In which of the following conditions is blood transfusion contra-indicated?

Appeared in: AIIMS Bhopal NO - 2018 (Shift-1st)

Explanation

Congestive Cardiac Failure (CCF) is a condition where the heart muscle is weakened and cannot pump blood effectively.
A blood transfusion adds extra fluid volume to the circulatory system.
In a patient with CCF, this increased volume can overwhelm the already failing heart, leading to a condition called Transfusion-Associated Circulatory Overload (TACO).
TACO manifests as acute pulmonary edema (fluid in the lungs), respiratory distress, and worsening heart failure, making transfusion a high-risk procedure in these patients.

Option B: Haemorrhage (severe bleeding) is a primary and urgent indication for blood transfusion, not a contraindication.
Option C: Haemophilia is a bleeding disorder caused by a lack of clotting factors. Treatment involves transfusing the specific missing factors, often as concentrates or cryoprecipitate derived from blood.
Option D: While minor bleeding from haemorrhoids does not require a transfusion, severe or chronic bleeding can lead to significant anemia, which is an indication for blood transfusion.

Clinical Relevance

Nursing practice connection: Knowing Contraindications for blood transfusion helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A key nursing responsibility is the pre-transfusion assessment, which includes checking for a history of heart failure, renal failure, or fluid balance issues.
During transfusion, nurses must monitor vital signs and respiratory status closely, especially in elderly patients or those with known cardiac conditions, to detect early signs of fluid overload.
If signs of TACO develop, the nurse's immediate actions are to stop the transfusion and notify the physician. Management may include administering diuretics and oxygen.

How to Approach the Question

First, identify the core question: It asks for a contraindication to blood transfusion.
A contraindication is a situation where a treatment should not be used because it may be harmful.
Analyze each option based on its pathophysiology and the effect of adding fluid volume.
Haemorrhage, Haemophilia, and severe Bleeding Haemorrhoids all involve blood or component loss, so replacing it is logical and therapeutic.
Congestive Cardiac Failure is a condition of fluid overload and poor pump function. Adding more fluid (via transfusion) would logically worsen this state.
Therefore, CCF is the condition where transfusion is most likely to be harmful and is thus considered a contraindication or a situation requiring extreme caution.

Concept Tested & Keywords

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E6 Medicine Davidson Principles Practice 24e p. 951-953

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