During blood transfusion therapy patient developed wheezing and her skin becomes flushed with hives. These are the characteristics of...

Appeared in: OSSSC Nursing Officer-2021

Explanation

The patient's symptoms of wheezing, flushed skin, and hives (urticaria) are the classic signs of an allergic reaction to a blood transfusion.
This reaction is caused by the recipient's immune system (hypersensitivity) responding to foreign plasma proteins in the donor's blood.
Wheezing indicates bronchospasm, a sign that the reaction may be severe (anaphylactic) and requires immediate intervention.

Option A: A hemolytic reaction is incorrect because it presents with different hallmark symptoms such as fever, chills, low back pain, and hemoglobinuria (dark urine) due to red blood cell destruction.
Option C: While an allergic reaction is a type of transfusion reaction, this option is too general and non-specific. The question asks for the diagnosis that best fits the specific characteristics presented.
Option D: A thrombotic crisis is unrelated to this clinical picture. It involves the formation of blood clots that obstruct blood vessels, a process not characterized by hives and wheezing.

Clinical Relevance

Nursing practice connection: Use the key finding related to Differentiating types of acute blood transfusion reactions based on clinical signs and symptoms to guide bedside assessment, documentation, and the next nursing action.
The first and most critical nursing action for any suspected transfusion reaction is to immediately stop the transfusion to prevent further exposure to the causative agent.
Nurses must maintain IV access with a new bag and tubing of normal saline to keep the vein open for emergency medication administration.
It is crucial to report the reaction to both the physician and the blood bank promptly for coordinated management and investigation.

How to Approach the Question

First, identify the key clinical event: a patient is developing symptoms during a blood transfusion.
Next, list the specific signs and symptoms reported: wheezing, flushed skin, and hives.
Systematically evaluate each option by matching the reported symptoms to the known characteristics of each condition.
Recognize that hives (urticaria), flushing, and wheezing (bronchospasm) are hallmark signs of an allergic or anaphylactic response.
Eliminate other options. Hemolytic reactions have different key signs (fever, back pain). Thrombotic crisis has a different pathophysiology. 'Transfusion reaction' is too general.
Select the option that provides the most specific and accurate diagnosis for the given clinical picture.

Concept Tested & Keywords

Concept Tested: Differentiating types of acute blood transfusion reactions based on clinical signs and symptoms.
Stem keywords: blood transfusion, wheezing, flushed skin, hives
Lead-in keywords: characteristics of
Clinical cues: The combination of respiratory (wheezing) and skin (flushing, hives) symptoms during a transfusion is a classic presentation.
Negative lead-in flag: false

QcBN7qrMFZQkp1hUBxnNlN

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 124-126

Practise the full OSSSC Nursing Officer-2021

Attempt every question from this paper in a timed mock, then review the full solution for each one.