Q 1. What are the indications for blood transfusion?
Answer: Indications for blood transfusion include:
- Transfuse any symptomatic patient (e.g., tachycardia, hypotension, CHF, and angina)
- Hemodynamic instability due to bleeding unresponsive to 2 L of saline
- Asymptomatic, presurgical, stable patient ( Transfuse to maintain Hb 7–8g/dL)
- Hemodynamically stable postsurgical stable patient ( Transfuse to maintain Hb 8 g/dL)
- Postsurgical patient at risk for ischemic disease (e.g., cardiac and bowel)
- Hemodynamically stable, nonpregnant, ICU patients >16 years old without ongoing blood loss
- Elderly patients following MI.
Q 2 . In the above given case scenario ou decide to transfuse 2 units of packed red blood cells. After 30 minutes, the patient complains of dyspnea and back pain. Repeat examination of this patient reveals a diaphoretic man with a pulse of 130 and BP of 88/50. His lung fields are clear (initial vitals
before the transfusion were a pulse of 110 and BP of 94/52.
A) Stop the blood transfusion and begin normal saline through the IV.
B) Increase the rate of transfusion.
C) Administer acetaminophen 650 mg PO.
D) Administer furosemide 40 mg IV.
E) Place a nasogastric tube for lavage.
Answer: The correct answer is “A.” The transfusion must be stopped. The patient is exhibiting signs and symptoms of a hemolytic transfusion reaction, which is generally the result of an ABO incompatibility. Patients may exhibit nausea, flushing, dyspnea, oliguria, back pain, and hypotension. Other findings include markers of hemolysis: hemoglobinuria, elevated serum-free Hb, reduced haptoglobin, and elevated bilirubin. Patients are positive for direct antiglobulin (Coombs) test.
Therapy includes IV saline at a high enough rate to initiate a brisk diuresis and prevent Hb from precipitating in the kidneys causing acute tubular necrosis
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