Haemolytic Transfusion Reactions-Free-Samples-Myassignmenthelp

Question: Describe the Pathophysiology of an Acute Haemolytic Transfusion Reaction. Answer: Pathophysiology of acute haemolytic transfusion reaction A haemolytic transfusion reaction is referred to the complications occurred after a blood transfusion, as a result of harmful reactions between the transfused RBCs with the recipients immune system (Massey, Davenport Kaufman, 2013). Aetiology The lack of compatibility among the donor and receivers blood is the key reason behind the immune reaction. In that condition, the immune cells of the recipients immune system attacks and destroys the incoming RBCs. The 2/3rd of these transfusions related issues are caused by a medical error in identifying the patient, blood sample or blood component and 1/3rd is due to an misconduct by the transfusion service. The key mediators of the immune reactions are the IgM or IgG antibodies or the non-ABO IgG antibodies like Rh, Kell or Duffy (Harmening, 2012). Risk factors Multiparous women, previous blood transfusion history, emergency uncross-matched transfusion, IgA deficiency, volume overload, transfusion of fresh frozen plasma, uncalibrated or poorly maintained blood warmer, mechanical damage of red cells, inadequate patient handling by staffs, inadequate diagnosis, concomitant medications are the key risk factors for developing haemolytic transfusion reaction (Bolton?Maggs Cohen, 2013). Pathogenesis Durring the first phase, the IgM/ IgG antibody of the recipient reacts with the transfused RBCs cell membrane. However, haemolysis occurs, if these antibodies are capable of activating components of complement system, i.e. C1 to C9. In the next phase, the RBCs, the non-hemolyzed RBCs bind to phagocytic cells, through IgG or C3b receptors; thereby stimulate the cytokine production, including IL-8 and TNF alpha. Then through phagocytosis, the bound cells are destroyed. This step is followed by the systematic effects of anaphylotoxins, C3a and C5a, cytokines; which then produce the clinical signs and symptoms of the haemolytic reactions (Bersus et al., 2013). Clinical manifestation The clinical manifestation of the haemolytic transfusion reactions are usually represented within 24 hours. These include the followings: Chills Fever Hypotension Renal failure Back or flank pin Oliguria Epistaxis Disseminated intravascular coagulation (DIC) Decreased fibrinogen Elevated bilirubin Hemoglobinemia Hemoglobinuria Clinical reasoning cycle Consider patients situation The patient, Mr. Ha had a medical history of gastric ulcer, hypertension and was getting tired easily. He was also passing black stool from last 3 years. His haemoglobin count was high, i.e. 89 mmol/l, indicating destruction of RBC. The blood pressure was also significantly low. The patient was prescribed with 2 units of PRBC transfusion. However, the second unit was ceased, when the patient represented symptoms of high temperature, 220/ min pulse rate along with shaking and stiffness. In this context, the following nursing care plan is being developed for the patient. Collection cues The patient had gastric ulcer and hypertension. His initial blood haemoglobin was high, along with the significantly low blood pressure, i.e. 60/90 mmHg. It indicates leakage in blood circulation or destruction of red blood cells. Upon the cessation of his second unit of transfusion, the pulse rate was dangerously high, i.e. 220/min along with high temperature. It has also been revealed that the patients vital signs were not measured through 1.15 hours. Process information Processing the available information, it has been revealed that the key cause of the adverse situation of the patient is lack of frequent monitoring the vital signs. Moreover, the situation is likely to rise as a result of incompatible transduction of blood cells. The high pulse rate, shaking and high temperature also indicate the occurrence of immune reaction or anaphylacytic reaction (Forbes Watt, 2015). The nurses should be more careful to monitor patients vital signs frequently, to prevent these kinds of severe reactions. Identify issues In the current situation, the patient is having high temperature, high pulse rate, losing consciousness and started shaking. Therefore, it is important to prioritise the key issues, which needed to be addressed first. The key issues are: High temperature and shaking High pulse Losing consciousness and haemolytic reactions in blood Establish goals Based on the key issues identified in the case, it is important to establish care goals for the patients. Therefore, the immediate key goals for the patient would be: To reduce temperature and control shaking To reduce pulse rate and control fluctuation of pulse rate To cross-check the patients compatibility to the transfused cells To Monitor vital signs and report deterioration To maintain IV line Take action To control the initial high temperature, the nurse need to report to the physician first and upon consultation, antipyretic medications should be provided. Moreover, to control patients shivering and stiffness, chloropromazine and diazepam could be administered, upon consultation. Intravenous saline solutions should be started to replenish fluid loss (Marcum, 2012). As the patient has undergone the previous situation, as result of infrequent monitoring, nurse should monitor patients vital signs every 5 minutes. To deal with inadequate cardiac output and hypotension, the IV line should be started with 0.9 % saline solution (NaCl) immediately. As the patient is losing consciousness, the nurse should continuously communicate with the patient, to reduce the risk of losing consciousness completely. Urine specimen should be tested for determining the presence of haemoglobin in urine (Alfaro-LeFevre, 2012). Immediately after recognizing the adverse condition, the transfusion should be ceased and patients actual order for the blood type and the administered packet of blood should be cross-checked for any kinds of administration error. To control further deterioration, the nurse should immediately consult with the physician and administer drugs including antihistamines, steroid, vasopressor or fluids to reduce allergic symptoms immediately and reduce the fatal risk (Ahopelto et al., 2011). Evaluate outcomes Evaluating the patients current situation and the interventions implemented for the patient, it can be interpreted that the patient would be benefited from the solutions, as these have been implemented in an evidence-based manner (Alfaro-LeFevre, 2012). Moreover, it can be interpreted that transfusion reactions should be performed upon checking the compatibility more than one time. Reflection Dealing with the case of Mr. Ha, the importance of cross-checking blood component compatibility between donor and recipient has been understood significantly. In addition, the role and accountability of a nurse in case of a patient with transfusion reactions, have also been understood. Reference List Ahopelto, I., Mikkil-Erdmann, M., Olkinuora, E., Kp, P. (2011). A follow-up study of medical students biomedical understanding and clinical reasoning concerning the cardiovascular system.Advances in health sciences education,16(5), 655-668. Alfaro-LeFevre, R. (2012).Applying nursing process: the foundation for clinical reasoning. Lippincott Williams Wilkins. Bersus, O., Boman, K., Nessen, S. C., Westerberg, L. A. (2013). Risks of hemolysis due to anti?A and anti?B caused by the transfusion of blood or blood components containing ABO?incompatible plasma.Transfusion,53(S1), 114S-123S. Bolton?Maggs, P. H., Cohen, H. (2013). Serious Hazards of Transfusion (SHOT) haemovigilance and progress is improving transfusion safety.British journal of haematology,163(3), 303-314. Forbes, H., Watt, E. (2015).Jarvis's Physical Examination and Health Assessment. Elsevier Health Sciences. Harmening, D. M. (2012).Modern blood banking and transfusion practices. FA Davis. Marcum, J. A. (2012). An integrated model of clinical reasoning: dual?process theory of cognition and metacognition.Journal of evaluation in clinical practice,18(5), 954-961. Massey, E. J., Davenport, R. D., Kaufman, R. M. (2013). Haemolytic Transfusion Reactions.Practical Transfusion Medicine, Fourth Edition, 77-88.