Transfusion Reactions

Question 1

What to do if a reaction is suspected?

Answer 1

STOP

Question 2

What do you do with the IV if a reaction is suspected?

Answer 2

Maintain a new IV line with NS in same site with surgical asepsis

Question 3

NC for suspected transfusion reaction?

Answer 3

• ask questions
• VS
• contact HCP and blood bank
• recheck equipment
• monitor urine output
• save blood bag and tube for blood bank
• report
• collected specimens for hemolysis

Question 4

Acute hemolytic reaction

Answer 4

• most life-threatening
• incompatible blood products

Question 5

Febrile, non-hemolytic reaction

Answer 5

Fever develops during infusion but hemolysis does not occur

Question 6

mild allergic reaction to transfusion

Answer 6

sensitization to donor WBCs (often), platelets, or plasma proteins (more common in people with history of allergies)

Question 7

Anaphylactic/severe allergic reaction

Answer 7

severe sensitization to donor plasma proteins; life-threatening

Question 8

septic reaction to blood transfusion

Answer 8

Bacteria present in the blood

Question 9

transfusion-associated circulatory overload

Answer 9

Excess blood volume administered

Question 10

What population is susceptible to a TACO

Answer 10

Older, heart failure

Question 11

Leukocyte-reduced blood products

Answer 11

• collected from whole blood
• contaminant of other cell blood components and can cause adverse effects including immune-mediated factors

Question 12

S/S acute hemolytic rxn

Answer 12

IMMEDIATE flush, fever, low back pain (kidneys), Hgb in urine, dyspnea, HA, tachy, hypoT, cardiac arrest/death

Question 13

NC for AHTR

Answer 13

PREVENTION IS KEY
- keep BP up with colloids, get blood sample from site, get urine sample for hematuria–send foley and equipment to the lab

Question 14

Febrile non-hemolytic rxn (FNHTR) s/s

Answer 14

chill and fever, HA, flushing, anxiety, vomit, muscle pain; LESS immediate; no shock or hematuria

Question 15

FNHTR NC

Answer 15

tell HCP, usually admin Tylenol and restart blood slowly; PREVENT by asking pt about past reactions, try to get leukocyte-reduced products for them

Question 16

Mild allergic transfusion reaction s/s

Answer 16

urticaria, flushing, itching

Question 17

mild allergic transfusion reaction NC

Answer 17

STOP - tell HCP; might admin steroid or antihistamine, restart slow (if ordered for mild sx), tx with prophylactic antihistamines and steroids, prevent by asking about previous reactions

Question 18

What blood product might be ordered for a mild allergic reaction?

Answer 18

Washed RBCs and platelets

Question 19

Severe anaphylactic rxn s/s

Answer 19

anxiety, urticaria, dyspnea, wheezing, cyanosis, hypotension, bronchospasm, cardiac arrest

Question 20

NC for severe anaphlaxis

Answer 20

CPR and oxygen, epinephrine, antihistamine, steroids, B2 agonists

Question 21

What blood products might a patient get for severe anaphylaxis?

Answer 21

very washed RBCs, maybe autologous components

Question 22

Bacterial/sepsis reaction s/s

Answer 22

fever, chills, V/D, hypotension

Question 23

Bac/sepsis reaction NC

Answer 23

• get culture
• return bag to bank
• tx septicemia with abx, IVF, vasopressor (inc BP)
  PREVENT by admin blood in under 4 hours

Question 24

TACO s/s

Answer 24

cough, dyspnea, pulmonary congestion, HA, inc VS, distended neck veins

Question 25

TACO NC

Answer 25

slow OR stop infusion, admin diuretics, oxygen, morphine, CXR STAT - recognize risks and prevent

Question 26

How to decrease risk of a reaction?

Answer 26

Ask about prior history of reactions, recognize high risk pts (esp TACO), use autologous components

Question 27

Autologous donation

Answer 27

store your own blood for future and freeze; if not frozen, use within a few weeks

Question 28

Disadvantages of autologous donations

Answer 28

insurance does not pay, can waste blood products

Question 29

Autotransfusion

Answer 29

take blood lost in surgery and recycle to put back in the body