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 combination of flushing, tachycardia, and hypotension occurring immediately after a blood transfusion begins is the classic presentation of an Acute Hemolytic Transfusion Reaction (AHTR).
• AHTR is a medical emergency caused by the infusion of ABO-incompatible blood, leading to rapid intravascular destruction of red blood cells.
• The destruction of red cells triggers a massive inflammatory response, causing systemic vasodilation (leading to flushing and hypotension) and a compensatory increase in heart rate (tachycardia).
• This specific triad of severe symptoms points directly to AHTR as the most likely and most dangerous cause, requiring immediate intervention.

Why Other Options Were Wrong

• Option A: A mild to moderate allergic reaction typically presents with urticaria (hives), itching, and flushing, but not usually hypotension and severe tachycardia.
• Option C: Shock is a state of inadequate tissue perfusion that results from the reaction; it is a consequence, not the primary reaction type itself.
• Option D: This option is incorrect because the signs and symptoms are most specific and characteristic of a hemolytic reaction, making it a more precise answer than the other options.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Recognition and differentiation of acute blood transfusion reactions in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• For a nurse, rapidly identifying the signs of an AHTR is a critical patient safety skill. The first and most important action is to immediately stop the transfusion to prevent further harm.
• Failure to recognize AHTR can lead to severe complications, including acute kidney injury, disseminated intravascular coagulation (DIC), and death.
• What if? If the patient developed only a rash and itching without changes in vital signs, the nurse would suspect a mild allergic reaction. The intervention would be to stop the transfusion, notify the provider, and anticipate an order for an antihistamine. The transfusion might be safely resumed if symptoms resolve.

How to Approach the Question

• First, identify the key elements in the scenario: a patient is receiving a blood transfusion and develops acute symptoms.
• Note the specific symptoms: flushing, tachycardia, and hypotension. Recognize this as a triad of severe, systemic signs.
• Consider the timing: 'Initially after starting' points to a rapid, acute reaction.
• Systematically evaluate each option. Recall the hallmark signs of different transfusion reactions.
• Compare the patient's symptoms to the classic presentations. A mild allergic reaction is mainly skin-related. Shock is a resulting state, not the initial event. The triad of flushing, tachycardia, and hypotension is the textbook presentation of a life-threatening hemolytic reaction.
• Select the option that represents the most specific and accurate diagnosis for the given clinical picture.

Concept Tested & Keywords

• Concept Tested: Recognition and differentiation of acute blood transfusion reactions.
• Stem keywords: blood transfusion, flushing, tachycardia, hypotension
• Lead-in keywords: indicate
• Clinical cues: Symptoms occurring 'initially after starting' a transfusion points to an acute, rapid-onset reaction.

Question ID

Qr2UynVH-2HT2n08-xYmwp

Copy ID

Reference Book

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

E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 77-79