Decreasing Hemolytic Reaction in Donor Acquired Blood Products
A hemolytic reaction is a catastrophic process that entails the reaction that happens when a recipient gets a blood transfusion. This reaction normally happens when there is incompatibility in the plasma antibodies or the blood type transfused to the recipient. The incompatibility occurs as a result of an individual receiving antibodies within the serum and this antagonizes the red blood cell antigens from the donor. Consequently, the immune system of the recipient destroys the red blood cells that have been transfused into his body. Errors in patient identification and clerical errors have been said to be the main cause of such reactions which actually stem from the administration of incompatible blood type to the wrong recipient. The said errors can be caused by testing errors, improper labeling of samples, or administering the wrong type of blood to the wrong recipient, hence increasing the risks of blood transfusion reactions.
The extent of such risks can be determined by a clinical case report which shows the effects or adverse reactions that can be seen after the transfusion. Nevertheless, there are many limitations to using clinical case reporting to determine transfusion risks and these include the fact that this method depends on the vigilance and awareness of the healthcare workers and physicians as well as their ability to identify the adverse effects, report them, and finally determine the cause of the effects makes it less effective(Pineda, Brzica, & Taswell, 1978). It is important for the caregivers to always be on the lookout for specific reactions and effects that the patient might exhibit during transfusion and FDA (Food and Drug Administration) requires provisional notification of fatal reactions in either the donors or the blood recipients and this has to be forwarded within twenty-four hours via mobile/telephone, or within a week in writing.
The high reported number of deaths that resulted from blood transfusion reactions birthed the need to reduce the hemolytic reaction in donor acquired blood products. For example, between 1976 and 1985, 328 deaths were reported, and after analysis, it was revealed that 159 of them were caused by hemolytic reactions, and 23 were as a result of delayed hemolytic reactions that stemmed from blood transfusion(Sazama, 1990).
Further research carried out on the 159 deaths that had been caused by hemolytic reactions, and it was revealed that 137 of these deaths were reported to have resulted from errors that involved the incompatibility of ABO blood type(Sazama, 1990). In fact, more than 50 percent of these fatal errors were found to have happened after blood had been provided by the blood bank and they resulted from the mistakes made by the physicians and nurses in the operating room, ward, or emergency room(Sazama, 1990).
There have been high incidences of hemolytic transfusion reactions ranging from 1/300,000 to 1/700,000 RBC transfusions, and this has forced anesthesiologists to device means and principles that are needed in order to improve the recognition and treatment of these reactions. These measures have been caused mainly by the high mortality and morbidity rates. One of the most catastrophic reactions during blood transfusion is called the intravascular hemolytic reaction and it is caused by intravascular hemolysis(Sazama, 1990; Wiener & Peters, 1940). It is the kind of reaction that happens when the complement and antibody of the recipient directly attack the transfused donor cells. This is a highly sensitive reaction that can take place with as a little as 10ml of blood infused into the recipient (Sazama, 1990). There are high chances of between 20% and 60% mortality rates for patients who suffer from adverse hemolytic reaction symptoms(Sazama, 1990).
The hemolytic reaction in the body is usually due to the infusion of a different blood type to that of the recipient. There are four major categories of blood, namely: A, B, O, and AB (Pineda et al.,1978). It is possible for the immune system of the recipient to differentiate its own blood cells from foreign ones. In case an error occurs and a patient is issued with the wrong type of blood, then their immune system will produce antibodies that will fight the foreign blood cells until they destroy them without any knowledge of the body (Domen, 1998). It is necessary for the healthcare providers and physicians to determine whether the rhesus (Rh) factors of the donor and recipient blood are positive or negative. This should be done before the transfusion takes place because incompatibility in the Rh factors ultimately causes the antibodies to form and start fighting against the infused blood within the recipient’s body. An attack on the donor’s blood cells are attacked by the antibodies of the recipient usually cause the blood cells to burst and this can become catastrophic.
Even though blood transfusion may be vital for treatment of severe leucopenia, anemia, and thrombocytopenia, it can also change from a life-saving procedure could turn into a life-threatening one in the event that policies and safe nursing procedures are not observed to the letter (Sazama, 1990). The aim of this paper is highlight and inform healthcare professionals concerning the risks involved, alternatives, as well as means for decreasing hemolytic reactions during blood transfusion. On the other hand, its main objectives were: to identify the main risks of blood transfusion-hemolytic reactions, to identify the various blood products and types, as well as outline the procedures for reducing risks that can be encountered during blood transfusion, and moreso those that result in hemolytic reactions, to identify the needed procedures for conducting safe administration of blood products and blood, and last but not least, to discuss the nursing interventions that should be carried out on a patient who exhibits transfusion reactions.
