A CKD patient had to undergo dialysis. His Hb was 5.5. So two blood transfusions were to be given. First bag was completed in 2 hours. Second was staed and midway between he developed shoness of breath, hypeension. Vitals: BP 180/120 mm Hg and pulse rate 110/min. What is the cause?
Usually 1 bag takes 4 hr. Option A- Allergic it is very nonspecific symptom Here word mismatch blood transfusion would be a better answer. Option B- TACO As he has been administered with 2 units of blood at a very fast rate causing volume overload Contributing to pulmonary edema Volume expansion-HTN- Compensatory tachycardia Option C- TRALI Ruled out d/t fact that in this case as 1st unit of blood was given much faster even though it wasn't an emergency from the perspective that he is not bleeding, Fast transfusion given to patients with bleeding, moreover it was wrong to give patient with CKD blood transfusion ideally SHOULD Be given erythropoietin injection or packed RBC to patient. If we do volume expansion of patients, chances of pulmonary edema are high. TRALI ruled out because in a question above there are symptoms of volume overload mentioned. TRALI could be answer if Normal BP & no volume overload (it is a non-cardiogenic pulmonary edema.) Option D- Febrile non hemolytic transfusion Rxn causes fever, chills and rigors but does not result in development of HTN, |HR in patients.
Allergic
Transfusion related circulatory overload (TACO)
TRALI
FNHTR
Blood Bank & Transfusion Therapy