Initially after starting a blood transfusion, the client shows flushing on the face, tachycardia, and hypotension. All these clinical features indicate?

1. A

   Allergic blood transfusion reaction

2. B

   Haemolytic reaction

3. C

   Shock

4. D

   All of the above

Appeared in: AIIMS Delhi NO - 2018

Explanation

• The triad of flushing, tachycardia, and hypotension occurring shortly after a transfusion begins is a classic presentation of an acute hemolytic transfusion reaction (AHTR).
• AHTR is a medical emergency caused by the rapid destruction of transfused red blood cells by the recipient's antibodies, typically due to ABO incompatibility.
• This massive hemolysis triggers a systemic inflammatory response, leading to vascular dilation (flushing), circulatory collapse (hypotension), and a compensatory increase in heart rate (tachycardia).
• While a severe allergic (anaphylactic) reaction can also cause these signs, AHTR is the most dangerous and classic cause for this specific cluster of symptoms in this context.

Why Other Options Were Wrong

• Option A: A mild-to-moderate allergic reaction typically presents with cutaneous symptoms like flushing, itching (pruritus), and hives (urticaria), without severe hemodynamic changes like hypotension.
• Option C: Shock is a state of inadequate tissue perfusion that is a potential consequence or complication of a severe hemolytic or anaphylactic reaction. The signs listed are the indicators of the underlying cause (the reaction) that is leading to shock.
• Option D: This option is incorrect because the signs and symptoms point most specifically to a severe systemic reaction (hemolytic or anaphylactic), not a mild allergic one. Furthermore, shock is a resulting syndrome, not the primary event itself, making 'All of the above' an imprecise choice.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Recognition and immediate management of acute blood transfusion reactions in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• A nurse's primary responsibility during a blood transfusion is vigilant monitoring for adverse reactions, especially within the first 15 minutes when most severe reactions occur.
• Recognizing the signs of an AHTR and immediately stopping the transfusion is a critical, life-saving nursing intervention.
• Patient safety protocol requires meticulous patient identification and blood product verification (a two-nurse check in many facilities) to prevent ABO-incompatible transfusions, which are the primary cause of AHTR.

How to Approach the Question

• First, analyze the clinical scenario: a patient is receiving a blood transfusion.
• Identify the key clinical data provided: the reaction occurs 'initially' and includes flushing, tachycardia, and hypotension.
• Evaluate each option by comparing the patient's symptoms to the classic presentations of different transfusion reactions.
• Recognize that flushing alone can be allergic, but its combination with tachycardia and hypotension indicates a severe, systemic event.
• Differentiate the primary causative event (the reaction) from its potential outcome (shock). The question asks what the signs indicate (the cause).
• Select the option that represents the most specific and life-threatening diagnosis that matches the complete cluster of signs.

Concept Tested & Keywords

• Concept Tested: Recognition and immediate management of acute blood transfusion reactions.
• Stem keywords: blood transfusion, initially after starting, flushing, tachycardia, hypotension
• Lead-in keywords: indicate
• Clinical cues: The timing 'initially after starting' points to an acute, rapid-onset reaction.
• Clinical cues: The combination of flushing with hemodynamic instability (tachycardia, hypotension) signals a severe systemic event.

Question ID

Qr2UynVH-2HT2n08-xYmwp

Copy ID

Reference Book

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