Blood Transfusion Reactions

Case study represents patient experiencing a hemolytic transfusion reaction (HTR)

Nursing
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Blood Transfusion Reactions

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Case study represents patient experiencing a hemolytic transfusion reaction (HTR)
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  1. Blood transfusion reactions

    Slide 1 - Blood transfusion reactions

    • Case study
    • Prepared by : Damir A.
  2. Statistics on Transfusion Errors

    Slide 2 - Statistics on Transfusion Errors

    • SHOT 2010 Report (SHOT, 2010)
  3. Case Study

    Slide 3 - Case Study

    • Mr. Kenny, 64 y.o male, has an order for 1 unit of packed RBCs. Baseline VS are: BP 125/78, HR 87, R 16, T 97.8. RN started the transfusion 10 minutes ago and the patient states : “Suddenly I feel like I’m having a flu. Please help me”. RN observes chills, nausea, and mild shortness of breath. His VS changed to BP 96/48, HR 112, R 24, T 101.6.
  4. Hemolytic Transfusion Reaction (HTR)

    Slide 4 - Hemolytic Transfusion Reaction (HTR)

    • HTR
    • Immune mediated response HTR
    • Acute HTR
    • Delayed HTR
    • Non-immune mediated HTR
    • Mechanical forces
    • Overheating
    • Freezing
    • Transfusing blood with hypertonic or hypotonic solutions
  5. Hemolytic Transfusion Reaction (HTR)

    Slide 5 - Hemolytic Transfusion Reaction (HTR)

    • HTR occurs when the patient gets blood products that are incompatible with his own blood product.
    • In most cases, mismatch occurs because blood specimen for type and crossmatch is drawn from the wrong patient or someone makes a clerical or procedural error before or during administration of the blood (Kyles, 2007).
    • Mr. Kenny’s Blood is B positive.
  6. Immediate response to the emergency and ongoing care

    Slide 6 - Immediate response to the emergency and ongoing care

    • Stop the infusion. Support ABCs
    • DC infusion set and change tubing
    • Hydrate the patient with 0.9% NS
    • Immediately notify HCP for orders
    • Orders that might be anticipated from physician :
    • Continue NS 0.9%
    • Dopamine 1-5 mcq/kg/min
    • Diuretics, such as 40 to 100 mg of furosemide given IVP to maintain urine output above 100mL/hr to decrease the risk of renal damage
    • Other therapies, such as heparin to prevent DIC or mannitol to promote osmotic diuresis.
    • 5. To manage coagulopathy or thrombocytopenia transfusion of blood products such as platelets, fresh frozen plasma, or cryoprecipitate might be ordered (Phillips, 2010)
    • S&S
    • Fever with or without chills, diaphoresis, flank pain, sense of impending doom
    • DIC
    • Shock
    • Death
    • Intravascular hemolysis
    • Hemoglobinemia
    • ,
    • hemoglominuria
    • , hypotension
  7. Case development

    Slide 7 - Case development

    • MRT
    • 0.9% NS IV @ 150mL/
    • hr
    • to help combat hypotension, initiate diuresis, and perfuse his kidneys
    • RN inserted indwelling urinary catheter to get a urine specimen to test for
    • hemoglobinuria
    • and accurately monitor Mr. Kenny's urine output
  8. Finding the source of the problem

    Slide 8 - Finding the source of the problem

    • Notify the blood bank
    • Check all labels
    • Draw appropriate lab specimens and send the blood bag, infusion set, and the IV bag or Y connector to the blood bank
    • Frequently monitor patients VS, respiratory, cardiac, and renal status.
    • Try to avoid administering any other blood product until investigation of the transfusion reaction is complete
    • Document the date and time of the transfusion reaction and patients assessment. Indicate time when transfusion was stopped, the time HCP was notified, and the patient’s response to stopping the transfusion. Also, indicate his response to ordered interventions and the time the blood bag, infusion set, and attached I.V. fluids were sent to the blood bank (Kyles, 2007).
  9. Lab work to detect hemolytic reaction

    Slide 9 - Lab work to detect hemolytic reaction

    • new ABO/Rh blood typing
    • direct antiglobulin test (DAr)~direct Coombs' test-to detect antibodies on the surface of RBCs that may cause cellular damage
    • complete blood cell count
    • urinalysis
    • total and direct serum bilirubin levels
    • lactate dehydrogenase level ( 140 units per liter (U/L) to 280 U/L or 2.34 mkat/L to 4.68 mkat/L.)
    • haptoglobin level ( 41 - 165 mg/dL)
    • blood urea nitrogen and creatinine levels to monitor renal function
    • platelet count, prothrombin time or international normalized ratio, and activated partial thromboplastin time to assess coagulation status
    • serum potassium levels to monitor for hyperkalemia (Kyles, 2007).
  10. Involving patient in transfusion safety

    Slide 10 - Involving patient in transfusion safety

    • Encourage patient and his family to take a proactive
    • role:
    • • Encourage them to voice any concerns.
    • • Tell the patient to immediately report any new or unusual sensations during or after the transfusion.
    • • Ask if he's had any previous transfusions and ask a female patient if she's ever been pregnant. The answers can provide insight into alloantibodies already present in the recipient's circulation.
    • • Ask the patient to describe previous experiences with transfusions.
    • • Explain the patient-identification process so he knows that clinicians should ask him to identify himself before any intervention or test
    • • Tell him his blood type and emphasize the need for clinicians to make sure that the blood product is compatible with that type (Kyles, 2007).
  11. NCLEX questions 1

    Slide 11 - NCLEX questions 1

    • Which statement is the scientific rationale for infusing a unit of blood in less than four (4) hours?
    • 1. The blood will coagulate if left out of the refrigerator for longer than four(4)hours.2. The blood has the potential for bacterial growth if allowed to infuse longer. 3. The blood components begin to break down after four (4) hours.4. The blood will not be affected; this is a laboratory procedure.
  12. NCLEX questions 2

    Slide 12 - NCLEX questions 2

  13. NCLEX questions 3

    Slide 13 - NCLEX questions 3

  14. NCLEX questions 4

    Slide 14 - NCLEX questions 4

  15. NCLEX questions 5

    Slide 15 - NCLEX questions 5

    • The nurse is caring for a child who is receiving a transfusion reaction of packed red blood cells. The nurse is aware that if the child had a hemolytic reaction top the blood, the sigs and symptoms would include which of the following? Select all that apply.
    • Fever
    • Rash
    • Oliguria
    • Hypotension
    • Chills
  16. References

    Slide 16 - References

    • Kyles, D. (2007). Is your patient having a transfusion reaction? Nursing, 37(4), 64hn1.
    • Philips, L. D. (2010). Manual of i.v. therapeutics: Evidenced-based practice for infusion therapy. F.A. Davis Company: Philadelphia, PA.
    • Serious Hazards Of Transfusion (SHOT) (2010). 2010 Shot annual report. Retrieved from : http://www.shotuk.org/wp-content/uploads/2011/07/SHOT-2010-Report.pdf
    • Stupnyckyj, C., Smolarek, S., Reeves, C., McKeith, J., & Magnan, M. (2014). Changing blood transfusion policy and practice. American Journal Of Nursing, 114(12), 50-59. doi:10.1097/01.NAJ.0000457412.68716.3b
    • Watson, D., & Hearnshaw, K. (2010). Understanding blood groups and transfusion in nursing practice. Nursing Standard, 24(30), 41-49.