A 45-year-old woman is admitted for severe symptomatic anemia secondary to abnormal uterine bleeding. Her hemoglobin is 6.2 g/dL. A transfusion of packed red blood cells is initiated. Fifteen minutes into the infusion, she complains of sudden-onset chills, severe lower back pain, and nausea. Her temperature is 38.9°C (102°F), blood pressure is 88/50 mmHg, pulse is 118/min, and respirations are 22/min. The Foley catheter bag shows a sudden change in urine color to dark reddish-brown. Arrange the following steps in the most appropriate chronological order for managing this patient's acute complication.
- 1Terminate the blood transfusion and disconnect the blood tubing from the intravenous access site
- 2Attach fresh intravenous tubing and initiate a rapid infusion of normal saline
- 3Perform a bedside clerical check of the patient's identification band against the blood product label
- 4Send the remaining blood product and newly drawn patient blood samples to the blood bank
- 5Consider administration of vasopressors or osmotic diuretics if aggressive hydration fails to stabilize hemodynamics and urine output
Cevap
The correct sequence is to first terminate the transfusion, then initiate normal saline through fresh tubing, followed by a bedside clerical check, sending samples and the blood bag to the blood bank, and finally administering advanced supportive care (like vasopressors) if initial hydration fails.
Acute hemolytic transfusion reactions are medical emergencies caused by ABO incompatibility. The priority is to stop the exposure, followed immediately by supportive hydration to prevent acute tubular necrosis from free hemoglobin. Diagnostics and advanced treatments follow stabilization.
Adım Adım Çözüm
Anahtar Kavram
Management algorithm for Acute Hemolytic Transfusion Reaction (AHTR)