Blood transfusion administration scenario question

[samiam4]

Outpatient Hematologic Oncology pt (pt ANC- 60 [pt is neutropenic], plts - 4, hgb-6) received platelet/PRBC transfusion. Prior to start of platelets baseline vital signs were T-97.9, Hr-94, RR-18, Bp-113/80. Pt received 650mg PO Tylenol premed 30 min prior to platelets transfusion due to hx of reaction. Post platelet vital signs T-99.6, Hr-97, RR-18, BP-112/75. Pt then received 1 unit of PRBC. 15 min VS into PRBC T-98.5, HR-95, RR-18, BP- 114/78. At 30min into PRBC VS were T- 98.3, HR- 95, RR- 18, BP- 117/76. Pt completed transfusion without incident with final VS as T-98.6, HR- 97, RR-18, BP- 107/80. Pt discharged. Curious your thoughts and if you think the blood administration was completed appropriately? Or if you think any intervention should have been done with this scenario? Thank you!

[kp2016]

OK. My first thought was for a Hgb of 6, I would have anticipated more than 1 unit of PRBs. 

[Wuzzie]

1 minute ago, kp2016 said:

OK. My first thought was for a Hgb of 6, I would have anticipated more than 1 unit of PRBs. 

Blood shortage. Current practice in a lot of places is one unit unless symptomatic.

[Quota, BSN, RN]

I work inpatient ONC and only difference I’d have is adding 25mg Benadryl to the pre-meds.  Nothing in those vitals would have caused me concern.  Same d/c instructions as all outpt neutropenic pts, go to ED for sustained fever over 100.4.  

[HiddenAngels]

The only thing that stood out for me was the increase in temp post platelets. It is tricky because while you kept it down less than 1.8  difference, you gave Tylenol so it would have been even higher but nothing you can worry about. Just monitor I don’t think  you need any intervention 

[sistrmoon, BSN, RN]

If there had been a full 2 degree increase between pre and post platelet vitals, that would have triggered a transfusion reaction investigation at my previous hospital. That was always the guideline. But it wasn’t a full 2 degrees. The only other possible thing I see is that vitals were done 30 minutes into the blood transfusion and we always did them 15 minutes in but that could vary by facility. I’m curious now though. 

[Damon McGill, BSN, RN]

As a cancer survivor that has received blood many times and a nurse who has given a river of blood to patients, I see nothing else that needs to be done. Treat the patient not the monitor or a single, slight bump in temperature. If the patient felt fine, good job.