Question

When monitoring blood product administration, there are hemolytic and nonhemolytic reactions that may occur. Discuss the monitoring parameters for one of these two reactions and what action the nurse should take when a reaction occurs.

Answer 1

Hemolytic Transfusion Reactions

They may be acute (occurring within 24 hours

of transfusion) or delayed (when signs of red

cell destruction do not occur until 4 to 10 days

after transfusion).

It include

Acute Hemolytic Transfusion Reaction

Definition: RBC destruction < 24 hrs of transfusion

Occurs mainly with RBCs and whole blood, but can occur with any plasma-derived products (platelets, FFP, cryo, etc…)

Fatal 1 in 100,000 – 600,000 units transfused Most common cause: incompatible RBCs leading to intravascular hemolysis

Nurses action

If suspected, STOP transfusion, And maintain IV access

Make initial rapid assessment of pt and requirements for basic and advanced support

Notify blood bank, collect transfused units (full or partial), tubing, etc. and return them to BB

Reconfirm identity of blood units & patient

Collect appropriate patient blood specimens

IV fluid resuscitation for hypotension

Maintain IV fluids

Diuretics Make efforts to maintain urine output at 30-100 mL/h.

Low dose dopamine

Replace procoagulant factors and fibrinogen with FFP and cryo; also patients as needed

Delayed Hemolytic Transfusion Reaction

Pathophysiology same as acute EXCEPT:

Low titer of reactivity so undetected on initial screen

Repeat post-transfusion sample will show the Ab

Nurses action

More sensitive antibody screens

Medical records of Ab maintained for patients

Patients with multiple transfusion histories like sickle cell disease, should undergo extensive Phenotyping

If suspected, STOP transfusion, And maintain IV access

Make initial rapid assessment of pt and requirements for basic and advanced support

Notify blood bank, collect transfused units (full or partial), tubing, etc. and return them to BB

Reconfirm identity of blood units & patient

Collect appropriate patient blood specimens

IV fluid resuscitation for hypotension

Maintain IV fluids

Diuretics Make efforts to maintain urine output at 30-100 mL/h.

Low dose dopamine

Replace procoagulant factors and fibrinogen with FFP and cryo; also patients as needed

Monitoring parameters

It means with regular interval check the vital signs,signs and symptoms and lab values for identifying the abnormal transfusion reactions

The common signs and symptoms and lab values are noticed below ,

Signs and Symptoms

Fever

Chills/rigors

Anxiety

Flushing

Chest/ abdominal/ back pain

N/V/D

Dyspnea

Hypotension

Hemoglobinuria

Pallor

Icterus

Oliguria/anuria

Pain at transfusion site

Diffuse bleeding jaundice

Labs value

CBC wBC,platelets

Hct decreased

bilirubin, BUN/CREATININE

Coags: PT/PTT/FSP/fibrinogen/haptoglobin

Unconjugated bilirubin,LDH increase

Febrile Nonhemolytic Transfusion Reactions (FNHTR)

Nonhemolytic febrile reactions are due to WBCs, WBC antibodies, or cytokines elaborated by either donor or recipient Granulocyte and human leukocyte antigen

5(HLA5) antibodies Cytokines accumulate during storage so to prevent this all samples are leuko reduced prior storage

Monitoring parametparameter

It can be done with identify sypmtoms and lab values

Symptoms

Fever (increase of temp 1°C from baseline)

Chills

In absence of other causes of fever

Nurses action

Discontinue transfusion

Administer Antihistamines drugs

If urticaria resolved, then can restart transfusion