Transplant and Transfusion Reaction Flashcards
Success of liver transplantation
successful immunosuppression
Complications of liver transplant
- Bleeding
- Infection
- Rejection
- Obstruction of the biliary anastomosis
- Impaired biliary drainage
- Vascular thrombosis & stenosis
Contraindications for kidney transplant
• Recent malignancy, active or chronic infection
• Severe irreversible disease (cardiac disease, chronic lung disease, severe peripheral
vascular disease)
• Active infection (HIV, hepatitis B and C)
• Class II obesity (body mass index >35 kg/m2)
• Current substance abuse
• Inability to give informed consent, Hx of non adherence to treatment regimens
Hyperacute rejection- kidney
in 24 hr
• Fever, malaise, tenderness,
• Immediate removal of the transplanted organ
Acute rejection- kidney
3 -14 days or after many years
• tenderness at the transplant site, ↑ creatinine, ↑ temp,
malaise, and oliguria
• Early recognition & immunosuppressant therapy
Assessing rejection
• Oliguria • Edema • Fever • ↑ BP • Weight gain • Swelling or tenderness over the transplanted kidney or graft
Monitor Urinary Function- living donor
Living donor
• Function immediately returns after surgery
• May produce large quantities of dilute urine
Monitor Urinary Function- cadaver donor
- May not function for 2 or 3 weeks
- anuria, oliguria, or polyuria
- Significant changes in fluid and electrolyte status
- May require hemodialysis
All Immunosuppressant Meds
Increased Risk for Infection
blood components- serum proteins
o Coagulation
o Healing
o Transport
o Osmotic pressure
PRBC’s
Hgb ↑ 1 g/dL per unit, Hct 2-3% per unit
Platelets
↑ 5K-10K per unit
Transfusion Pre-Procedure
- Confirm order, confirm type & crossmatch done by lab (verifying RN)
- Consent and patient ID (verifying RN)
Transfusion Procedure
- Obtain blood (initiate within 30 minutes)
- Dual check with another RN
- Vitals Q 15min (30min)→ Q 30min (1h) → Q 1 h
- Close monitoring for 15-30 minutes
Reaction Symptoms
- Fever
- Chills
- Respiratory distress
- Low back pain
- Nausea
- Pain at the IV site
- Anything “unusual.”
Febrile Nonhemolytic Reaction (within 2h) S&S
S/Sx’s
• Chills (minimal to severe)
• Followed by fever that begins within 2 hours after transfusion
• Muscle stiffness
Antipyretics can be given to prevent fever
Acute Hemolytic Reaction S&S
Most dangerous and life threatening • Reaction with as little as 10 mL of PRBCs • Errors in blood component labeling & identification S&Sxs • Fever, chills • Low back pain • Nausea • Chest tightness • Dyspnea • Anxiety
Allergic Reaction
S/Sx’s • Urticaria • Itching • Flushing • Resolve after administration of an antihistamine
Transfusion-Associated Circulatory Overload (TACO) S&S
- Dyspnea, orthopnea, crackles
- Tachycardia
- ↑ Blood pressure
- Sudden anxiety
- JVD
Transfusion-Associated Circulatory Overload (TACO)
- Hypervolemia: too much blood volume too fast
- Condition aggravated in patients with ↑circulatory volume (or↓CO)
- Assess for signs of circulatory overload
- As late as 6 hours after transfusion
Transfusion-Related Acute Lung Injury (TRALI) S&S
- Acute SOB
- Hypoxia
- Hypotension
- Fever
- Eventual but acute pulmonary edema
TRALI
- Potentially fatal, idiosyncratic reaction: abrupt onset
- Acute lung injury within 6 hours after blood transfusion
- Most common cause of transfusion-related death
- Pulmonary edema with decrease of oxygenation
Nursing Management- blood transfusion reaction
- Stop transfusion immediately if suspected reaction
- Notify provider
- Patient assessment
- Determine the type and severity
- Initiate slow infusion of NS IV through new IV tubing, same IV access
- Compare vital signs with baseline, including O2 saturation
- Assess patient’s respiratory status
- Notify provider of assessment findings & implement treatments
- Notify blood bank of suspected transfusion reaction
- Send blood container & tubing to blood bank for repeat typing & culture