Background and Significance
Hemolytic transfusion reactions that occur as a consequence of blood products acquired from donor mostly appear within 24 hours of the transfusion (during or after the transfusion)and can be in the forms o adverse signs and symptoms during or after the transfusion(Pineda et al., 1978). In some instances, such reaction can develop a number of days after the transfusion has taken place as is the case of delayed hemolytic transfusion reactions. Among the key signs and symptoms that accompany hemolytic reactions include chills, fever, urticarial, and pruritus.In addition to thesse, patients may also exhibit the following symptoms severe shortness of breath, high fever, red urine, and/or loss of consciousness in the case of fatal reactions.
Transfusion reactions usually require quick recognition, clinical management, and laboratory investigation. When a patient is suspected to be having such a reaction during the transfusion process, the best alternative would be to immediately stop the procedure and maintain an open intravenous line. After this, it would be necessary to conduct a clerical check in order to confirm the identity of the patient as well as information regarding the blood unit level. Hemolytic reactions may sometimes happen in complex clinical situations and hence require the diagnosis to distinguish between a complication that occurs by coincidence as a result of the illness being treated and the actual reaction to the blood product being transfused.
Monitoring of Hemolytic Reaction
In the course of the blood transfusion, the healthcare providers would usually be looking out for unfamiliar symptoms on the patient. Transfusion reaction can either be monitored while the patient is in the conscious or unconscious state. Where the patient is unconscious, the healthcare providers will see uncontrollable bleeding resulting from disseminated intravascular coagulation. When the patient is the conscious,he or she could report experiencing symptoms such as feeling of impending doom. These can also be accompanied by other visible symptoms such as chills and fever, heating along the vein in which blood is being transfused, constricting chest pains, hypo-tension, lumbar-region pains, tachycardia, and hemoglobinemia (Klein & Anstee, 2008; Domen, 1998).
Innovative solution approaches
The healthcare facilities have come up with many ways of curbing the issue of transfusion reactions. First off, blood received from donors is usually categorized into the Rh and ABO groups so as to minimize the risks of errors. Prior to the commencement of a transfusion process, compatibility is determined by cross-matching both the donor and patient. This is usually done through the mixing of small blood samples from both the donor and the recipient in order to check for any signs of reactions by the antibodies under the watchful eye of a microscope. Most healthcare facilities and blood transfusion centers have become very vigilant in trying to ensure that there is checking and rechecking of the blood so as to ascertain that the blood being transfused is the correct sample for the patient in question (Klein & Anstee,2008).
Advantages and disadvantages of innovative approach
The innovative approaches undertaken at various levels have significantly helped to reduce the rate of hemolytic reactions. The procedures used in this case have made sure that there is minimum risk level while the scientific and technological measures have also helped to enhance the efficiency of blood transfusions with very minimal margins for errors. Nonetheless, the manpower used in implementing such innovative approaches pose a major challenge. It is only by great discipline, practice, integrity and effective technology that human errors can be completely eliminated and all these factors depend to a great extent on the competence and level of attention paid by the healthcare providers and technicians in general (Klein & Anstee, 2008).
Despite being very rare, hemolytic reactions during blood transfusion are usually very lethal and when they happen they can actually be life-threatening. Many times, these reactions happen as a result of human error during the blood transfusion process.These has endangered many lives as has been discussed above and thus necessitated the need to address the issue. Through the initiatives by the healthcare and blood transfusion facilities in devising means to reduce and eventually eliminate their mistakes altogether, as well as adoption of innovative approaches to enhance efficiency, cases of hemolytic reactions resulting from blood transfusion have reduced considerably.
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Domen, R. E. (1998). Adverse reactions associated with autologous blood transfusion: evaluation and incidence at a large academic hospital. Transfusion, 38(3), 296-300.
Klein, H. G., & Anstee, D. J. (2008). Mollison’s blood transfusion in clinical medicine. Wiley.com.
Pineda, A. A., Brzica Jr, S. M., & Taswell, H. F. (1978). Hemolytic transfusion reaction. Recent experience in a large blood bank. In Mayo Clinic proceedings. Mayo Clinic, 53 (6), 378.
Sazama, K. (1990). Reports of 355 transfusion‐associated deaths: 1976 through 1985. Transfusion, 30(7), 583-590.
Wiener, A. S., & Peters, H. R. (1940). Hemolytic reactions following transfusions of blood of the homologous group, with three cases in which the same agglutinogen was responsible. Annals of Internal Medicine, 13(12), 2306-2322.