Hemolytic Transfusion Reaction-Free-Samples-Myassignmenthelp.com

Question: Describe the Pathophysiology of an Acute Haemolytic Transfusion Reaction. Answer: Pathophysiology of Acute Hemolytic Transfusion Reaction Acute hemolytic transfusion reaction (AHTR) has been found to occur within 24 hrs of transfusion because of ABO incompatibility of the packed red blood cells or in other rare instances because of incompatibility of large volume of plasma that may be identified as the etiology. Red blood cells during transfusion usually get destroyed by the persons immune system. In other forms of allergic transfusion reactions, hemolysis might not take place. It mostly occurs as a systemic response displaying phases related to humoral immune reaction, phagocytes activation, and generation of cytokine mediators in conjunction with production of wide ranging cellular responses. Transfusion serving error like that of labeling, typing, cross-matching or clinical service error because of wrong patient sample and application of wrong unit on blood might pose threat and culminate in AHTR. Clinical manifestations of AHTR are often found to result in exhibition of early symptoms of fever with chills and/or ri gors, nausea, vomiting, pain at the site of infusion, diffuse bleeding, back and flank ache, epistaxis, hypo or hyper tension, hemoglobinuria (Bolton?Maggs Cohen, 2013). The pathophysiology pertaining to AHTR is usually found to take place across three phases. Initially during phase 1, IgG or IgM antibodies remain bound to the membranes of the RBC. Subjected to the capability of causing activation of the complements (C1 to C9) by these antibodies, hemolysis occurs. Further, in the subsequent step of phase 2, the non- hemolyzed cells might bind to the phagocytic cells by means of antibody IgG or complement of C3b receptors thereby causing stimulation of the production of cytokines like that of IL-8and TNF-. On the contrary, the RBCs that are bound undergo destruction due to phagocytosis. Finally, in case of phase 3, the clinical signs and symptoms of the AHTR is manifested through expression of the systemic effects of anaphylotoxins, cytokines and other complements such as that of C 3a and C5a. Risk factors include individual patient characteristics, blood component, equipment used, concomitant medications and intravenous fluids administered and procedures applied. Less frequent occurrence of minor ABO mismatch because of transferring of donor anti-A or anti-B for the plasma contained products might also pose threat to the culmination of AHTR (Tinegate et al., 2012). Nursing Care Plan for Patient experiencing Acute Hemolytic Transfusion Reaction The Nursing Care Plan for the case study provided with respect to the patient admitted to hospital for performing gastroscopy following report of being easily fatigued and discharging black stool with symptoms of burning epigastric pain will be prepared. The Clinical Reasoning Cycle will be resorted to for carrying out assessments that will encompass identification of three nursing diagnosis, establishing goals, selecting suitable interventions and undertaking evaluation of outcomes (Nightingale, 2015). The condition of the patient experiencing AHTR on being kept under transfusion will be analyzed and presented in the nursing care plan with support from relevant and current health care related literature. Priority Nursing Diagnosis will include the following: Patient has been reported of having high body temperature of 40? Hyperthermia or fever have occurred following transfusion. Fever might have set in as a result of AHTR accounting for altered homeostatic mechanism due to fault in the hypothalamic regulation following inaccurate transfusion. The catastrophic consequence of AHTR induced fever must be kept at bay. Pulse of the patient upon undergoing transfusion has been found to be well above normal. Heightened heart rate poses threat to the patient thereby incurring load to the cardiovascular system. The complement mediated intravascular hemolysis along with the production of vasoactive amines and other mediators cause contraction of the bronchial and intestinal smooth muscle cell Blood pressure of the patient who underwent transfusion with pRBC at two instances was found to vary rapidly. The fluctuation in blood pressure may be of threat to the patient as it will increase the cardiovascular workload on the patients heart predisposing the affected individual to experience the penance of such differential