Question

The nurse is evaluating an older adult client with an upper gastrointestinal bleed who received several packed red blood cell transfusions in the past 24 hours. Assessment findings include crackles to auscultation, bounding pulses, orthopnea and an oxygen saturation of 90% on room air. Vital signs include heart rate of 106 bpm, blood pressure 160/80 mm Hg, respirations 24 and temperature 98.6o F (37o C). Which adverse transfusion reaction is the client most likely experiencing?

A
Hemolytic transfusion reaction
B
Circulatory overload Correct Answer (Blank)
C
Transfusion-associated graft-versus-host disease
D
Bacterial transfusion reaction

Answer 1

The client displaying crackles upon auscultation, bounding pulses, orthopnea, and decreased oxygen saturation following multiple packed red blood cell transfusions is most likely experiencing circulatory overload, not hemolytic transfusion reaction, TA-GVHD, or bacterial transfusion reaction.

Step-by-step explanation:

The patient's clinical presentation suggests circulatory overload as the most likely adverse transfusion reaction. Circulatory overload, also known as transfusion-associated circulatory overload (TACO), is a condition that can occur when the volume of blood or blood components transfused is too much for the patient's circulatory system to handle. Symptoms include shortness of breath, orthopnea (difficulty breathing when lying down), rapid or bounding pulses, hypertension, increased heart rate, and crackles upon lung auscultation due to pulmonary edema. Oxygen saturation can decrease as a result of compromised gas exchange in the lungs.

The patient, being an older adult with an upper gastrointestinal bleed, is at increased risk for TACO because of the possibility of cardiac or renal insufficiency, which in the face of multiple packed red blood cell transfusions, can exacerbate fluid overload.

In contrast, a hemolytic transfusion reaction would present with fever, chills, back pain, and potentially dark urine from hemoglobinuria within hours after receiving incompatible blood. This can occur when there is an ABO incompatibility between the donated blood and the recipient's blood. Transfusion-associated graft-versus-host disease (TA-GVHD) and bacterial transfusion reaction present with different clinical features, like fever, rash and shock for TA-GVHD, and fever, hypotension for bacterial contamination.