Which action would the nurse take first when a client who is receiving a blood transfusion develops fever chills and low back pain?
OverviewA blood transfusion is a routine medical procedure in which donated blood is provided to you through a narrow tube placed within a vein in your arm. Show
This potentially life-saving procedure can help replace blood lost due to surgery or injury. A blood transfusion also can help if an illness prevents your body from making blood or some of your blood's components correctly. Blood transfusions usually occur without complications. When complications do occur, they're typically mild. Why it's donePeople receive blood transfusions for many reasons — such as surgery, injury, disease and bleeding disorders. Blood has several components, including:
A transfusion provides the part or parts of blood you need, with red blood cells being the most commonly transfused. You can also receive whole blood, which contains all the parts, but whole blood transfusions aren't common. Researchers are working on developing artificial blood. So far, no good replacement for human blood is available. RisksBlood transfusions are generally considered safe, but there is some risk of complications. Mild complications and rarely severe ones can occur during the transfusion or several days or more after. More common reactions include allergic reactions, which might cause hives and itching, and fever. Bloodborne infectionsBlood banks screen donors and test donated blood to reduce the risk of transfusion-related infections, so infections, such as HIV or hepatitis B or C, are extremely rare. Other serious reactionsAlso rare, these include:
How you prepareYour blood will be tested before a transfusion to determine whether your blood type is A, B, AB or O and whether your blood is Rh positive or Rh negative. The donated blood used for your transfusion must be compatible with your blood type. Tell your health care provider if you've had a reaction to a blood transfusion in the past. What you can expectBlood transfusions are usually done in a hospital, an outpatient clinic or a doctor's office. The procedure typically takes one to four hours, depending on which parts of the blood you receive and how much blood you need. Before the procedureIn some cases, you can donate blood for yourself before elective surgery, but most transfusions involve blood donated by strangers. An identification check will ensure you receive the correct blood. During the procedureAn intravenous (IV) line with a needle is inserted into one of your blood vessels. The donated blood that's been stored in a plastic bag enters your bloodstream through the IV. You'll be seated or lying down for the procedure, which usually takes one to four hours. A nurse will monitor you throughout the procedure and take measures of your blood pressure, temperature and heart rate. Tell the nurse immediately if you develop:
After the procedureThe needle and IV line will be removed. You might develop a bruise around the needle site, but this should go away in a few days. Contact your health care provider if you develop shortness of breath or chest or back pain in the days immediately following a blood transfusion. ResultsYou might need further blood testing to see how your body is responding to the donor blood and to check your blood counts. Some conditions require more than one blood transfusion. Clinical trialsExplore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. To minimize the chance of an adverse reaction during a transfusion, health care practitioners take several precautions. Before starting the transfusion, usually a few hours or even a few days beforehand, the person is cross-matched with the donor blood (not done for transfusions of plasma or platelets). After double-checking labels on the bags of blood that are about to be given to ensure the units are intended for that recipient, the health care practitioner gives the blood to the recipient slowly, generally over 1 to 4 hours for each unit of blood. Because most adverse reactions occur during the first 15 minutes of the transfusion, the recipient is closely observed at first. After that, a nurse checks on the recipient periodically and must stop the transfusion if an adverse reaction occurs. Most transfusions are safe and successful. However, mild reactions occur occasionally, and, rarely, severe and even fatal reactions may occur. The most common reactions, which occur in 1 to 2% of transfusions, are
The most serious reactions are
Rare reactions include
Fever may be caused by a reaction to the transfused white blood cells or to chemicals (cytokines) released by the transfused white blood cells. For this reason, most hospitals in the United States remove white blood cells from the transfused blood after it is collected. Usually, acetaminophen to reduce fever is the only treatment needed. People who have had a fever and need another transfusion may be given acetaminophen before the next transfusion. Symptoms of an allergic reaction include itching Itching Itching can be very uncomfortable. It is one of the most common reasons people see doctors who specialize in skin disorders (dermatologists). Itching makes people want to scratch. Scratching... read more , a widespread rash, swelling, dizziness, and headache. Less common symptoms are breathing difficulties, wheezing Wheezing Wheezing is a high-pitched, whistling sound that occurs during breathing when the airways are partially blocked. (See also Wheezing in Infants and Young Children.) Wheezing results from a narrowing... read more , and airway