Was this a blood transfusion reaction ?

[BSNbeauty, BSN, RN]

Long story short: Patient had about 20ml of RBC's left before her transfusion was complete. Then suddenly, she had the strong urge to have a BM. I found this strange since she was less than 24 hours post op from a c-section and normally our C-section patients don't have a BM for a few days after surgery. The only ABT she received was in the OR for prophylaxis. Anyway, patient ended up having a large amount of diarrhea. Since diarrhea, was listed as one of the transfusion reactions in our hospital policy. I stopped the transfusion. Retrieved vitals, which were WNL and notified the MD and Blood Blank. The pathologist from the Blood bank told me that diarrhea is not a transfusion reaction from blood and is only a reaction seen in bone marrow transfusions. I notified him of what our policy says " stop transfusion for the following Graft/Host reaction including : N/V/D and etc. Our policy basically have a long list of reactions of when to stop a transfusion and iarrhea was definitely one that was on the list. He reassured me that all is well, and no transfusion reaction follow up is needed.

Have anyone ever heard of diarrhea being a transfusion reaction ?

[klone, MSN, RN]

No, and I would probably not stop the infusion for a non-anaphylactic reaction.

[BSNbeauty, BSN, RN]

Now I'm starting to think that we need to clarification in our policy. Per the CDC, diarrhea is noted as a bone marrow transplant reaction rather than a blood transfusion reaction. Welp, guess you learn something new every day. I've given blood a many times and never had this issue come up before.

[SoldierNurse22, BSN, RN]

I'm aware that diarrhea can be a sign of a transfusion reaction, but in very limited cases--such as oncology patients or in pediatrics. We'd occasionally see it in severely immunocompromised patients where GVHD was already a serious risk--or sometimes GVHD was already present and we gave blood anyway. But you've got to figure these patients don't have an immune system, so an anaphylactic response is going to look different in that population.

I think you did the right thing per your policy, though perhaps next time, stop the infusion, ask the doc, and see if s/he wants the transfusion halted entirely or if the patient's symptoms are mild enough to continue with their consent. It may not be a bad time to clarify your policy as well to ensure that patients who are otherwise healthy aren't going to have their infusions stopped due to a symptom that wouldn't point toward anaphylaxis.

With an OB/GYN patient, I wouldn't think that diarrhea would be a sign of GVHD unless there's something else going on.

[MunoRN, RN]

Diarrhea can actually be a symptom of a couple different transfusion reactions, although it's certainly not worth stopping a transfusion due to diarrhea alone. The most concerning reaction that causes diarrhea is graft vs host, although with that the diarrhea doesn't typically begin for about two days post reaction.

Sudden onset diarrhea during or following a transfusion warrants further investigation, but is not at all proof of a reaction by itself.

[BSNbeauty, BSN, RN]

I'm aware that diarrhea can be a sign of a transfusion reaction, but in very limited cases--such as oncology patients or in pediatrics. We'd occasionally see it in severely immunocompromised patients where GVHD was already a serious risk--or sometimes GVHD was already present and we gave blood anyway. But you've got to figure these patients don't have an immune system, so an anaphylactic response is going to look different in that population.

I think you did the right thing per your policy, though perhaps next time, stop the infusion, ask the doc, and see if s/he wants the transfusion halted entirely or if the patient's symptoms are mild enough to continue with their consent. It may not be a bad time to clarify your policy as well to ensure that patients who are otherwise healthy aren't going to have their infusions stopped due to a symptom that wouldn't point toward anaphylaxis.

With an OB/GYN patient, I wouldn't think that diarrhea would be a sign of GVHD unless there's something else going on.

Wow, thanks for the education I've learned a lot from your post. I basically did exactly what our policy said do. I will definitely recommend for the policy to clarified. I guess it is always better to err on the side of caution, and thankfully she was done with her transfusion with the exception of a about 20ml of blood left in the tubing. The MD was okay with it being stopped at that point. When I showed my co-workers the policy they are agreed that diarrhea is clearly listed as a reaction and they would have done the same thing.

[firstinfamily, RN]

This is a new one for me!!! I can see where it would be considered a reaction for host and oncology type patients, but have never seen this listed as a blood transfusion reaction. Pts can have reactions to blood up to 48 hours post transfusion. You did the right thing, great critical thinking skills!!! Great job!!!

[Esme12, ASN, BSN, RN]

Wow, thanks for the education I've learned a lot from your post. I basically did exactly what our policy said do. I will definitely recommend for the policy to clarified. I guess it is always better to err on the side of caution, and thankfully she was done with her transfusion with the exception of a about 20ml of blood left in the tubing. The MD was okay with it being stopped at that point. When I showed my co-workers the policy they are agreed that diarrhea is clearly listed as a reaction and they would have done the same thing.

You did the right thing...follow policy. I would ask for further clarification about the policy.