感染全球很大一部分人的DNA病毒,通过多种途径传播,输血也是传播途径之一。CMV感染在免疫功能正常个体中,通常是无症状的,但在免疫功能受损或低下的患者中有很高的发病与死亡率。献血人群CMV血清学反应阳性比例较高,采供血机构应采取措施,如筛查CMV阴性献血者血液和/或白细胞减少,以及病原体灭活技术,防止CMV传播给有风险的患者。本文综述目前献血人群CMV检测方法,流行率,以及预防策略在输血传播CMV(TT-CMV)的效果。     

Practical dosimetric aspects of blood and blood product irradiation

The method of choice to reduce susceptibility to transfusion-transmitted graft-versus-host disease is irradiation of allogenic blood and blood products for transfusion to immunosuppressed recipients. Optimal irradiation requires delivery of a known and homogeneous absorbed dose. The use of absorbed dose in air measured at the center of the irradiation volume without proper compensation for sample absorption can lead to approximately 20 percent underexposure. A lucite cylinder was used to provide the delivery of a homogeneous irradiation dose to blood products of different volumes by allowing rotation of the product.     

中年男性超重者与体重正常者的血压、血脂、血糖、血尿酸的差异及减重对策

目的探讨高收入中年男性超重者与体重正常者的血压、血脂、血糖、血尿酸的差异,为中年男性超重者提供减重的护理对策.方法对2004年3月～2005年4月在解放军总医院特需门诊查体的254例35～50岁男性患者询问病史,根据BMI分为2组,BMI 25.0～29.9kg/m2为超重组(n=127),BMI 18.5～24.9 kg/m2为正常组(n=127).结果超重组的血压、血脂、血糖、血尿酸均高于正常组,差异均有显著性意义(P＜0.05).结论对超重的中年男性,必须采取相应的减重对策,减轻体重,预防肥胖相关的疾病发生.     

中年男性超重者与体重正常者的血压、血脂、血糖、血尿酸的差异及减重对策

目的探讨高收入中年男性超重者与体重正常者的血压、血脂、血糖、血尿酸的差异,为中年男性超重者提供减重的护理对策。方法对2004年3月~2005年4月在解放军总医院特需门诊查体的254例35~50岁男性患者询问病史,根据BMI分为2组,BMI 25.0~29.9 kg/m2为超重组(n=127),BMI 18.5~24.9 kg/m2为正常组(n=127)。结果超重组的血压、血脂、血糖、血尿酸均高于正常组,差异均有显著性意义(P<0.05)。结论对超重的中年男性,必须采取相应的减重对策,减轻体重,预防肥胖相关的疾病发生。     

The risks associated with blood and blood product transfusion

Although transfusion of blood and blood products is often of life-saving benefit for the many patients who receive transfusions every year, it is not without considerable risk. Nurses need to be aware of these risks so that they can respond to patient anxiety about transfusion. This article outlines risks associated with transfusion and the measures taken to minimize them. Attention will be focused principally on the two most significant risks: transmission of serious blood-borne infection and the potentially fatal acute immune haemolytic reaction that can occur if patients receive incompatible red cells. Other significant adverse effects will be discussed briefly. Recent initiative aimed at monitoring the incidence of these adverse effects and increasing the safety of blood transfusion will be discussed, with special emphasis on the nurse's role in the transfusion process.     

Military walking blood bank and the civilian blood service

In most countries whole blood transfusions have been replaced by component therapy. This has allowed for both better usage of the blood donations and better quality during storage. While this strategy was initially motivated by the commercial need for plasma the plasma reduction also reduced the levels of low grade proteases and sialidase, hence minimizing the cellular storage lesion/microvesiculation during prolonged storage. Plasma reduction also reduces transfusion reactions associated with plasma. During special military conditions, however, blood transfusion is urgently needed without corresponding access to blood components, in particular platelets. Accordingly, new focus on whole blood has aroused and added a new challenge to the blood transfusion services. This special issue of "what is happening" highlights the planed efforts by Swedish and Norwegian groups in the developments of military walking blood bank, which is applicable to civil blood services.     

Ceftriaxone distribution between maternal blood and fetal blood and tissues at parturition and between blood and milk postpartum.

The penetration of ceftriaxone into the fetus at parturition was studied in 17 subjects. Despite its high protein binding, ceftriaxone quickly reached the umbilical cord blood, amniotic fluid, and placenta, achieving substantial concentrations, which then disappeared, with elimination half-lives of approximately 6 h, identical to that of the mother. The elimination half-life of ceftriaxone of 5 to 6 h in these mothers was somewhat shorter than that reported for normal subjects. The concentrations of ceftriaxone achieved in fetal tissues were sufficient for therapeutic effects. The penetration of ceftriaxone into milk was studied 3 days postpartum in 20 other patients. This antimicrobial agent entered breast milk rapidly and disappeared with a half-life of 12 to 17 h. The concentrations achieved were only 3 to 4% of those in maternal serum and were most likely of little clinical relevance.