Hemolytic Transfusion Reactions – Andrea Raidl

ABO incompatibility is a reaction that occurs when an incompatible blood type is transfused. This results in a severe and possibly deadly reaction.

The recipient’s antibody binds to the antigen on the donated RBCs. IgM activates the complement system, which results in intravascular hemolysis, overproduction of terminal membrane attack complexes, and compromise C5-C9 that results in the forming of pores in RBCs. The complements bind to anaphylatoxins which activate mast cells causing degranulation and the release of histamine. Ruptured RBCs causes the release of free hemoglobin that occlude renal tubules in the kidneys, causing renal vasoconstriction, and potentially leading to acute tubular necrosis and renal failure. Antibodies from the recipient opsonize the donor RBC leading to phagocytosis by macrophages and phagocytes. The RBCs travel through the spleen and liver, where macrophages and phagocytes are highly concentrated. After several passes the membranes of the RBC become fragile which is the process referred to as osmotic fragile aphaeresis.

Some diagnostic tests discussed in the projects included completing repeated ABO and RH testing (Group and screen) to ensure the correct blood type was given, testing for RBC destruction, renal panels, coagulation tests, and ECG. Some diagnostic test to determine RBC destruction include, looking for hemoglobinemia, hemoglobinuria, hyperbilirubinemia, low haptoglobin, and LDH. All the lab values show signs that a RBC has been destroyed and released hemoglobin, bilirubin, or LDH. Renal panels show renal changes caused by renal vasoconstriction and ECG is performed to monitor heart function. A hemolytic transfusion reaction can lead to complications such as arrhythmias or myocardial stress. Severe hemolysis can cause electrolyte imbalances, such as hyperkalemia which can impact cardigan function.

Some symptoms that are common include fever and chills, tachycardia, blood in urine, chest pain, back pain, hypoxia, hypotension, dyspnea or wheezing, nausea and vomiting, restlessness, anxiety, headache, and rash. When any of these symptoms occur, it is important to begin safety measures first. These include stopping transfusion, assessing ABCs, monitor vital signs and urine output, and begin the rescue line of NS. After these safety steps are taken treatment will depend on the symptoms being experienced. Furosemide may be administered to increase blood flow and preserve urinary output. Corticosteroids, antihistamines, and epinephrine should be given if the airway is compromised. If treatment is ineffective, exchange transfusion may be required. Exchange transfusions include removing the patient’s blood and replacing it with a transfusion blood product.

Overall, I think the project was done very well and was very thorough. I enjoyed how the pathophysiology was explained and then supported by the case study. This helped strengthen my understanding of acute hemolytic transfusion reactions. One area that may have improved the listener’s overall understanding would be to make more connections between the pathophysiology, the symptoms, and the diagnostics. I find having the knowledge behind why certain symptoms are present or why we complete specific diagnostics solidifies my understanding. The group did a great job with showing the symptoms and discussing the diagnostics in the context of the case study, but I would have enjoyed seeing a few more connections being made back to the pathophysiology.

The whole project was enjoyable and informative but what really stuck out was how the group provided the information in many ways. I learn better when there are different styles of learning being used. Especially when visual learning is incorporated. Therefore, I enjoyed that the group included images alongside the pathophysiology and used a live action case study video as they both supported my learning greatly. During each step of the pathophysiology a corresponding image was shown. The most helpful images I found were the pathophysiological pathways. These simplified the pathophysiology in manageable chunks and made it easier to digest the complex information being explained. All the images were relevant to the information being provided. It also made it easier to focus on the information being given. As there was a lot of knowledge being taught, having the pictures throughout the audio made it easier to focus. The case study was done well and helped support my learning. I found that it solidified the information discussed in the patho section of the project. The part where the patient acted out the symptoms and then the symptoms were stated again solidified the information. It explained the information through visual and auditory styles. It also incorporated a real-life scenario which highlighted the relevance of the information. Acute Hemolytic Transfusion Reactions are very complex and involve many systems. Having the information provided in many ways made everything easier to digest. Overall, the project was done very well, and I think it helped solidify the information.

I thought that this project was done well, and I found that the information was provided in an interesting way. One thing that I would recommend going forward is switching the order of the pathophysiology and the case study. I found that the case study set up the information very well and allowed for the discussion around diagnosis and treatment to be easier to understand. I think if you put the case study at the beginning and then explained the pathophysiology, it may have been easier to absorb. Since we have learned this information before I already had a level of knowledge on this topic, therefore the patho was quite clear. If I did not have this information, I think it would be slightly harder to digest. When I think about how I was able to understand the treatment and symptoms section of your project it was very easy to digest as I was able to put it into this perspective of the case study. The case study provided context to the information and added a visual element. Having the case study, the focused explanation of each step, and then a summarization allowed me to process little bits of information that built off each other. After that section I found my understanding on those portions of the project was very clear. It would have been nice to see the case study at the beginning, an explanation of the patho and then the symptoms and diagnoses afterwards. I think that little change would have made the project flow a little bit better.

Acute Hemolytic Transfusion Reactions are a very serious complication that can occur during blood transfusions. This project provided a lot of education around safety measures, diagnostics, and treatment for acute hemolytic transfusion reaction. After graduating, I plan to work on a surgical floor. It is very common on surgical floors to administer many blood products. I will take the information provided in this video with me as I continue my career. The video highlights some important safety checks that are in place to protect our patients. One area of prevention that was emphasized in the video was the completion of a group and screens. In the case study the nurse and doctor did not complete a group and screen but rather took the word of the family member. As a result, the patient had an Acute Hemolytic Transfusion Reaction, and their recovery would most likely be much more difficult. Completing a group and screen reduces the risk of Acute Hemolytic Transfusion Reactions and increases the safety of our patients. The video showed a set of vitals were taken before administration of blood products to show the patients baseline and so we can assess for changes. The main vital sign related symptoms discussed in the video are tachycardia, hypoxia, hypotension, and a new onset fever. During the case study, they also showed them setting up and using a rescue line. A rescue line refers to setting up a separate line with normal saline in case there is a transfusion reaction. This is an important step as it decreases the time between stopping the blood product and being able to administer normal saline if needed. The video discussed some other important steps, including, providing antihistamines, epinephrine, or furosemide depending on the severity and symptoms.  Overall, this assignment has deepened my understanding of the safety measures that are in place to provide blood products. It was a refresher to the steps involved in blood transfusion and it provided more understanding to the ‘why’ involved with some of the policy. It was helpful to have the pathophysiology being explained, then a visual representation of the scenario, and then additional summarizing.