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Zorluk: ZorPreoperative and Postoperative Care

A 6868-year-old man is recovering in the surgical ward on postoperative day 11 following an open abdominal aortic aneurysm repair. His preoperative hemoglobin was 11.2 g/dL11.2 \text{ g/dL}, and his postoperative hemoglobin is 7.1 g/dL7.1 \text{ g/dL}. A transfusion of packed red blood cells is initiated. Approximately 2020 minutes into the transfusion, the patient complains of sudden-onset chills, severe flank pain, and shortness of breath. His temperature is 38.9∘C38.9^\circ\text{C} (102.0∘F102.0^\circ\text{F}), blood pressure is 90/60 mm Hg90/60 \text{ mm Hg}, and heart rate is 115/min115/\text{min}. A Foley catheter drains dark, reddish-brown urine. Arrange the following management steps in the most appropriate chronological sequence for this patient's acute complication.

  1. 1Stop the blood transfusion immediately and disconnect the blood product tubing.
  2. 2Maintain intravenous access by initiating a normal saline infusion through new tubing.
  3. 3Verify the patient's identification wristband against the blood product label at the bedside.
  4. 4Send the discontinued blood bag and newly drawn patient blood samples to the blood bank.
  5. 5Administer aggressive intravenous hydration to prevent acute kidney injury.

Cevap

The correct sequence is: 1) Stop the transfusion, 2) Initiate normal saline through new tubing, 3) Verify identification bands, 4) Send samples to the blood bank, 5) Administer aggressive intravenous hydration.
The correct chronological management prioritizes patient safety by immediately stopping the offending agent. This is immediately followed by securing IV access with entirely new tubing to prevent further exposure while allowing for fluid administration. Once the patient is stabilized, determining the cause (clerical check) and confirming the diagnosis (blood bank testing) are performed, followed by definitive complication management (aggressive hydration for renal protection).

Adım Adım Çözüm

1
Stop the blood transfusion immediately and disconnect the tubing.
Further administration of incompatible red blood cells is halted.
This is the most critical first step to minimize the severity of the acute hemolytic transfusion reaction.
2
Maintain intravenous access by initiating a normal saline infusion through new tubing.
Intravenous access is secured for resuscitation without administering more incompatible blood.
Using new tubing prevents flushing the remaining incompatible blood from the old tubing into the patient.
3
Verify the patient's identification wristband against the blood product label.
A clerical error is identified or ruled out.
ABO incompatibility due to clerical error is the most common cause of acute hemolytic transfusion reactions.
4
Send the discontinued blood bag and newly drawn patient blood samples to the blood bank.
Diagnostic workup is initiated.
A direct antiglobulin test and repeat crossmatching are necessary to confirm the diagnosis and guide further transfusion needs.
5
Administer aggressive intravenous hydration to prevent acute kidney injury.
Renal perfusion is maintained and free hemoglobin is diluted.
Free hemoglobin from lysed red blood cells can precipitate in the renal tubules, causing acute tubular necrosis.

Anahtar Kavram

The management of an acute hemolytic transfusion reaction requires immediate cessation of the transfusion, maintenance of intravenous access using entirely new tubing, bedside clerical verification, laboratory confirmation, and prevention of acute kidney injury with aggressive hydration.
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Preoperative and Postoperative Care

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