Acute Hemolytic Transfusion Reaction response- Ben Prokopetz

HTR, acute hemolytic transfusion reaction, happens when a blood donor and recipient of the blood have different blood types (ABO incompatibility).  The red blood cells antigens and antibodies are the catalysts in this reaction, while the recipient’s antibody titer will decide how severe the reaction is.  How this reaction happens is that the antibodies in the recipient’s blood connect to the donor’s blood.  This then triggers IgM to be released which then causes breakdown and destruction of the blood cells (hemolysis).  MAC (membrane attack complex) proteins attack by puncturing the RBCs membranes which then kills the RBC (lysis).  The next step is the release of histamine from complement proteins binding to mast cells which then causes degranulation.  Vessels become more permeable and dilated, cytokines are released, and there’s also a side effect of bronchoconstriction.  When the RBCs are lysed, this causes a release of free hemoglobin that can cause renal tubule failure.  When this happens the recipient’s antibodies tag the foreign blood RBCs from the donor to be eliminated by phagocytes (opsonization).   This then leads to extravascular hemolysis, and while this is happening, the RBCs become fragile due to circulating through the liver and spleen.   

Conditions to look out for with a patient going through HTR include hypoxia, hypotension, pain in the chest and back, tachycardia, and anxiety.  Diagnosing this condition involves repeating the process of antibody screening and crossmatching.  This is because there could be antibodies in the recipient’s blood that were not previously there before they had a reaction.  This can also be detected when high levels of hyperbilirubinemia, hemoglobinemia, and lactate dehydrogenase, while haptoglobin would be low.  Other tests that can be completed include running platelet count, PT, APTT, and fibrinogen tests.  ECGs, and a renal panel can determine if there has been any other adverse reactions to the kidneys and and heart.  If it is found that HTR is the culprit of the client’s condition, then the transfusion should be immediately stopped if not already, vitals should be taken, consider ABCs, run normal saline, and assess how much urine the patient is putting out.  To prevent acute kidney injury, furosemide can be administered if there is low urine output.

I think that this video was very well put together and I had to nitpick to decide what could’ve enhanced my understanding of the subject.  I think one of the aspects that could’ve been worked on more was the case study aspect of the project. I think that the case study could’ve been examined in a more in depth manner.  The case study I believe started at the 6 minute mark of the video, not leaving your group a lot of time to explain the situation.  I think that if the video started with the case study that it would’ve helped with expanding on the patients symptoms, and there could’ve been a more in depth demonstration of how the health care team would respond to the transfusion reaction. Minor gap and to be clear I still thought the skit was phenomenal.  This leads me into my second area of improvement.  I think that the patho flow of the presentation was a bit jumpy at times and delved into different areas of the condition in sometimes an un-orderly fashion.  I think specifically the points in the video that come to mind is when the different reactions are being discussed, such as when the topic of renal failure was discussed and then right after that extravascular hemolysis was explained. I think there could’ve been a better way, like explaining the entire patho flow of the transfusion reaction and then separating alternate reactions aside after the process was explained. Again, I feel as if I’m nitpicking, this was a very well done presentation.

I think one learning strategy that really supported my learning was the addition of the slides, diagrams, and pictures that were included for the patho flow portion of the video.  Being able to have a visual aspect to take in and learn from while listening to your group explains it enhanced my understanding even more as I am a visual learner.  The way you presented the photos as well was nice, you didn’t leave each image up for too long, nor did you take them off the screen too soon which kept me interested.  Throughout the first half of the video your group didn’t add in too many photos either, you kept it simple but effective.  There was also a good combination and ratio of diagrams and miscellaneous photos that contributed to the creative side of your groups project.  These images also helped connect me back to the last couple months of our patho class, such as the complement cascade process, how a mast cell operates in relation to the complement proteins, how ABO blood group differentiation works, and especially the full body image that details the main symptoms of an acute hemolytic reaction.  I also thought the editing of the video was amazing, the amount of different graphics and images that were thrown onto the screen while bouncing back and forth to the acting was a very nice touch.  Adding in images that outlined the process of what to look for in a patient experiencing this type of reaction, and then another slide of the order of steps to take to help the patient is a great way to capture the viewer’s attention and to aid in the broadening of their knowledge on the subject. 

I think that one strategy that could’ve aided in furthering viewers’ understanding and ability to grasp your group’s project would’ve been to integrate the case study more into the video.  I thought the content was clear and everyone’s ability to teach the content was clearly proven, but the case study was only brought into the video at the six minute mark.  By that point of the 

video I had found myself trying to remember the patho flow of the situation at hand with the patient experiencing a transfusion reaction.  Though there was infographics and some editing done during the skit to help bring out extra information for the viewer and to help explain the patho aspect, I think it may have been rushed.  The skit was fast moving, and though this is what would happen in a real life situation, for educational purposes I think it could’ve been slowed down.  Instead I would’ve started the case study explanation at the very start of the video.  Doing this would’ve allowed you to explain the situation at hand, and then integrate the patho flow step by step, allowing the viewers to see what is happening to the patient in real time.  You would even have time to stop the skit and go back to just voicing over slides to explain the patho, and then resume back into the skit, and so on.  I recognized there were some aspects to education that involved talking about additional reactions and patho that wouldn’t have been pertinent to the case study, so I think putting that at the end of the video would’ve been appropriate.  All in all I still think the video is well structured and the production of the skit was great and had some amazing acting!

This video and presentation was significantly helpful to deepen and broaden my understanding on the topic of acute hemolytic transfusion reactions.  The group’s work was able to accomplish not only by providing clear and efficient ways of explaining the pathophysiology of the condition, but by creating a realistic case study of what would happen in a real life situation.  Showing the process of what happens to help the patient within the health care team and educating the viewer on the lab diagnostics was also incredibly helpful.

Right now, I’m an employed student nurse on the daycare surgery floor in Royal Inland Hospital.  The vast majority of our patients come from the operating room, and once they clear assessment in the post anesthetic recovery ward, they are sent to daycare surgery.  A large component of my care on this floor is to assess any irregular signs and symptoms and to monitor the area of where they were operated on.  This presentation was very helpful especially for me because these patients sometimes need blood transfusions during or right after their operations, and though we rarely if ever do blood transfusions on the floor, it’s helpful to know the signs and symptoms of an acute hemolytic transfusion reaction.  Now when I go to check my patients lab levels, I will know what to look out for such as hemoglobin levels and electrolyte labs.  After watching this video, I’m also now more apt to seek for any reports that indicate that a blood transfusion occurred.  If in the case that one of my future patients has had a blood transfusion, I now know what signs and symptoms to look for such as fever, low urine output, tachycardia, low back pain, and chest tightness.  Finally, if in the unfortunate circumstance that my patient has a hemolytic transfusion reaction, I know have an outline on how to respond and react in an appropriate manner to help save my patient, such as stopping the transfusion, infusing normal saline with new tubing, and then sending the previous blood bag and tubing to lab for further testing.  Overall, your group’s presentation was very helpful to further the development of my nursing practice.