NCLEX-RN cheat sheet · Hematology and oncology
Blood products and transfusion reactions
Compatibility, safe checks, monitoring, and reactions
AI-checkedChecked by AI against current guidelines, with spot-checks by a registered nurse.
A transfusion can save a life, and a mismatched unit can end one. At the bedside, the nurse is the last check.
Download the free PDF: Blood products and transfusion reactions, 2 pages
Two printable pages, free. No sign-up.
At a glance
Red cell compatibility
| Client's type | Can receive |
|---|---|
| A | A or O |
| B | B or O |
| AB | A, B, AB or O: no anti-A or anti-B |
| O | Only O: it carries both antibodies |
| Rh-negative | Rh-negative red cells preferred, especially with childbearing potential; emergency protocols may use Rh-positive |
Red cells only: Plasma and platelets follow different compatibility rules. Don't delay a lifesaving transfusion.
ABO, Rh and the crossmatch
- Blood groups come from A and B antigens on red cells. People carry antibodies against the antigens they lack.
- Mismatched blood is attacked, and the red cells burst: that's hemolysis, and an ABO mismatch can be fatal.
- Rh means the D antigen. Rh-negative people have no anti-D until they're exposed; a later exposure can cause severe hemolysis.
- A type and screen finds the group, the Rh type and unusual antibodies; a crossmatch also tests a specific donor unit. Typing sample: within 72 hours, or as your policy states.
Blood products
| Product | Used for |
|---|---|
| Red cells | Oxygen-carrying capacity, for bleeding or symptomatic anemia. One unit typically raises hemoglobin about 1 g/dL in an adult; the effect varies with active bleeding. Consider below 7 g/dL in most stable adults, individualized; 8 g/dL may suit heart disease, 7.5 g/dL cardiac surgery |
| Fresh frozen plasma | Clotting factors: for bleeding, or to bring a high INR down quickly |
| Platelets; cryoprecipitate | A low or poorly working platelet count. Cryoprecipitate supplies fibrinogen, as in massive bleeding or DIC |
| Albumin | Expands volume, as in burns, when salt solutions aren't enough |
| Leukocyte-reduced; autologous | Leukocyte-reduced cells help clients who had a fever reaction before. Autologous blood is the client's own, collected ahead of surgery |
Before you start
- Confirm written consent, unless it's an emergency. Some clients, like Jehovah's Witnesses, decline blood: follow policy.
- Verify the order and any premedication; ask about allergies and past reactions. Acetaminophen and diphenhydramine are common premeds after a past reaction; furosemide may be ordered in heart failure.
- Fever over 100.4 °F, or abnormal vital signs? Call the provider before you get the blood: it can't go back.
- Use a 20 to 24 gauge catheter, or 18 to 20 for a rapid transfusion.
- Prime filtered blood tubing with normal saline, the standard; albumin or ABO-compatible plasma may be allowed, per product and policy. Dextrose, lactated Ringer's, parenteral nutrition and medicines don't go in the blood line.
Bedside check and monitoring
- Start within 30 minutes of pickup. Don't keep blood in the unit fridge or shake it; warm it only in a blood warmer, if ordered.
- Two people check at the bedside: the order, two identifiers on the wristband against the bag, group, Rh, unit number and expiry. Inspect the bag too.
- Baseline vital signs, with lung sounds, within 15 minutes before starting.
- Start slowly, about 2 mL a minute, and stay with the client for the first 15 minutes, when most reactions happen.
- Recheck vital signs at 15 minutes, then raise the rate so the unit finishes within 4 hours.
- Teach the client to report chills, itching, hives, shortness of breath or chest pain right away.
- Afterwards: compare vital signs to baseline, flush with saline, and teach the signs of a delayed reaction.
