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BLOOD ADMINISTRATION

Colleton County Fire-Rescue

Prisma Health Ambulance Service

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Objectives

Describe Blood and its components and functions of blood
Identify rationale for blood administration
Review policies and Standing Orders for blood administration
Discuss and be able to identify signs/symptoms of blood transfusion reactions
Explain logistics and storage requirements
Outline documentation requirements

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Saline is ineffective and dangerous

Dilutes clotting factor
Leads to hypothermia and acidosis
Doesn’t carry oxygen
Increases the speed of blood loss
Multiple studies correlate saline administration with increases in mortality.

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Why do we administer Blood Products?

Trauma’s Lethal Triad

Hypothermia
Acidosis
Coagulopathy

Warmed blood improves oxygenation of tissue, decreases hypothermia, provides clotting factor, and supports perfusion.

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Pathophysiology

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What is Blood?

Body fluid in humans – delivers necessary substances such as nutrients and O2 to the cells
Transports metabolic waste products away from those same cells
Classified as a connective tissue
Approximately 8% of body weight
Males: 5-6 Liters
Females: 4-5 Liters
pH of 7.35 – 7.45
Mean temperature of 38 degrees C

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Components of Blood

Plasma
Erythrocytes (Red Blood Cells)
Leukocytes (White Blood Cells)
Thrombocytes (Platelets)

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Components of Blood – Plasma

Makes up approx. 55% of blood volume
Water: 90 – 92%
Plasma Proteins: 6 – 8%

Albumin – helps maintain proper blood osmotic pressure, important in exchange of fluids across capillary walls
Globulins – defensive proteins, antibodies or immunoglobulins
Fibrinogen – key protein in formation of blood clots

Organic nutrients – glucose, carbohydrates, amino acids
Electrolytes
Non-protein nitrogenous substances – lactic acid, urea, creatinine

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Components of Blood – Red Blood Cells

2 main functions of RBCs

Pickup and transport O2 from the lungs
Pickup and transport CO2 to the lungs

Make up approx. 45% of blood volume
Disc shaped cells with thick rim and a sunken center

Allows for quick diffusion of O2 and CO2

Live for approx. 120 days before dying in the spleen
Plasma membrane – glycoproteins and glycolipids

determine blood type

Inner membrane surface – actin and spectrin
Incapable of aerobic respiration

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Components of Blood – White Blood Cells

Make up <1% of total blood volume
All WBCs are nucleated
Involved in protecting the body against infectious

disease and foreign invaders

5 different types of WBCs

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Components of Blood – Platelets

Not really cells – small fragments of bone marrow cells
Functions of platelets

Secrete vasoconstrictors
Form platelet plugs
Secrete procoagulants
Digest and destroy bacteria
Secrete chemicals to attract neutrophils and monocytes
Secrete growth factors to maintain linings of blood vessels

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Three Main Functions of Blood

O2 and CO2 between the lungs and the rest of the body
Nutrients from the digestive tract and storage sites to the rest of the body
Waste products to be detoxified or removed by the liver and kidneys

Transportation

Leukocytes (WBCs) destroy invading microorganisms
Antibodies and other proteins destroy pathogenic substances
Platelet factors initiate blood clotting

Protection

pH
Core body temperature

Regulation

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Blood Type – ABO System

To determine the “type” of blood we should understand two things:

Antigens on the surface of red blood cells
Antibodies in the plasma

4 main “types”

Type A blood – A antigens on the red blood cell and anti B antibodies in plasma
Type B blood – B antigens on the red blood cells and anti A antibodies in plasma
Type AB blood – has both A and B antigens on the red blood cells and NO type antibodies in the plasma (Universal recipient)
Type O blood – has NO type antigens on the red blood cells and BOTH anti A and anti B antibodies in the plasma (Universal donor)

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Blood Type – ABO System, Continued

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Blood Type – Rh System

Rh (Rhesus) blood grouping system consists of 50 defined blood-group antigens. D, C, c, E and e are the most important
Rh positive & Rh negative ONLY refer to the D antigen on the red blood cell
Unlike the AB system, the body does NOT normally produce antibodies against antigen D
Why is this important? Pregnant females…
Even when given Rh+ blood, Rh- recipients produced anti-D antibodies only 20% of the time

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Hemoglobin & Hematocrit

Hemoglobin – the amount of hemoglobin in whole blood

Males: 14 – 18 g/dL
Females: 12 – 16 g/dL

Hematocrit – volume % of RBCs

Males: 40 – 50%
Females: 35 – 46%

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Blood Administration

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Consent

Obtaining consent is the responsibility of the provider
The patient has the right to refuse blood or blood products
In the event of an emergency when consent cannot be obtained, the provider must document the necessity of the transfusion in the patient care report.

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Whole blood O neg or O pos

O neg is preferred. But low supply

Universal Donor
No risk of isoimmunization
Safe for all Patient populations

O positive is acceptable

Based on published STRAC data the risk of isoimmunization of 0.012 and 0.12 patients/year
Would take 3000 months (250 years) to have 100 Rh- women of childbearing age receive LTO+WB, and somewhere between 3 and 30 of them would develop isoimmunization without the administration of RhIg
Without transfusion of LTO+WB in the prehospital setting over this time period, nearly 500 women of childbearing age would die of hemorrhage

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Contraindications for Administering O+ Blood

Known hypersensitivity to blood transfusions in the past
Women between the ages of 0-55 whom it cannot be confirmed if they have had a hysterectomy or other procedure that will not allow them to become pregnant.

O+ Whole Blood can ONLY be administered to this group with ONLINE MEDICAL CONTROL ONLY from the Receiving Facility.

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Blood Component Therapy

Packed Red Blood Cells (PRBC)

O negative

Fresh Frozen Plasma (FFP)

Blood Type and Rh factor not relevant

Administer one unit of PRBC and one unit of FFP together.
Reassess and provide additional units if necessary

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Interfacility Blood Administration

Paramedics can initiate and transport blood products with a physician order,
Blood must be type and crossed for the specific patient
Consent must be obtained by the paramedic prior to administration
Blood that has been type and crossed with a physician order does not have to be warmed during administration

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During Administration

Provide normal saline only
Frequent vital sign checks including temperature
Monitor for transfusion reactions
Warm all emergency blood products
Do not administer medications in the same IV line as blood

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Criteria for Administration

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Criteria

Physiological Parameters: Needs to meet 2 parameters:

Systolic (SBP) < 90mm Hg
Single reading of Heart Rate (HR) >120
Shock Index (SI) >1

HR/SBP=SI

Signs of significant hemorrhage. - Must be present
Patients > age of 5 years
Signs of significant hemorrhage
Any patient that fall outside these parameters should consult Medical Control.

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Transfusion Reactions

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Allergic reactions

Mild-itching, rash, Flushed skin.
Severe (anaphylaxis)-difficulty breathing.
Tachycardia
Hypotension
Hives
Anxiety
Nausea\Vomiting
Abdominal Pain

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Acute hemolytic transfusion reaction

Rapid destruction of red blood cells that occurs during, immediately after or within 24 hours of a transfusion when patient is given incompatible blood type
Recipients body begins to destroy donated RBCs
Sx include:

Fever
Pain (back, chest)
SOB
N/V
Kidney failure

Approximately 10% of these reactions are fatal

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Febrile

Temperature elevation of 2 degrees Fahrenheit that occurs up to 4 hours after transfusion.

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