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2 Minute EBP Challenge

Monday, March 08, 2010
Restoring Hemoglobin
One of the goals for a patient who has a large blood loss is the restoration of normal hemoglobin levels.  This is partially done by blood transfusions, usually to a hemoglobin level of about 10g/dL.  A hemoglobin level that low will leave the patient feeling fatigued, but should be high enough to protect the heart from anemic ischemia.

Sunday, February 28, 2010
Renal Dysfunction
Mrs. Mersa is admitted with sepsis and hypotension.  Her labs indicate:
BUN 58 mg/dl
Serum creatinine 2.1 mg/dl
Urine sodium 70 mEq/L
Urine specific gravity 1.010, with cellular casts and RBCs in the urine.
Based on these findings you would consider:

Friday, February 12, 2010
Which action first?
Which information about a patient who has just been admitted to the hospital with nausea and vomiting will require the most rapid intervention by the nurse?

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Home > 2 Minute EBP Challenge > Complications of Blood Transfusion

Complications of Blood Transfusion

Monday, January 04, 2010

Stay up-to-date the easy way!

How would you answer this question?

As many as 84-90% of patients having surgery develop perioperative anemia.  Perioperative blood transfusion is necessary in many of these patients due to anemia preoperatively or blood loss during surgery.  Which of the following is an adverse effect of perioperative blood transfusion?

a. Increased mortality
b. Increased length of stay
c. Immunosuppression
d. All of the above

The correct answer is "d" all of the above.

Perioperative anemia is a common problem faced by nurses.  The traditional treatment is blood transfusion, and although generally considered safe, blood transfusions can lead to many complications including immunosuppression, increased infections rates, increased mortality and increased length of stay.

The underlying cause of all of these adverse effects is a systemic inflammatory response.  When banked blood is transfused into the patient an inflammatory response occurs due to antigens on the transfused blood.  Despite typing and crossmatching blood products, the blood belongs to someone else and a minor inflammatory reaction will occur.  Maybe you have witnessed the slight increase in temperature that occurs when transfusing blood.  This is an indication of the underlying inflammation.

The inflammatory reaction will be magnified by giving additional units of blood products.  So, the chance of adverse effects goes up with each additional unit of blood products that are transfused.

The systemic inflammatory response syndrome (SIRS) caused by blood transfusion leads to inflammation in other organs, like the lungs (ARDS), and immunosuppression.  The overwhelming inflammation from SIRS consumes immune components leading to immunosuppression. 

The main thing to remember in relation to transfusions is that your patient will have an inflammatory response to blood products and that significant adverse effects and complications can arise.  Try to limit the amount of blood your patients need by decreasing blood draws using "pediatric" tubes, returning "the waste" to the patient when drawing through a central line, and implementing measures to stop bleeding when it occurs.

From: Jaffer, A., et al. (2009). Anemia Management Today: Blood Conservation, Transfusion, & New Options.  Retrieved from http://cme.medscape.com/viewprogram/7403 on January 4, 2010. 

Congratulations to Eileen Negri who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly.  Congratulations Eileen!   

Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.

PS. Ed4StudentNurses.com has resources for students too!

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