blood reaction

[2bnurse15]

i have this assignment , and it ask to state the three main complications. its about this fellow who has had crohns since he was 17. anyway he had surgery (temporary ileostomy) and post surgery had blood transfusion. he tolerated the first unit well, however 15 minutes into the second unit of packed red blood cells he said he was feeling unwell, obs were taking an found the following, temp 39, BP 126/80, HR 128, Resp 24 and SpO2 92%. just wondering wat the reaction would be? all i can think of is some sort of a hemolytic reaction... but they usually occur 15 minutes into the first unit.... someone please help..

[ghillbert, MSN, NP]

Sounds like a transfusion related reaction to me. Do you mean you need to state the three main complications of blood transfusion?

Might help to search "TRALI" - transfusion related acute lung injury"

[2bnurse15]

na i need to state the three main complications that the patient would come across post surgery eg. pain and so on. i no the blood transfusion reaction would be the 1st priority. i was just trying to figure out what type of reaction it would be. thanx tho :wink2:

[Daytonite, BSN, RN]

the fever is the only symptom of a transfusion reaction that this patient has. other symptoms would be flushing, chills, nausea, low back pain and headache, palpitations (usually when hypotension is present); difficulty swallowing or breathing (possible anaphylaxis); tingling of fingers, muscle cramps, vomiting, faintness (hypotension, arrhythmia, hypocalcemia); muscle weakness, irritability, bradycardia (hyperkalemia when large volumes of older stored blood is transfused).

you want to look at the complications of the surgery itself and anesthesia:

• http://www.surgeryencyclopedia.com/fi-la/ileostomy.html - ileostomy, includes the risks (complications)
  
• http://www.webmd.com/ibd-crohns-disease/proctocolectomy-and-ileostomy-for-inflammatory-bowel-disease - proctocolectomy and ileostomy
  
  • "the main complications of ileostomy involve infection and problems with the opening to the abdomen (stoma). the following complications may occur:
    
    up to 30% of people develop infection.
    
    

    
    

    small bowel obstruction occurs in 15% of people.
    
    
    a problem with the stoma develops in up to 30% of people.
    
    
    between 20% and 25% of people need another surgery to repair the stoma."
    
    

    
    

  [*]chart of commonly transfused blood products.doc - includes the signs and symptoms of transfusion reaction

  [*]the complications of major anesthesia include:

  • breathing problems (atelectasis, hypoxia, pneumonia, pulmonary embolism)
    
  • hypotension (shock, hemorrhage)
    
  • thrombophlebitis in the lower extremity
    
  • elevated or depressed temperature
    
  • any number of problems with the incision/wound (dehiscence, evisceration, infection)
    
  • fluid and electrolyte imbalances
    
  • urinary retention
    
  • constipation
    
  • surgical pain
    
  • nausea/vomiting (paralytic ileus)