Transfusion reaction? tachycardia and nothing else

[JennyD22]

just got home from work on the ortho surg ward... The dr's are (in my junior opinion) a little aggressive in treating anemia on my unit - I've been there for 3 months and it's just a bit different from what I'm used to... So my pt had hgb of 76, and the hospitalist ordered 2units PRBCs. She wasn't symptomatic but this is common practice for anyone under hgb of 80, regardless of symptoms.

Our clinical reaction guidelines are basically the same as this: Adverse Transfusion Reactions

An hour into the 2nd unit the pts hr increased from 76 to 144 30 mins after that unit started. She was also detoxing from ETOH, but was on ciwa protocol and had previously been responding well to that. We stopped the transfusion and ran NS TKVO as per guidelines. An ecg showed tachy sinus rhythm, otherwise normal. The pt showed no other symptoms of a transfusion reaction as listed in the link above. The Dr came to assess and came to the conclusion she was tachy d/t ETOH w/d. Thus we restarted the transfusion twice and her HR increased to 140-150 each time, within 5 mins. Each time when we started NS, her HR would go down to 100-110 within a minute after switching from the blood to NS. No other changes. The other nurses and the Dr were skeptical that it was a transfusion reaction and I agree it didn't fit a typical reaction that I have seen before, or as described in reference materials... But has anyone seen this or know what it might have caused this? I got a few raised eyebrows because I was assertive in stopping the transfusion... I've been practicing for just under 1.5 yrs so maybe im a little tenuous when everyone else is more experienced and questioning my judgement but there was a definite correlation between the transfusion and the tachycardia, and it was witnessed by another nurse as well. I wasn't comfortable in doing something that appeared to cause tachycardia regardless if it makes sense or not... I'm just wondering if anyone has an explanation?

Thanks! This is my first post btw...

[classicdame, MSN, EdD]

I applaud you. Until proven otherwise, any new symptom is a transfusion reaction! In my facilty we contact the Medical Director for the Blood Bank. Sometimes that involves questions and sometimes she does her own assessment.