Gender Ethnicracial And Life Span Considerations

Infants and the elderly are more likely to experience problems of fluid overload with transfusion, and children are more likely to develop transfusion-related HIV infections than are adults. The incidence of transfusion reactions does not appear to be based on gender. Non-hemolytic febrile reactions and extravascular hemolytic reactions are more common in females who have been pregnant. Ethnicity and race have no known effect on the risk of blood transfusion reaction.

^ ASSESSMENT

HISTORY. Individuals who report a history of numerous allergies or previous transfusions should be monitored more carefully since they are at higher risk for reaction. A history of cardiovascular disease should be noted because those patients need to be monitored more carefully for fluid overload. Note also if a patient has a history of Raynaud's disease or a cold agglutinin problem, because, before being administered and with physician approval, blood needs to be warmed. Once the transfusion is in process, the patient may report any of the following signs of transfusion reaction: heat or pain at the site of transfusion, fever, chills, chest tightness, lower back pain, abdominal pain, nausea, difficulty breathing, itching, and a feeling of impending doom.

PHYSICAL EXAMINATION. A change in any vital sign can indicate the beginning of a transfusion reaction. Note if the urine becomes cloudy or reddish (hemolysis). Observe any change in skin color or the appearance of hives. Be alert for signs of edema, especially in the oropharynx and face. Auscultate the lungs before beginning the transfusion, and note any baseline adventitious

Blood Transfusion Reaction 133

sounds. Then monitor for crackles or wheezes if the patient shows any signs of fluid overload, and inspect the patient's neck veins for distension.

PSYCHOSOCIAL. Blood bank protocols have lowered the risk of human immunodeficiency virus (HIV) transmission from more than 25,000 cases before 1985 to a risk of 1 in 50,000 to approximately 1 in 150,000 currently. In spite of the decreased risk, many patients worry about contracting HIV when they need blood products. In reality, the risk of hepatitis B and C is much higher. If a blood transfusion reaction occurs, the fears and anxieties are compounded and may warrant specific interventions.

Diagnostic Highlights

In the event of a transfusion reaction, Immediately stop the transfusion. Send the unit of blood, or empty bag and tubing if the infusion is complete, along with samples of the patients blood and urine to the lab for analysis. Blood type and cross-matching are repeated to determine if mismatched blood was administered.

In the event of a transfusion reaction, Immediately stop the transfusion. Send the unit of blood, or empty bag and tubing if the infusion is complete, along with samples of the patients blood and urine to the lab for analysis. Blood type and cross-matching are repeated to determine if mismatched blood was administered.

Test

Normal Result

Abnormality with Condition

Explanation

Free hemoglobin:

Negative In urine

Free hemoglobin in urine

Transfusion reaction leads to

Urine and plasma

<3 mg/dL In blood

and blood; hemoglobinuria

escape of hemoglobin from red

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