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Zorluk: KolayHematology and Oncology

A 45-year-old woman is receiving a packed red blood cell transfusion for symptomatic anemia. Fifteen minutes into the transfusion, she develops a fever, chills, tachycardia, and right flank pain. Her temperature is 38.8°C (101.8°F), blood pressure is 90/60 mmHg, and pulse is 115/min. Arrange the following management steps in the most appropriate chronological order.

  1. 1Stop the red blood cell transfusion immediately
  2. 2Disconnect the blood tubing and attach new tubing with normal saline
  3. 3Verify the patient identification and blood product tags
  4. 4Send the remaining blood product and patient samples to the blood bank

Cevap

The correct chronological sequence is: 1) Stop the red blood cell transfusion immediately, 2) Disconnect the blood tubing and attach new tubing with normal saline, 3) Verify the patient identification and blood product tags, 4) Send the remaining blood product and patient samples to the blood bank.
An acute hemolytic transfusion reaction typically presents within minutes of starting a transfusion with fever, chills, flank pain, and hemodynamic instability. The immediate management sequence prioritizes patient safety by stopping the exposure, maintaining hemodynamic support safely, identifying clerical errors, and finally confirming the diagnosis. Stopping the transfusion is always the first step. Next, the IV line must be maintained with normal saline through new tubing to prevent flushing incompatible blood. Bedside checks for clerical errors follow, and finally, samples are sent for definitive testing.

Adım Adım Çözüm

1
Recognize the signs of an acute hemolytic transfusion reaction.
The patient's fever, chills, hypotension, tachycardia, and flank pain shortly after starting a transfusion highly suggest ABO incompatibility.
Immediate recognition is required to prevent fatal outcomes from ongoing hemolysis.
2
Halt the offending agent.
The red blood cell transfusion is stopped immediately.
Limiting the volume of incompatible blood administered is the most critical intervention to reduce morbidity and mortality.
3
Maintain supportive intravenous access safely.
Old tubing is disconnected and new tubing with normal saline is attached.
Intravenous fluids are needed to support blood pressure and maintain renal perfusion, but flushing the old line would push more incompatible blood into the patient.
4
Perform bedside investigation.
Patient identification and blood product tags are verified.
Clerical error is the most common cause of ABO-incompatible transfusions. A bedside check provides immediate clues to the etiology.
5
Obtain definitive laboratory confirmation.
The remaining blood unit and fresh patient blood and urine samples are sent to the blood bank.
The blood bank must perform a direct antiglobulin test (DAT), repeat crossmatch, and check for hemoglobinuria to confirm the diagnosis and ensure future transfusion safety.

Anahtar Kavram

Management of acute hemolytic transfusion reactions
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Konular

Hematology and Oncology

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