Case Study: "A Case of Bad Blood"

[mmc51264, ADN, BSN, MSN, RN]

We have had pts with low Hgb, but near normal crits that don't get blood, but I think they are chronic anemia pts.

Very interesting!!! Thank you for sharing. I love learning new things. Since we don't get a lot of emergent situations, it is good to be able to think outside the box just a little.

[SycamoreGuy]

SycamoreGuy said:

Nevermind the 1000's of people who have been saved by blood transfusion. You are entitled to your religious beliefs but don't USE a rare reaction as proof.

Should be use, not pulse.

[FranEMTnurse, CNA, LPN, EMT-I]

jalyc RN said:

Jehovah's Witnesses receive a lot of criticism for our stance on blood, but this is a good example of why our choices are better. That was a very poor surgeon, if he needed to give 3 units. We have encouraged and pushed doctors to become far better due to NOT having to give blood. Even open heart surgeons can do it with NO blood.

I lost half my blood when a C-section incision was done through my placenta. I had no transfusion and did just fine. Working L&D we had a JW who had a Hgb of 4 and soon walked out to go home.

People do not need Hgb over 10 in spite of what doctors preach. Like most of our bodies, we have multiples of everything for reserves.

I emitted 2 and a half liters of blood in the ER back in 2007. My BP was so low, I was unable to raise my head without passing out. I later went into kidney failure because an aide raised my bed into the high fowlers position. This can happen when there is miscommunication between individuals, even in a healthcare setting.

[annie.rn]

Loved this article. Thank you! Had a few questions so read more about it. Interesting fact I read.... blood from multiparous women and blood > 14 days old more likely to cause TRALI. Also, it can recur in about 10% of people.

[core0]

phaniea69 said:

Loved this article. Thank you! Had a few questions so read more about it. Interesting fact I read.... blood from multiparous women and blood > 14 days old more likely to cause TRALI. Also, it can recur in about 10% of people.

This also points out a problem if you work at a tertiary medical center. These are the hospital that gets the oldest blood. We turn over our blood bank every few days. On the other hand a small hospital may turn it over every few weeks. So when the local blood bank sends out blood the oldest units (closest to expiration) go to the places with the highest turnover. We see TRALI about 1-2 times a month throughout the hospital. There are probably a couple other cases that get missed because they resolve quickly.

[annie.rn]

Oops. Just looked at the article again and realized it addresses the multiparous female donor issue. Sorry.

To "core0". Too bad that some hospitals have to use a lot of older blood. It would be good to inservice the nurses giving the blood about TRALI so they can be more aware of it and hopefully catch it early when it happens.