Blood Products and Transfusion: July 2006



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Blood Products and Transfusion: July 2006


Hello all. It’s been a while between projects – here’s a new FAQ article on blood: components, transfusion, bleeding situations, coag- and anti-coagulation – you get the idea. For this one we asked for audience participation, which came mostly from two sources (who also seem to enjoy this kind of self-torture) – SF and Becky. The material after their answers is mine, and I did the editing, so any errors in this article only come from me. They get a lot of thanks for going over the questions in detail, and taking the time to provide their own answers. They may not yak as much as I do, but they’ve both been there, done that, and wear the t-shirt. (“My mom transfuses blood in emergencies, and all I got was this lousy t-shirt.”) Thanks, ladies.


As usual, please remember that these articles are not meant to be official references, but to represent what an experienced ICU preceptor passes on to a new RN orientee. (Plus some homework to fill in the gaps.) Let us know when you find errors or omissions, and we’ll fix them right away. Thanks!



  1. What do we use blood for in the MICU?



Blood Counts





  1. What are some normal blood values?

  2. What is a normal hematocrit?

  3. What if the hematocrit is too high?

  4. What if it’s too low?

  5. What is a “dilutional” crit drop?

  6. What is a “delusional” crit drop?

  7. What does iron have to do with it?

  8. What is a normal white cell count?

  9. What if the white count is too high?
  10. What if it’s too low?


  11. What are the different kinds of white cells?




  • Neutrophils

  • Lymphocytes

  • Eosinophils

  • Monocytes

  • Bands




  1. What is “bandemia”?

  2. What is “band-aid-emia?

  3. What is “leukopenia”?

  4. What is a normal platelet count?

  5. What if the platelet count is too high?

  6. What if it’s too low?

  7. What does “thrombocytopenia” mean?


Transfusion and Typing





  1. What is transfusion?

  2. What blood components do we give in the MICU, and what do I need to worry about when giving each of them?




  • Red Cells

  • Fresh Frozen Plasma

  • What does albumin have to do with this?

  • Platelets

  • What are “cryos”?




  1. Can you please review the basics of blood typing?

  2. What about Rh? What is RhoGam?

  3. What does a transfusion reaction look like?

  4. What should I do if I think my patient is reacting?

  5. How is a reaction treated?

  6. What is involved in follow-up for a transfusion reaction?

  7. Can a person have a reaction to FFP?

  8. What about platelets?

  9. What is a Coombs test?


Giving Blood Products




When to Get Ready





  1. What kinds of procedures can make my patients lose blood?
  2. What about bleeding from a line insertion site?


  3. Why does it matter where they put the lines?

  4. What if my patient needs a line, and is anticoagulated?

  5. Should my patient get FFP before line placement? Or platelets?

  6. What if I find a hematoma somewhere on my patient for no apparent reason?

  7. What about embolus formation?

  8. What is an embolectomy?



Tools





  1. What kinds of blood transfusion tubing do we use?

  2. What is a multi-unit transfusion filter?

  3. What kind of IV access should my patient have?

  4. Can I hang more than one unit of blood at a time?

  5. Can I hang more than one kind of blood product at a time?

  6. What is a blood warmer?

  7. What is a rapid infuser?

  8. What if it looks like I’m losing the race?


Special Help





  1. When does GI get called in to look at the patient?

  2. When does surgery get called in to look at the patient?

  3. What is plasmapheresis?

  4. What is dialysis?

  5. What is “liver dialysis”?

  6. What are some of the situations in the MICU when I would give blood products?

- Cardiac

- Pulmonary

- GU


- Bone Marrow Diseases

- Postop Situations



- Neuro

- GI Bleeds




  1. What do I need to know about GI bleeds?

  2. How can you tell the difference between an “upper” GI bleed and a “lower” one?

  3. What are “coffee grounds”?
  4. What is melena?


  5. What is the difference between testing gastric contents for blood, and stool for blood?

  6. Why might be GI bleed patient need to be intubated?


Upper GI Bleeds





  1. How are upper GI bleeds treated?

  2. What is endoscopy all about?

  3. Who does endoscopy?

  4. What can endoscopy treat, or not treat?

  5. What are “bands”?

  6. What if the bands come off?

  7. What do they use the epinephrine for?

  8. Does the patient need to be intubated for upper endoscopy?

  9. What kind of conscious sedation do we use for endoscopy if the patient isn’t intubated?

  10. What is a blakemore tube?

  11. Who puts in the blakemore tube?

  12. What are the different balloons and lumens for?

  13. How long does a blakemore tube stay in?

  14. Should patients with varices have NG tubes put in? Taken out?

  15. How often should I monitor my patient’s counts?

  16. What is a TIPS procedure?

  17. What is portal hypertension?

  18. What is a porto-caval shunt?

  19. Why do these patients become more encephalopathic?

  20. What is a normal ammonia level?

  21. Should I give lactulose to a patient with a GI bleed?

  22. Should I give tube feedings to a patient with a GI bleed?

  23. Can variceal bleeds be prevented?

  24. What is helicobacter all about?

  25. How can h.pylori infections be diagnosed?

  26. What antibiotics are used to treat helicobacter?

  27. What about carafate?

  28. What about cimetidine, ranitidine, famotidine, James Dean?
  29. What about Prilosec? If a person is taking Prilosec, and has bad breath, do I have to sit Nexium?

  30. What about liquid antacids?




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