If a patient complains of flank pain, chills, fever, and hematuria during a blood transfusion, these symptoms indicate the following complication?

1. A

   Pyrogenic transfusion reaction

2. B

   Hemolytic transfusion reaction

3. C

   Anaphylactic transfusion reaction

4. D

   Allergic transfusion reaction

Appeared in: HSSC Staff Nurse - 2015

Explanation

• The combination of flank pain, chills, fever, and hematuria is the classic presentation of an acute hemolytic transfusion reaction (AHTR).
• AHTR is a life-threatening emergency caused by ABO or Rh incompatibility, leading to rapid intravascular destruction of transfused red blood cells.
• The destruction of red blood cells releases free hemoglobin, which is toxic to the renal tubules, causing flank pain and hemoglobinuria (appearing as hematuria).
• The immune and inflammatory response to the incompatible blood triggers the systemic symptoms of fever and chills.

Why Other Options Were Wrong

• Option A: A pyrogenic (febrile non-hemolytic) reaction is characterized by fever and chills but typically does not involve flank pain or hematuria, as there is no red blood cell destruction.
• Option C: An anaphylactic reaction is a severe, rapid allergic reaction presenting with respiratory distress (wheezing, dyspnea), severe hypotension, and shock. It does not typically present with fever, flank pain, or hematuria.
• Option D: A simple allergic reaction is the most common type and is much milder. It presents with skin manifestations like hives (urticaria), itching (pruritus), and flushing. It does not cause systemic symptoms like fever, flank pain, or hematuria.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Recognition and differentiation of blood transfusion reactions based on clinical presentation to guide bedside assessment, documentation, and the next nursing action.
• Recognizing an acute hemolytic transfusion reaction is a critical nursing responsibility. It is a medical emergency, and immediate cessation of the transfusion is the most important action to prevent life-threatening complications like acute kidney injury, disseminated intravascular coagulation (DIC), and shock.
• The nurse's priority actions are to stop the transfusion, maintain IV access with normal saline, notify the provider and blood bank, and closely monitor the patient's vital signs.
• What if? If the patient had only developed a rash and itching, the nurse would stop the transfusion, notify the provider, and anticipate an order for an antihistamine like diphenhydramine. If symptoms resolve, the transfusion may be cautiously restarted, unlike a hemolytic reaction where it is never resumed.

How to Approach the Question

• First, identify the key clinical event: a patient developing symptoms during a blood transfusion.
• Next, cluster the specific signs and symptoms presented: flank pain, chills, fever, and hematuria.
• Analyze the pathophysiology behind this cluster. Flank pain and hematuria strongly suggest kidney involvement and red blood cell breakdown (hemolysis). Fever and chills indicate a systemic inflammatory response.
• Evaluate each option against this symptom cluster. An allergic reaction involves skin symptoms. A pyrogenic reaction involves fever/chills but not hemolysis. An anaphylactic reaction involves severe respiratory/cardiovascular collapse.
• Conclude that only a hemolytic transfusion reaction accounts for all four of the patient's presenting symptoms.

Concept Tested & Keywords

• Concept Tested: Recognition and differentiation of blood transfusion reactions based on clinical presentation.
• Stem keywords: blood transfusion, flank pain, chills, fever, hematuria
• Lead-in keywords: indicate the following complication
• Clinical cues: Symptoms occurring during a blood transfusion

Question ID

QmEDHvOo2MS_5c0DD7m0-A

Copy ID

Reference Book

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

E6 Gynecology Williams p. 8-30