A 45-year-old woman is receiving a packed red blood cell transfusion for symptomatic anemia. Thirty minutes into the infusion, she develops sudden-onset chills, severe flank pain, and dyspnea. Her temperature is (), blood pressure is , and heart rate is . Her urine in the Foley catheter tubing has acutely become dark red. Arrange the following steps in the most appropriate chronological order for managing this patient's suspected acute hemolytic transfusion reaction.
- 1Stop the blood transfusion immediately
- 2Disconnect the blood tubing and maintain intravenous access with normal saline using fresh tubing
- 3Perform a bedside clerical check of the patient identification and blood product labels
- 4Send post-transfusion blood samples, urine, and the remaining blood bag to the blood bank
- 5Administer aggressive intravenous fluid hydration to maintain renal perfusion
Answer
The correct sequence is: 1) Stop the transfusion, 2) Maintain IV access with fresh tubing and saline, 3) Perform a clerical check, 4) Send samples and the blood bag to the blood bank, 5) Administer aggressive intravenous fluids.
An acute hemolytic transfusion reaction (AHTR) is a life-threatening medical emergency caused by ABO incompatibility. The chronological priority is immediately halting the offending agent (stopping the transfusion). Because the patient is hypotensive, IV access is critical; however, the line must be disconnected and replaced with fresh tubing and normal saline to avoid pushing residual incompatible blood into the patient. A bedside clerical check is then performed because misidentification is the leading cause of AHTR. Subsequently, the blood bank must receive new samples and the donor bag to investigate the etiology (Coombs test, hemolysis labs). Finally, definitive supportive care, including aggressive IV fluids, is initiated to maintain urine output and flush hemoglobin from the renal tubules, thereby preventing acute tubular necrosis.
Step-by-Step Solution
Key Concept
The management of an acute hemolytic transfusion reaction requires immediately stopping the transfusion, securing IV access without flushing the blood tubing, checking for clerical errors, sending diagnostic samples, and providing aggressive hydration to prevent acute kidney injury.