Hemolytic Transfusion Reaction - personal experience

Esme12, ASN, BSN, RN · Oct 18, 2013

Why do you need personal experience?

acedit · Oct 18, 2013

Why do you need personal experience?

I am attempting to get more data for my project.

In researching the topic, I have found that these reactions are rare because of the measures in place to ensure blood compatibility. In the event we have a nurse who has experienced this, I would like to know about the experience.

Esme12, ASN, BSN, RN · Oct 18, 2013

so you want experiences that nurses have had with patients like this not that they have experienced a transfusion reaction themselves while being transfused.

acedit · Oct 18, 2013

so you want experiences that nurses have had with patients like this not that they have experienced a transfusion reaction themselves while being transfused.

Good evening!
I am working on a project about hemolytic transfusion reactions. I have been unsuccessful thus far in finding someone who has first-hand experience with this type of reaction.
If you have worked with a patient who had this reaction, could you please share the experience with me? I don't have any specific questions, per se, I simply would like to "hear" an account of events that occurred in the room at the time of the reaction.
Thank you in advance!

Yes. I am hoping to hear from a nurse who has personally been in the the room with a patient who, during a blood transfusion, experienced a hemolytic transfusion reaction. I would like to "hear" a first-hand account of what happened, rather than what the books tell me, which is what to do in the event this reaction occurs.

nurseprnRN, BSN, RN · Oct 18, 2013

OH, yeah.

Many years ago I had a fresh open heart patient who was a second case, meaning the first case at 0700 was finished, and then they turned over the OR room and started him. Alas, nobody checked to see that blood in the blood warmer was changed, too, so he got two whole units of mismatched blood from the first case while anesthetized, paralyzed, and draped, so he couldn't complain of any funny feelings.

When he rolled into my room in the ICU his Foley was draining orange-like-a-pumpkin urine (from the hemolysis).

All the initial routine blood work we sent to the lab on admission came back, "Hemolyzed, draw another sample," and when we did that, twice, and finally drew it extra carefully so as not to hemolyze it, we got the same thing. Mmmmmm.

Then we took another look at the urine: but alas again, that stopped pretty soon as his kidneys clogged up and died. He got more orange and died in two weeks.

The anesthesia resident who checked the blood in the warmer for the first case but didn't check the labels on it for the second case was canned. The circulating nurses who checked the blood properly for the first case but didn't clean out the blood warmer and check in new blood for the second case (each thought the other had done it with somebody else) got hell. Sad business all around.

Esme12, ASN, BSN, RN · Oct 18, 2013

It actually isn't so rare in certain specialties. Patients who receive frequent blood and blood products will being to harbor antibodies and become increasingly sensitive to transfusions.

I have seen things from fever chills to full blown hemolysis....my Uncle died this past summer because of this "complication".

acedit · Oct 19, 2013

Oh, my stars, GrnTea! Thank you so much for sharing this with me. It didn't occur to me that the signs could be difficult to notice if the patient is unable to complain. So, how else would the nurses and staff know this reaction is occurring? Are there any automatic monitors that would alert the nurse to these changes, like if a fever occurs?

acedit · Oct 19, 2013

Oh, Esme, I'm sorry that your uncle had such a severe reaction.

Does the development of harboring antibodies compare at all to Rh+/Rh- incompatibility? I have read about Rh- blood developing antibodies when exposed to Rh+ blood.

Also, do you mind sharing with me in which specialties this reaction is more common?

nurseprnRN, BSN, RN · Oct 19, 2013

Oh, my stars, GrnTea! Thank you so much for sharing this with me. It didn't occur to me that the signs could be difficult to notice if the patient is unable to complain. So, how else would the nurses and staff know this reaction is occurring? Are there any automatic monitors that would alert the nurse to these changes, like if a fever occurs?

In this case, the patient was on cardiopulmonary bypass, so he couldn't develop a fever. The bypass machine controls body temp. They used to bring people back to us at around 36•C but now they warm them to normal temp because they clot better and they don't start using up a lot of metabolic energy shivering. So no, unless they were looking at the u/o (which I guess they didn't) (or maybe the blood wasn't given til late in the case, and the urine didn't start getting funky until just about time to transport him to ICU), no way to tell.

Esme, sorry to hear about your uncle...

akulahawkRN, ADN, RN, EMT-P · Oct 19, 2013

It actually isn't so rare in certain specialties. Patients who receive frequent blood and blood products will being to harbor antibodies and become increasingly sensitive to transfusions.
I have seen things from fever chills to full blown hemolysis....my Uncle died this past summer because of this "complication".

I'm related to someone that is very sensitive to transfusion. Blood is to be very carefully cross-matched to avoid hemolysis.

Sorry to hear about your uncle.

Esme12, ASN, BSN, RN · Oct 20, 2013

Thanks.....sigh...it was a long summer. He developed MDS.... myelodysplastic syndrome....from blood reaction and post CABG spesis. His marrow never recovered.

The more transfusions someone receives the more likely they will have a reaction. Reactions can be delayed