A 65-year-old man is hospitalized for symptomatic anemia and is receiving a transfusion of packed red blood cells. Thirty minutes into the transfusion, he develops severe chills, flank pain, and shortness of breath. His temperature is 39.1°C (102.4°F), blood pressure is 85/50 mm Hg, and heart rate is 115/min. The urine in his Foley catheter tubing suddenly appears dark red. An acute hemolytic transfusion reaction is suspected.
Arrange the following management steps in the most appropriate, evidence-based sequential order for this patient.
- 1Immediately halt the blood transfusion.
- 2Disconnect the blood tubing and infuse normal saline through a new intravenous line.
- 3Perform a bedside clerical check of the blood product labels and patient identification.
- 4Send the remaining blood product and post-transfusion patient blood samples to the blood bank.
Answer
The correct sequence is to first halt the transfusion, then disconnect the tubing and run normal saline through new tubing, followed by a bedside clerical check, and finally sending the blood and new patient samples to the blood bank.
The management of a severe transfusion reaction must prioritize patient safety by immediately stopping the offending agent. Next, hemodynamic support is established using normal saline through completely new tubing to avoid flushing residual incompatible blood into the patient. Once the patient is secured, a bedside clerical check is performed to identify obvious labeling errors, followed by sending the blood bag and fresh patient samples to the blood bank for definitive testing.
Step-by-Step Solution
Key Concept
Algorithm for the acute management of a suspected hemolytic transfusion reaction.