A hospitalized patient has received transfusions of 2 units of blood over the past few hours. A nurse enters the room to find the patient sitting up in bed, dyspneic and uncomfortable. On assessment, crackles are heard in the bases of both lungs, probably indicating that the patient is experiencing a complication of transfusion. Which of the following complications is most likely the cause of the patient’s symptoms?
A. Febrile non-hemolytic reaction
B. Allergic transfusion reaction
C. Acute hemolytic reaction
D. Fluid overload
Correct Answer: D. Fluid overload
Fluid overload occurs when the fluid volume infused over a short period is too great for the vascular system, causing fluid leak into the lungs. Symptoms include dyspnea, rapid respirations, and discomfort as in the patient described. Transfusion associated circulatory overload includes any four of the following occurring within 6 h of a BT – acute respiratory distress, tachycardia, increased blood pressure (BP), acute or worsening pulmonary edema and evidence of a positive fluid balance.
Option A: Febrile non-hemolytic reaction results in fever. Febrile non-hemolytic is generally thought to be caused by cytokines released from blood donor leukocytes (white blood cells). Transfusion reactions range in frequency from relatively common (mild allergic and febrile non-hemolytic reactions) to rare (anaphylaxis, acute hemolytic, and sepsis).
Option B: Symptoms of allergic transfusion reaction would include flushing, itching, and a generalized rash. Attributed to hypersensitivity to a foreign protein in the donor product. The severity and incidence vary depending on the type of transfusion reaction, the prevalence of disease in the donor population, and the extent of follow-up care the patient receives.
Option C: Acute hemolytic reaction may occur when a patient receives blood that is incompatible with his blood type. It is the most serious adverse transfusion reaction and can cause shock and death. Can result in intravascular or extravascular hemolysis, depending on the specific etiology (cause). Immune-mediated reactions are often a result of recipient antibodies present to blood donor antigens.