Professional Documents
Culture Documents
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. Platelets
5. Cryoprecipitate
6. Albumin
1. Acute Reactions
a. Febrile, non-hemolytic
1. Most common--Not life threatening
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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;
Also, hypotension, bronchospasm and anaphylaxis can occur
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.
2. Delayed Reactions to Blood Transfusion
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.
2. Cells are hemolyzed per RES and is gradual
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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
B. Low RBCs
1. Overall S&S with low RBCs (There are some specific S&S particular
to different anemias)
1. Lack of stimulation
b.
c.
d.
a. All myeloid cells increased, but mostly RBCs, thus Hgb and Hct are
elevated
b. Eventually bone marrow "burns out" and becomes fibrotic
c. Dx by CBC, enlarged spleen, and S&S
d. Can end up in Acute Myeloid Leukemia (AML)
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4. Secondary Polycythemia
V. WBCs: Main function is that they protect body against infection and tissue
injury; Normal is 5,000 - 10,000
A. A&P of WBCs
3. Types of granulocytes
a. Neutrophils—segmented neutrophils (Segs)
important for phagocytosis
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. Produces in bone marrow, circulate briefly and then become
macrophages in various body tissues such as spleen (main site),
liver, lungs, and lymph nodes
Macrophages are the Reticuloendothelial System (RES)
1. B Lymphocytes
a. Produced in bone marrow
b. Can differentiate into plasma cells which produce
immunoglobulins or antibodies which are proteins that destroy
foreign material—humoral immunity
2. T Lymphocytes (also called CD4 Count)
a. Produced in bone marrow but migrate to and mature in the
thymus
b. Responsible for delayed allergic reactions, destruction of tumor
cells, and transplant rejection
B. Low WBCs:
1. Terminology
a. Leukopenia
b. Neutropenia
c. Granulocytopenia (Agranulocytosis)
a. Myeloid
1. Acute Myeloid Leukemia-AML
a. Proliferation of all myeloid cells
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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 & crowd out production of
other cells: S&S are of decreased RBCs, platetlets, and
increased immature white cells; Also bone pain common
e. Tx: chemo, radiation, allogenic bone marrow transplant
a. Hodgkin's Lymphoma
1. Rare malignancy, easily cured in early stages; extends
through lymphatic system
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b. Non-Hodgkin's Lymphoma
1. Dx:
2. S&S
3. Multiple Myeloma
a. Malignancy of the plasma cell (mature form of lymphocyte)
b. Remember plasma cells secrete immunoglobulin which is
necessary for antibody production
c. Diagnosed by:
VI. Platelets
A. Main function is control of bleeding
4. Thombocytopenia
a. Caused by:
1.
2.
3.
b. Petechiae
c. Hemorrhage
d.
e.
b. DX:
c. Treatment
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d. Nursing care:
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 I
Immunity
WBCs
T cytotoxic
EOSINOPHILS Killer cells
Neutralize histamine; defend against parasites