Transfusion reaction???

[Devil_Duckie, LVN]

Hello all, have a question but let me give you a little background first:

Received a new patient last night admitted from the emergency department. Her presenting complaint to the ED was left leg pain and after labs came back it was determined she was also in metabolic acidosis. She was admitted for the metabolic acidosis and also to rule out a DVT.

Anyways, the patient came up with orders to type and cross and tranfuse 2 units PRBCs. The patient had an extensive medical history and had received blood before but I still did the education on the different types of adverse reactions to transfusions and began the blood. The first unit went fine, vitals all AOK, patient remained afebrile, no complaints of pain or rash, etc. Started the second unit.

Again the patient was fine, no reactions noted, patient remained afebrile, etc. Protocol is to check vitals before initiation, 10 minutes after initiation, thirty minutes after, and then every hour until completion. Almost 1/2 of the way through the second unit, I checked her vitals at 0330, planning to come back in an hour and recheck vitals. During a routine check at 0415, she told me that for 'about an hour, my jaw has been hurting.'

Immediately, I check her vitals and pause the blood. Her lower left jaw was tender and warm to the touch, and she even recoiled when I felt the area. Her vitals were fine and her temp had on increased 7/10's of a degree to 99.3. Baffled, I kept the blood on hold and got her a percocet for the pain and paged the doc. He came up to see her and was completely at a loss as well.

The patient, while she had poor dentition said she rarely had toothaches and that the pain was in her jaw, not her teeth! The doctor saw her and after some consideration, he asked if I was comfortable re-starting the blood. I did and the rest of the unit finished without a problem and the patient's pain went away within the next hour and a half.

Now, sorry for the long, drawn out background, but do you think the jaw pain was unrelated to the blood? I'm aware of all the common reactions to blood like flank/back pain, fever, rash, chills, syncope, hypotension, and hematuria, but jaw pain?

At a loss here..... :uhoh21:

[EmmaG, RN]

Her lower left jaw was tender and warm to the touch, and she even recoiled when I felt the area.

...

The patient, while she had poor dentition said she rarely had toothaches and that the pain was in her jaw, not her teeth!

Doubt it's related to the blood. Could be starting an abscess. Had a young man whose abscessed tooth presented the same way; the infection had formed a fistula tract to his neck just under the jaw. He ended up on a vent due to a compromised airway from the pressure of the pus collection.

[nrsang97, BSN, RN]

Don't think blood reaction. You did state that the pt had poor dentition. She may say she rarely has a toothache, but sounds like abscess starting to me. Usually if you react to blood it is within the first 5-15 minutes of the transfusion.

[Virgo_RN, BSN, RN]

I'm with the others on this.

[Chloe'sinNYNow]

Ditto hun. I'm not as familiar w/ abscesses and fistulas,but I hung a lot of blood in my short time on my last unit. Sounds like you did fine!

[DutchgirlRN, ASN, RN]

Duckie you did everything right and handled it by the books. Seriously doubt that jaw pain had anything to do with the blood. Either way, you know she was fine after the transfusion so that's all that matters.