A patient of hemorrhagic shock requires Blood transfusion. His blood group is B+ve. Blood bank informed that B+ blood is not available. Which blood can be used?

1. A

   A+

2. B

   AB-

3. C

   AB+

4. D

   O+

Appeared in: NCL (MP) Nursing Officer - 2020

Explanation

• A patient with B+ blood has B antigens on their red blood cells and anti-A antibodies in their plasma.
• This means they can receive red blood cells that lack the A antigen, which includes blood types B and O.
• Since the patient is Rh positive, they can safely receive both Rh positive and Rh negative blood.
• O+ blood lacks A antigens and is Rh positive, making it a safe and compatible choice for a B+ recipient.

Why Other Options Were Wrong

• Option A: A+ blood contains A antigens. A B+ recipient has anti-A antibodies, which would cause an acute hemolytic transfusion reaction upon receiving A+ blood.
• Option B: AB- blood contains A antigens. The B+ recipient's anti-A antibodies would attack these red blood cells, leading to a severe transfusion reaction.
• Option C: AB+ blood contains A antigens. A B+ recipient has anti-A antibodies, which would trigger a dangerous immune response against the transfused blood.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Blood Transfusion Compatibility (ABO and Rh systems) in acute care settings.
• Administering incompatible blood can lead to a life-threatening acute hemolytic transfusion reaction. Meticulous verification of blood compatibility is a critical nursing responsibility to ensure patient safety.
• In emergency situations like hemorrhagic shock, if type-specific blood is unavailable, O-negative blood is the universal donor for RBCs and is often used. O-positive blood is the next best choice for Rh-positive patients.
• What if the patient was B-negative? In that case, O-negative blood would be the preferred choice. While O+ could be given in a dire, life-saving emergency to a male or a female past childbearing age, it would sensitize the patient to the Rh antigen, which can cause complications in future pregnancies or transfusions. For a female of childbearing age, O- would be strongly preferred.

How to Approach the Question

• First, identify the recipient's blood type: B positive (B+).
• Recall the antigens and antibodies associated with this blood type. B+ has B antigens on RBCs, anti-A antibodies in the plasma, and the Rh antigen.
• The core principle of RBC transfusion is to avoid giving the recipient an antigen they have antibodies against. In this case, the recipient has anti-A antibodies, so any blood with A antigens (types A and AB) must be avoided.
• Evaluate each option: A+ (has A antigen - incorrect), AB- (has A antigen - incorrect), AB+ (has A antigen - incorrect).
• The remaining option, O+, lacks the A antigen. Since the patient is Rh positive, receiving Rh-positive blood is safe. Therefore, O+ is the correct compatible choice.

Concept Tested & Keywords

• Concept Tested: Blood Transfusion Compatibility (ABO and Rh systems)
• Stem keywords: hemorrhagic shock, Blood transfusion, B+ve, blood not available
• Lead-in keywords: Which blood can be used?
• Clinical cues: Recipient blood type is B+
• Clinical cues: Type-specific blood (B+) is unavailable, requiring an alternative

Question ID

QunB1bsY7G9l5BFQ3nR4DQ

Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 75-77

E6 Medicine Harrison 22e Part 1 p. 944-946