Mrs. Smith is receiving a blood transfusion after total hip replacement. After 15 minutes, you went back to check her vital signs and she complained of high temperature and back pain?

1. A

   Renal Colic

2. B

   Urine Infection

3. C

   Common adverse reaction

4. D

   Serious adverse reaction

Appeared in: IGNOU Post B. SC. Nursing entrance-2019

Explanation

• The combination of high temperature (fever) and low back pain occurring shortly after a blood transfusion begins is a hallmark sign of an acute hemolytic transfusion reaction (AHTR).
• AHTR is the most dangerous type of transfusion reaction and is considered a medical emergency, thus classifying it as a serious adverse reaction.
• The back pain is caused by the breakdown products of red blood cells (hemoglobin) accumulating in and damaging the renal tubules of the kidneys.
• This reaction is typically caused by ABO incompatibility between the donor's blood and the recipient's blood.

Why Other Options Were Wrong

• Option A: Renal colic is caused by kidney stones and is not related to a blood transfusion. The onset and associated symptoms would be different.
• Option B: A urine infection (UTI) is a bacterial infection that develops over a longer period (hours to days) and would not manifest so acutely within 15 minutes of starting a transfusion.
• Option C: A common adverse reaction, like a febrile non-hemolytic reaction, involves fever and chills but typically lacks the severe low back pain characteristic of hemolysis.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Recognition and management of acute transfusion reactions helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• The first 15 minutes of a blood transfusion are a critical observation period. The nurse must stay with the patient or monitor them very closely to detect early signs of a reaction.
• An acute hemolytic reaction is a 'never event' that is almost always preventable through meticulous adherence to patient identification and blood product verification protocols.
• What if the patient only complained of itching and hives? This would suggest a milder allergic reaction. The nurse would stop the transfusion, notify the provider, and likely administer an antihistamine. The transfusion might be resumed if symptoms resolve, unlike with a hemolytic reaction where it is never resumed.

How to Approach the Question

• First, analyze the clinical scenario: a patient is undergoing a specific procedure (blood transfusion).
• Identify the key pieces of information: the patient's complaints (high temperature, back pain) and the timing (15 minutes after initiation).
• Connect the symptoms and timing to the known complications of the procedure. An acute onset of fever and back pain during a transfusion is a classic red flag.
• Evaluate the options. Differentiate between a 'serious' and 'common' reaction based on the specific symptoms. The presence of back pain in addition to fever points towards a more severe process (hemolysis) than just a fever alone.
• Eliminate options that do not fit the acute timeline or etiology (Renal Colic, Urine Infection).
• Select the option that best explains the entire clinical picture, which is a serious adverse reaction.

Concept Tested & Keywords

• Concept Tested: Recognition and management of acute transfusion reactions
• Stem keywords: blood transfusion, high temperature, back pain, 15 minutes
• Lead-in keywords: what is the cause
• Clinical cues: The timing of symptoms (15 minutes after starting the transfusion) is a critical clue pointing to an acute reaction.

Question ID

QyNNrWnCkQ009sHLC22kzd

Copy ID

Reference Book

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

E6 Gynecology Williams p. 8-29