Acute Hemolytic Transfusion Reaction Rhea Little

ABO incompatibility is the main cause of acute hemolytic transfusion reactions and is usually a result of a procedural error. The reaction occurs when there is an incompatibility between the blood product and the recipient. There are several steps to the transfusion reaction. 1. The recipient antibodies bind to the antigens on the donated red blood cells 2. Activation of the complement system begins cell lysis in the bloodstream. 3. The activation of the complement system creates a mass production of membrane attack complexes. 4. C5-C9 creates pores in the walls of the red blood cells. 5. Complement proteins bound to mast cells and cause the release of histamine. 6. Histamine causes blood vessel dilation, bronchoconstriction, and proinflammatory cytokine release. 7. Lysis of RBC releases free hemoglobin blocking renal tubules in the kidneys. 8. Renal vasoconstriction leading to acute tubular necrosis and kidney failure.

There are several diagnostic tests which are used in determining an acute hemolytic transfusion reaction. These tests include 1. Repeated ABO and Rh testing (most common cause of reaction) 2. Repeated antibody screen and cross-typing. 3. Hemoglobinemia and hemoglobinuria (to check for free hemoglobin in the plasma and urine indicating RBC lysis in circulation) 4. Hyperbilirubinemia (bilirubin is a product of RBC breakdown). 5. Renal panel (monitor if kidney function is impacted by free hemoglobin). 6. Haptoglobin (hemoglobin depletes haptoglobin) 7. LDH levels (an enzyme released in RBC destruction) 8. PT, APTT, fibrinogen, INR, and platelet count (monitor for DIC). 9. ECG. 10 (monitor for complications like arrhythmias and myocardial stress).

Symptoms include increased temperature, chills, tachycardia, blood present in urine, chest pain, decreased urine output, pain in the back, hypoxia, hypotension, dyspnea, wheezing, nausea, vomiting, restlessness, headache, anxiety, sense of impending doom and finally a rash.

In order to treat hemolytic transfusion reactions we will need to 1. Stop the infusion. 2. Maintain IV access. 3. Assess airway, breathing and circulation. 4. Check vital signs. 5. Monitor urine output 6. If there are more severe symptoms emergent resuscitation and treatment will be required. 7. Give NS for hypotension. 8. Potentially administer furosemide. 9. Administer corticosteroids, antihistamines, and epinephrine if there is airway compromise. 10. Patients may require an exchange transfusion.

I think this was a great video and I learned a lot from it. There were just a few small things that I think would further help my understanding of the topic. I think that the pathoflow was a bit confusing at times. The speed the information was delivered was a bit fast and a little bit unorganized. I had to rewatch a few sections a couple of times to understand it fully. Specifically around the part talking about the complex system. This is a big part of the hemolytic transfusion reaction so I would have liked it to be a bit slower and more clear. Also, the section on extravascular hemolysis was confusing to me. I also had to rewatch that a few times to understand it as I found the picture at first confusing and the voiceover was quite fast. I think something that would have helped the pathology section be clearer is if there were steps or if it was organized by each of the body systems that were affected. I also would have liked to know what type of hypersensitivity reaction acute hemolytic transfusion reactions are as this would have better connected the video to the class and helped my understanding. Finally, I think it would have been beneficial to have the case study integrated throughout the video instead of just at the end. We could have been introduced to the patient at the beginning and paused throughout the unfolding case study to understand what was happening and why. 

As a visual learner, I found that incorporating diagrams and pictures significantly enhanced my understanding of the topic. This is a complex subject with a lot of information, and the visuals helped me to better understand the steps and processes being discussed. They also strengthened my understanding by allowing me to connect the material to prior classes. For example, seeing the image of the tubule reminded me of our pathology class from last year, which helped me grasp the connection between the new content and what I had previously learned.

I thought it was creative to use a written document to explain the case study. This approach saved time in the video and provided a clear background for the case study, which I appreciated. Including IHA policies was super helpful as well as it demonstrated the real-world relevance of the case study and tied everything together nicely. As someone who wants to work in IHA, I found this aspect very valuable, as it allowed me to see how the information could directly apply to my future career and practice.

I also appreciated the variety of visuals used throughout the presentation. There was a good balance between detailed diagrams, pathology images, and simple but relevant background photos. The inclusion of a video segment at the beginning and the creative case study at the end was very engaging. It broke up the repetitive nature of voice-over visuals and maintained my interest in the content. Overall, these thoughtful elements made the material more accessible, engaging, and useful to my learning.

I think that Improving the clarity of the audio would really improve the overall quality of this video. There were several instances where the audio affected my ability to fully understand the content. For example, at the beginning, the audio sounded slightly echoey. This issue could be resolved by recording in a more controlled environment, such as the TRU sound booth, or by using an audio editing website to improve the sound quality. Additionally, there were moments when the voiceovers talked too quickly, particularly during the pathology section. Because of this, I found myself needing to rewatch certain parts to understand what was said, which impacted my learning experience. 

Another challenge was during the case study when the patient’s voice was very quiet and the nurses/doctors were very loud. Balancing out the sound levels would have improved the video. The case study also moved very quickly which made it a little bit difficult to fully understand. I get that this is how a scenario would be placed in the real world but for learners, it was a bit too quick in my opinion. 

Overall I enjoyed the use of pictures and the creative case study, as they helped me to connect with the material. However, the issues with audio clarity and pacing did make it harder to fully grasp all aspects of the presentation. With some adjustments to the audio quality and pacing, this video could be even more impactful and enhance the learning experience for viewers like myself.

In the future, I want to work in the emergency room. As seen in the case study there are many instances in the emergency where a person is in need of a blood transfusion. Sometimes there are traumas where a person loses a lot of blood or they may have some underlying condition in which they need a blood transfusion. In many cases there is an urgent need for blood and a patient is having many other symptoms. This can make it confusing to know what symptoms are coming from the trauma or injury the patient had and which are coming from a transfusion reaction. We have learned a lot in class about the process of administering blood products but I feel in our lessons the topic of transfusion reactions was rushed. For the most part, we just learned that if a reaction occurs we need to pause the infusion and give normal saline. Watching this video helped to deepen my understanding of transfusion reactions. It provided great explanations of what symptoms I need to watch for as well as why these symptoms occur which helped to strengthen my memory of the symptoms as I can connect them directly to the pathology of the reaction. When going over the diagnostics you also explained why we are doing each of these tests. This helped again to strengthen my understanding and make clear connections between the course material and pathology to how it is applied in a clinical setting. This clear explanation will make it easier to know which are symptoms of a transfusion reaction versus which symptoms are from their trauma. After watching this video and case study I feel more confident administering blood products, knowing what to look for in a reaction and how to deal with a reaction if one were to ever occur in my patients. I feel I am able to provide safer and more competent care after watching this video. You also added the IHA policies which I will directly be using in my practice.