Blood transfusions and Transfusion Reactions.docx

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Transfusion Reactions RN Lesson 6-A Pharmacological & Parenteral Therapies Transfusion reactions & risks associated with transfusions o Allergic reaction most common type of reaction findings: hives and itching may be treated with antihistamines, e.g., diphenhydramine o Febrile reaction a reaction to the white blood cells in the donated blood more common in clients who have had previous transfusions and in multi- para women findings: fever within 24 hours of the transfusion, including headache, nausea, chills, or a general feeling of discomfort may be treated with antipyretic, e.g., acetaminophen o Transfusion-related acute lung injury (TRALI) may occur with any type of transfusion but more common with fresh frozen plasma or platelets more common in clients who are gravely ill findings: trouble breathing, often within 1 to 2 hours of starting the transfusion but may begin up to 72 hours post transfusion findings are often under-recognized (which leads to a delay in treatment and an increased mortality rate)
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o Acute hemolytic reaction rare, but most serious type of transfusion reaction occurs when donor and client blood types do not match usually the result of human error, e.g., mislabeled pre-transfusion specimen, transfusion of properly labeled blood to the wrong person, clerical errors findings: chills, fever, chest and lower back pain, nausea progressing to hypotension, bronchospasm, vascular collapse and disseminated intravascular coagulation (DIC) o Delayed hemolytic reaction this reaction involves the body slowly attacking the antigens on the transfused blood cells findings usually none, but may develop fever 4 to 8 days, up to 1 month, after blood transfusion lab findings include falling hematocrit and a positive direct antiglobulin (Coombs) test more common in clients who have had previous transfusions Transfusion Reactions 2 RN Lesson 6-A Pharmacological & Parenteral Therapies Graft-versus-host disease (GVHD) o occurs in severely immunocompromised clients o white blood cells in a transfused blood product attack client's tissues o more common when a relative or someone with the same tissue type has donated blood o findings: within a month of the transfusion, the client may have fever, liver dysfunction, rash, diarrhea, pancytopenia
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o high mortality rate Non-immune hemolysis o lysis of RBCs due to improper storage, handling, or transfusion conditions o findings: may include hemoglobinemia and hemoglobinuria Disease acquisition o bacterial more common in platelets since they must be stored at room temperature, allowing bacteria to grow quickly sepsis o viral (including Hepatitis B & C, HIV) o babesiosis, malaria, Lyme disease, syphilis, Chagas disease, Creutzfeldt-Jakob disease can be spread by blood product transfusions Hypotension o findings: a drop of at least 10 mm Hg in systolic or diastolic arterial blood pressure in the absence of other findings of transfusion reactions o
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