values of blood pressure Nursing Care Plan SL No. Establishing Goals or Plans Nursing Interventions Evaluating Outcomes 1. Temperature of the patient will revert back to normal range and in the subsequent steps of the patient will feel better with regained consciousness and vitality and will no longer express of being confused or express symptoms of anxiety. Additional symptoms of chills/rigors or shaking and stiffness will also subside for patient following pertinent intervention within the next hour (Cserti-Gazdewich et al., 2015). Antipyretic medication may be administered to the patient in the form of IV injection following directives from the physician. As the fever followed pRBC transfusion, sample must be sent for confirming the patients ABO type, visual checking for hemoglobinemia and performing direct antiglobulin test (DAT) (Webert Heddle, 2017). Measurement of body temperature of patient showed decreased values within normal limits. Patient felt better without any complain of feeling dizzy or lethargic. The patient is awake and fully aware of the happenings around. The chills and rigors occurring in conjunction with fever also diminished. 2. The heart rate response of the patient will decrease and get back within the normal physiological limits thereby reliving the pressure on the cardiovascular system for carrying out extra load of work by the heart. The cardiovascular response of the patient will be normalized thereby ameliorating the risk associated with accentuated heart rate in the AHTR affected patient (Morosky Joyner, 2013). In order to combat the AHTR induced functional changes in the body, appropriate measures are required. Heart rate reduction might be done in addition to catering to taking measures for reducing the risks of renal failure. Maintenance of adequate urine output and fluids may be ensured by means of administration of diuretics like furosemide. Further, prophylactic actions might include vigorous hydration with intravenous crystalloid solutions coupled with osmotic dieresis by mannitol (Scott Greineder, 2014). Assessment of vital signs like heart rate showed values to lie within normal range. Urine output found to be within normal limits. 3. The blood pressure of the patient will be stabilized with values falling within the normal range. Mismatch transfusion that might have caused the RBCs to hemolyse and result in accentuated workload on the cardiovascular system will be taken care of through conduct of clinical tests that will include CBC, detection of bilirubin, haptoglobin and coagulation (Yahalom Zelig, 2015). Specific to the treatment of hypotension, low dose dopamine may be administered in order to enhance renal perfusion that is considered crucial in the maintenance of urine output for AHTR affected patients. Thus, regulation of urine output will indirectly help in maintaining blood pressure within normal limits (Dasararaju Marques, 2015). Blood pressure arrived within normal limits without showing any symptoms of fluctuation. Urine output is maintained at normal levels. References Bolton?Maggs, P. H., Cohen, H. (2013). Serious Hazards of Transfusion (SHOT) haemovigilance and progress is improving transfusion safety.British journal of haematology,163(3), 303-314. Cserti-Gazdewich, C. M., Pendergrast, J. M., Lin, Y., Callum, J., Lieberman, L. D., Escorcia, A., Ramirez-Arcos, S. (2015). Post-Transfusion Fevers and Post-Reaction Culture Practices at a Large Academic Hospital Transfusion Service: Quality of Information and Calculated Bacterial Contamination Event Rates.Blood,126(23), 3569-3569. Dasararaju, R., Marques, M. B. (2015). Adverse effects of transfusion.Cancer Control,22(1), 16-25. Morosky, C. M., Joyner, A. B. (2013). Blood Product Transfusion for Massive Hemorrhage.Topics in Obstetrics Gynecology,33(5), 1-7. Nightingale, K. E. (2015). Embedding Simulation-Based Learning in a Capstone Undergraduate Nursing Subject to Develop Clinical Reasoning Skills. Scott, K., Greineder, C. (2014). EM Critical Care. Tinegate, H., Birchall, J., Gray, A., Haggas, R., Massey, E., Norfolk, D., ... Allard, S. (2012). Guideline on the investigation and management of acute transfusion reactions Prepared by the BCSH Blood Transfusion Task Force.British journal of haematology,159(2), 143-153. Webert, K. E., Heddle, N. M. (2017). Investigation of Acute Transfusion Reactions.Practical Transfusion Medicine, 69. Yahalom, V., Zelig, O. (2015). Handling a transfusion haemolytic reaction.ISBT Science Series,10(S1), 12-19.