obstruction. Rarely, an allergic reaction is severe enough to cause low blood pressure Low Blood Pressure Low blood pressure is blood pressure low enough to cause symptoms such as dizziness and fainting. Very low blood pressure can cause damage to organs, a process called shock. Various drugs and... read more and shock Shock Shock is a life-threatening condition in which blood flow to the organs is low, decreasing delivery of oxygen and thus causing organ damage and sometimes death. Blood pressure is usually low... read more . If an allergic reaction occurs, the transfusion is stopped and the person is given an antihistamine. More serious allergic reactions may be treated with hydrocortisone or even with epinephrine. Transfusion recipients can receive more fluid than their body can easily handle. Too much fluid may cause swelling throughout the body or difficulty breathing. This complication is the most common cause of transfusion-related death. Recipients who have heart disease are most vulnerable, so their transfusions are given more slowly and they are monitored closely. People who receive too much fluid are given a drug to help the body remove fluid (a diuretic). Another very rare reaction, called transfusion-related acute lung injury (TRALI), is caused by antibodies in the donor's plasma. This reaction may cause serious breathing difficulties. This complication is the second most common cause of transfusion-related death. It occurs in 1 in 5,000 to 1 in 10,000 transfusions, but many cases are mild and so may not be diagnosed. Most people with mild to moderate lung injuries are given oxygen and other treatments that aim to support breathing until the lungs heal. Using plasma donated by men reduces the risk of having this reaction. Despite careful typing and cross-matching of blood, mismatches due to subtle differences between donor and recipient blood (and, very rarely, errors) can still occur. When such a mismatch occurs, the recipient's body destroys the transfused red blood cells (a hemolytic reaction) shortly after the transfusion. As soon as doctors suspect a hemolytic reaction, they stop the transfusion. Doctors give treatment to support the person's breathing and blood pressure. Doctors do blood and urine tests to confirm that red blood cells are being destroyed. Sometimes a hemolytic reaction is delayed, occurring within the month after a transfusion. Usually, such a reaction is mild and may only be noticed when blood tests are done to monitor the person's recovery from the disorder that necessitated the transfusion. These reactions occur due to the presence of an uncommon blood group antigen in the donor blood that is not routinely tested for. Despite careful testing and storage of blood products, infectious organisms are sometimes transmitted during a transfusion. Testing of blood and careful evaluation of blood donors keep transmission of infectious organisms low. However, sometimes testing does not detect organisms in blood from a donor who was very recently infected or infected by an organism for which there is no test.
Sometimes, massive transfusion can cause hypocalcemia
Hypocalcemia (Low Level of Calcium in the Blood) In hypocalcemia, the calcium level in blood is too low. A low calcium level may result from a problem with the parathyroid glands, as well as from diet, kidney disorders, or certain drugs. As... read more (low calcium level in the
blood) and/or hypokalemia
Hypokalemia (Low Level of Potassium in the Blood) In hypokalemia, the level of potassium in blood is too low. A low potassium level has many causes but usually results from vomiting, diarrhea, adrenal gland disorders, or use of diuretics. A... read more (low potassium level in
the blood). Very low calcium levels can cause symptoms such as muscle spasms (tetany) and abnormal heart rhythms
Overview of Abnormal Heart Rhythms Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more
Because blood is refrigerated while in storage, transfusion of many units of blood may result in a low body temperature. To prevent a low body temperature due to massive transfusion, doctors use a special device that gently warms the blood as it passes through the intravenous tubing. What is the first thing to do if patient has a blood transfusion reaction?When a transfusion reaction is suspected, the transfusion should be immediately stopped, and the intravenous line should be kept open using appropriate fluids (usually 0.9% saline). A clerical check should be performed by examining the product bag and confirming the patient's identification.
What do you do first when a patient has a new fever during transfusion?A fever is often a sign that the patient's body is reacting to white blood cells, plasma, or platelets in the donated blood. Doctors can usually treat transfusion-related fever with medicines, such as aspirin or acetaminophen, which reduce fever.
What should the nurse do if a transfusion reaction is suspected?If you suspect a transfusion reaction, take these immediate actions:. Stop the transfusion.. Keep the I.V. line open with normal saline solution.. Notify the physician and blood bank.. Intervene for signs and symptoms as appropriate.. Monitor the patients vital signs.. What causes back pain after blood transfusion?Acute Immune Hemolytic Reaction
The attack triggers a release of a substance that damages the kidneys. This is often the case when the donor blood is not a proper match with the patient's blood type. Symptoms include nausea, fever, chills, chest and lower back pain, and dark urine.
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