Transfusion reactions
| Reaction | Clues | Then |
|---|---|---|
| Acute hemolytic (mismatch) | Starts within minutes: fever, chills, low back pain, a fast pulse, low pressure | Send blood and urine samples to the lab, with the bag and tubing |
| Febrile (among the most common, with allergic reactions; donor white cells) | Fever and chills | Antipyretics as ordered |
| Allergic | Itching and hives; anaphylaxis adds wheezing and low pressure | Anaphylaxis: epinephrine as ordered |
| TACO (fluid overload) | Crackles, breathlessness, high pressure, neck vein distension; mostly older and heart or kidney clients | Stop the transfusion, sit the client up, give oxygen; a diuretic as ordered |
| TRALI (lung injury from donor antibodies) | Low oxygen and low pressure; fever | Oxygen; prepare for intubation |
| Septic (contaminated blood) | High fever, low pressure | Cultures and antibiotics follow |
Any suspected reaction: Stop the transfusion first. Keep the vein open with normal saline through new tubing, not the old tubing, which would push more blood in. Urgently notify the provider and blood bank, and follow the reaction policy.
Priority and safety calls
- ★ Ten minutes in, low back pain and chills: stop the transfusion. Early back pain and chills suggest a hemolytic reaction.
- ★ Stop, don't slow: slowing keeps the possibly mismatched blood flowing.
- After stopping, hang normal saline with new primed tubing attached at the catheter, not through the old blood tubing.
- Acetaminophen treats a fever, but doesn't stop the reaction. A new unit can wait: the client comes first.
- An 82-year-old with heart failure, on a second unit, develops crackles, a pounding pulse, BP 172/94 mmHg and distended neck veins: likely TACO, fluid overload.
- A mismatched transfusion is a sentinel event, a serious and preventable harm. Two people check at the bedside.
- You can't delegate the transfusion. Once the client is stable after 15 minutes, an assistant may take vital signs and report.
How the NCLEX tests it
- The exam loves the first action.
- Expect type O compatibility, compatible fluids, the first 15 minutes, a fever before pickup, and TACO versus TRALI.
- TACO brings high pressure and crackles; TRALI brings low oxygen and low pressure.
- For red cells: type O receives only O, type AB any, and Rh-negative gets negative when possible, without delaying lifesaving blood.
- Consent, a two-person check, saline as the standard fluid, and start within 30 minutes. Start slow, stay 15 minutes, finish within 4 hours.
- Traps: slowing instead of stopping, saline through the old tubing, medicine in the blood line, and leaving the room early.
Practice it next
This sheet comes from Blood products and transfusion reactions in our NCLEX-RN course. Try free practice questions, or see the lessons it was written from.
Quick self-quiz
- Type O can receive red cells only from type ___.
Show answer
O - The typing sample must be drawn within the past ___ hours, or as your policy states.
Show answer
72 - Start the transfusion within ___ minutes of pickup.
Show answer
30 - Stay with the client for the first ___ minutes.
Show answer
15 - A unit must finish within ___ hours.
Show answer
4 - Prime the tubing with 0.9% normal ___.
Show answer
saline - Febrile and allergic reactions are among the most ___ transfusion reactions.
Show answer
common - In most stable adults, consider red cells below a hemoglobin of ___ g/dL, individualized.
Show answer
7
Sources
- Open RN, Nursing Advanced Skills, 3.2 Basic Concepts (blood products)
- Open RN, Nursing Advanced Skills, 3.3 Applying the Nursing Process
- Open RN, Nursing Advanced Skills, 3.4 Checklist for Administration of Blood Products
- Canadian Blood Services, Clinical Guide to Transfusion: Blood administration
- AABB, Updates in red blood cell transfusion thresholds
- Australian Red Cross Lifeblood, What can cause adverse events
More hematology and oncology cheat sheets
- Anemias, bleeding and oncologic emergencies NCLEX cheat sheet
- Immune disorders, HIV and anaphylaxis NCLEX cheat sheet
Educational use only. This sheet is a study aid for the NCLEX-RN, not a substitute for clinical judgment, your facility’s policy or the provider’s orders. Where practice varies, follow facility policy and state law. NCLEX® and NCLEX-RN® are registered trademarks of NCSBN, which does not endorse these materials.