Excess Blood Transfusion

[discobunni]

I am hoping someone can help me... I am a nursing student, but I was wondering if anyone else has ever experienced this.

Last night, my father-in-law was taken to the ER because he had a piece of food lodged in his throat and was having trouble breathing.

They then said he was extremely anemic because his Hgb was a 4.

They gave him a blood transfusion, and a hemotologist was suppose to see him today, when they discovered, WOOPS! Mistake! His Hgb is actually 14.... they said they "read the lab results wrong":angryfire. He has COPD and CHF, he tachy's all the time between 130-140. I looked up information on polycythemia, but I couldn't find a whole lot of information except that it could cause heart failure or thrombosis, but since this is not true polycythemia, I don't know if it applies here. What have they really put him at risk for? Has anyone ever seen this happen and what did they do to correct it? I am just concerned because he is already in bad health. Am I overreacting? Are there additional questions I should be asking? Thanks for the help in understanding this situation!

Angela

[november17, ASN, RN]

Relax, let the physicians handle it.

[BBFRN, BSN, PhD]

He could be at risk for fluid volume overload. Hopefully, he's getting a diuretic?

[discobunni]

Relax, let the physicians handle it.

:lol_hitti

[chris_at_lucas_RN, RN]

Nothing teaches like experience, and you are having quite some experience!

This sounds a lot like they are treating the lab results instead of the patient. If he had a Hgb of 4, he would have been pale, and his gums would have been practically white, plus he would have been weak and unable to stand or move on his own very much. (I learned the gum thing from the vet, but it works with humans too!)

This is why we always look at the patient, no matter what the test results say. If the patient seems too good for the lab results, we redo the test!

His body will throw off the unnecessary cells. The bad effects you read about polycythemia relate to the kind that is the result of a problem in the body, not an unneeded transfusion.

The diuretic should help with the extra fluid. If he has CHF, he's probably on one already. Thank goodness for small favors!

Do keep us posted, and know that this is the kind of experience that teaches you something about how imperfect health professionals can be: so when the time comes, and it will, cut yourself some slack, but always double check.

[discobunni]

Thank you Chris! I haven't even gotten to see him yet (stuck at home w/sick kid) but my husband said his color was good. I kept asking him the same question last night...he wasn't pale?????? He was carrying on a conversation with you as usual?? I just found that odd. Thanks for the reminder about "treat the patient". I think that is something we can all strive to use in day to day nursing to cut down on mistakes. He's going home, sounds like he will be OK.

[Tweety, BSN, RN]

Even with his health problems the body is pretty good at maintaining homesotasis. The body will recognize that it doesn't have to manufacture any new RBCs for a little bit and things will balance out to what is going to be normal for him.

I would have been more worried about fluid overload with his CHF, but that would have been noted the first day.

[leslie :-D]

i agree with tweety.

i imagine he didn't get more than a couple units?

that's 2 c. of add'l fluid.

any overload would have been noted during or immediately after.

polycythemia is a different bird altogether.

leslie

[AnnieOaklyRN, BSN, RN, EMT-P]

I agree with the others about just worrying about the fluid overload.

Remember some athletes do this type of thing on purpose, although with their own blood of course, so again more than likely it will be the excess in fluid that might be a problem versus the extra RBCs.

Sweetooth

[Dolce, RN]

I find it hard to believe that someone actually thought he had a Hgb of 4 yet did not present any other clinical presentations of anemia. If he actually had an Hgb that low he should have probably been worked up for cause of bleeding, etc.

For people with CHF it is safe to give blood transfusions with caution and common sense. It is very common practice to give the blood slowly, give lasix in between, and watch for fluid overload. I imagine that the nurses were monitoring him for fluid overload during the transfusion.

As a nursing student this is a great example to you to assess the patient not just the monitor, VS, labs, or test results. If something doesn't seem right or match up with how the patient seems than something might be wrong. This is why nurses' gut instincts are so valued--we try to look at the whole picture not just the erroneous lab results.