Gave Blood transfusion too fast maybe?

  1. Wanted to ask if anyone knew any effects of issuing a blood transfusion too fast besides the obvious ones that are easily found or included in text. What happened is my patients was admitted for a Hemoglobin level of 3.2. This was his first time to receive a blood transfusion. Only 1 unit was transfused at a time over four hours. I ran it at 50 over the first 15 minutes and patient had no issues. Turned it up to 90 ml/hr and after it was done his hemoglobin ( after two hours h&h was done) it only went from 3.2 to 4.7 after a unit of blood or (250 mls) were given.
    Couod there be a reason why it only went up so little.
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    About Maria1308

    Joined: Oct '14; Posts: 6; Likes: 5
    from CA , US

    36 Comments

  3. by   brownbook
    Generally, approximately, the hemoglobin goes up one gram per unit of blood.

    The main siginificant effect of giving blood too rapidly is too much fluid for the body/heart/circulatroy system to handle all at once and fluid "backing up" into the lungs.
  4. by   smf0903
    That is an expected increase in hgb. One unit of blood is expected to raise hgb by 1 g/dL.
  5. by   MilliePieRN
    I'd say a almost 50% increase in the hgb level is pretty good. Really, 3.2 is sooooo low, it's gonna take more than 1 unit to get it back up to normal. Plus, I've noticed the next day levels to even be a little higher after a transfusion. You didn't run it too fast. I'm surprised only 1 unit was ordered before the H&H.
  6. by   cleback
    Holy cow... had a patient with a heme of 6 that was so symptomatic and made nervous. At 3, was the patient even alert?? One unit is nothing...
  7. by   LovingLife123
    Only one unit for a hgb that low?? And I would have probably pressure bagged it in, not transfused over 4 hours. That's a very long time to transfuse blood.

    Our orders state transfuse over 2-3 hours. So if the person is say 6, I start at 125 for the first 15 minutes, check for reaction, then up the rate to 175.

    Was this person alert?
  8. by   MunoRN
    That's actually a pretty good bump from only 1 unit.

    Keep in mind though that the close-observation period for transfusion reactions that would be detectible during the transfusion should continue until at least 50mls have infused, which is why the transfusion should actually be run faster (at least 150ml/hr, preferably 200ml/hr) during the first 15-20 minutes if that is the close observation period, then it can be turned back to the desired rate for remainder of the transfusion.
  9. by   smf0903
    People are so different. I had a pt once who came in with a hgb of 2. Didn't come in because they were tired or dizzy or anything like that. Pt came in for knee pain. If I remember correctly, pt ended up getting a total of 6 or 7 units during the stay.
  10. by   LovingLife123
    I see where it was transfused over 2, sorry, thought I read 4. Our units are usually over 300mL.

    We also pull an H and H one hour after each unit but with a hgb that low I probably would have had a cooler of at least 4 units and would have pulled one after each unit.

    I had a person below 3 one time and it was ugly. I'm assuming your person was very symptomatic.
  11. by   brownbook
    The good and bad about the marvelous human body is that it can compensate to a SLOWLY declining hemoglobin. Thus patients can be alert and oriented with hemoglobins of 2 and 3, crazy as it sounds!
  12. by   That Guy
    Blood too fast at 90/hr? I can cram a bag in in under 3 minutes and thats not even trying that hard. No those results are awesome for what it was.
  13. by   KelRN215
    Quote from Maria1308
    Wanted to ask if anyone knew any effects of issuing a blood transfusion too fast besides the obvious ones that are easily found or included in text. What happened is my patients was admitted for a Hemoglobin level of 3.2. This was his first time to receive a blood transfusion. Only 1 unit was transfused at a time over four hours. I ran it at 50 over the first 15 minutes and patient had no issues. Turned it up to 90 ml/hr and after it was done his hemoglobin ( after two hours h&h was done) it only went from 3.2 to 4.7 after a unit of blood or (250 mls) were given.
    Couod there be a reason why it only went up so little.
    Because you only transfused 1 unit. That's an expected rise in Hgb with 1 unit of blood. A patient with a hemoglobin of 3 needs more than 1 unit of blood.
  14. by   AceOfHearts<3
    I would have been pressure bagging the blood in- multiple units. I've been in a situation like that before- the residents were running to the blood bank to get coolers of blood. Over half my unit was in the patient's room and we had multiple pressure bags with fluids and different blood products going into every IV and central line we had. It was an incredible learning experience and the patient went home fine after a few days.

    I had a patient recently get a unit of blood and their hgb was over 7. I was told to give it in an hour then check an H and H 2 hours after completion. As others have said you can expect hgb to go up about 1g per unit of blood.

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