 Welcome to Nursing School Explained and this video on Transfusion Reactions. Whenever we administer a blood product, there is a chance that the patient might have an allergic reaction to it and there are several types of reactions, but really the nursing interventions or what we need to do when we first notice signs and symptoms that could possibly represent an allergic or a transfusion reaction, the steps are always the same. So let's look at those first and then we'll look into the different types of reactions. So first of all, we need to stop the transfusion. We need to basically get rid of the offending agent, which is in this case the blood that's infusing into the patient. This likes to come up on exam questions as well as the NCLEX, so your first choice is always stop the transfusion and that is even before you get into the patient assessment. We typically want to answer with assess the patient, but now we stop the transfusion. Step number one, super important. And then we want to maintain a patent IV with normal saline only, so disconnect everything that has blood tubing or blood in it, the bag tubing, but save it because you're going to need to send it out to the blood bank later. And the patent IV is necessary because we're going to need to treat the patient if they have a severe reaction to this blood product. Then certainly we want to notify the healthcare provider as well as the blood bank to let them know something went wrong. And if the severe, if the allergic reaction is severe, we might want to consider calling a rapid response, calling the RRT. We want to assess our patient, their vital signs, as well as their human output and you'll see what that is important when we discuss the different types of infections and reactions. Then treat the patient per whatever orders we receive. Recheck all the ID tags and numbers of the blood product. Patient ID pen, blood type, blood bag number, expiration date. Visually inspect the blood again, see what's happening there. And then save any blood bag tubing and send that back to the blood bank because they need to investigate as to what happened as well. We need to collect blood and urine samples from the patient because that will give us a better idea how severe the reaction is and then certainly we want to document. So the different types of reactions that we have here vary from very mild to severe and where the patient could potentially die from those. And so the first reaction here that we'll be looking at is an acute hemolytic reaction. If you think about hemolysis, that means that the blood cells are lysing. So they are being destroyed by the patient's own blood cells. So signs and symptoms will be fever and chills and the patient will have pain that's typically located in the chest, back, abdomen or flank area. So mostly located in the torso. They will show signs of shock such as increase in heart rate as well as respiratory rate and their blood pressure will drop. They might be acutely jaundiced because the liver is all of a sudden being overloaded with all these blood cells that the body is now trying to fight and get out of the system. They might have signs and symptoms of acute kidney injury, disseminated intravascular coagulopathy as well as shock. And we'll talk more about anaphylactic shock here when we talk about this reaction. So how do we treat the patients if they have an acute hemolytic reaction? We treat the shock with IV fluids, most likely crystalloids such as normal saline. Drop blood on urine samples to present to the labs, to the lab to find out what's going on. Monitor meticulous INOs, but the patient might need dialysis because this acute kidney injury can make the kidney so severely damaged that now we have to put the patient on dialysis temporarily until this issue is resolved. What can we do to prevent it? Well, we need to meticulously check the blood products against the patient against every ID tag, preferably with a second nurse if that is the policy of your facility so that this mistake doesn't happen. This typically happens from APO incompatibility. So the wrong blood type was given to the patient and unfortunately that's pretty significant. Second time reaction is the most common one, which is a febrile non-hemolatic reaction. So clearly the name already says it. Patient will have a sudden onset of febrile and chills and that usually means a temperature that increases by more than one degree Celsius. They will feel flushed with that increase in temperature. They might also have a headache or anxiety. What do we do about it if it happens? Again, first of all, we'll stop the transfusion and go through all the steps that we discussed here initially. We'll need to give the men's apparatus to treat their fever and the infusion might be able to continue if specifically instructed to do so. So initially we want to stop everything and treat it as if it was a more severe reaction but as it turns out it might just be a febrile reaction. Then the provider might say, okay, continue this transfusion. How can we prevent it? Well, some patients are prone to these reactions, especially if they've had multiple blood transfusions in the past. So prophylaxis treatment with antipyretics and antihistamines might be beneficial and consider administering leukocyte reduction in the blood cells that we would be administering, which helps to lower down the chances of an allergic reaction. And then mild allergic reactions. So this would be like any allergic reaction resulting in itching and hives. And then again, we would treat it like an allergic reaction with antipyretics, antihistamines, maybe some oxygen and steroids if the allergic reaction results in hives that are very uncomfortable. And again, may restart the transfusion if specifically instructed to do so. What can we do to prevent it? Prophylaxis treatment with antipyretics and antihistamines to prevent this mild allergic reaction from happening. And then here we go into the more severe reactions. So first, anaphylaxis. So that means the patriotists allergic, anaphylactic, severely allergic to this blood problem that we administering. They will have signs and symptoms of itching, anxiety, respiratory distress. They might have wheezing. Their respiratory rate might increase. Their O2 set might drop. They might be shocking, increased heart rate, low blood pressure and end up in hyperbolemic shock or anaphylactic shock where everything really dilates and they completely lose their blood pressure and I have a separate video on anaphylactic shock. How do we treat it? Again, antipyretics, antihistamines, oxygen, steroids if needed. And we might need to do CPR. If this is a significant allergic reaction, anaphylaxis, then the patient might lose the pulse completely and require CPR. It can be prevented by using washed red cells or these kind of removing cells that might be causing an allergic reaction in the patient or using autologous blood, which is blood that comes from the patient. So this can happen as an auto-transfusion where the patient knows that they're going to have a procedure where they might require blood and they go ahead and donate their own blood ahead of time or it can be used such as if the patient is bleeding, that blood can actually be used to be re-instilled or re-administered to the specific patient so it's administering their own blood. And then the last reaction that I want to go over here is fluid volume overload and that really has nothing to do with the blood product in itself, such as an allergic reaction, but it has to do with the volume of blood product the patient receives and they will show signs and symptoms of congestive heart failure. They will have crackles, there will be a respiratory distress, the heart rate might go up, their blood pressure will probably go up. They might show some edema all of a sudden and some GED. So they'll go into this like flash pulmonary edema sudden onset of CHF symptoms. How do we treat it? We want to relieve their respiratory distress, elevate the head of the bed, take an immediate chest x-ray and then give them O2 and diuretics to get rid of this extra fluid. What can we do to prevent it? It would be to adjust the rate to the patient and any underlying conditions. So mostly patients with congestive heart failure as well as renal failure might be prone to fluid volume overload, so you might need to space out the transfusion over the maximum number of hours that's allowed for hours or even talk to the blood bank and reduce the volume that you've given them so that it's not the typical volume of around 300 milliliters, but maybe they can make half a bag, 150 that you can then administer over a very short, over a very long period of time, very slowly, to prevent this from happening. The other reaction that I didn't write on the board here that can occur is sepsis. So if the blood for some reason is contaminated with bacteria of any kind, it can cause sepsis in the patient and that, again, I discussed in a separate video in sepsis and septic shock. So thank you so much for watching this video on transfusion reactions. Please already also watch the video on the blood transfusions in general where I talk about the different types of blood that can be administered as well as the steps of how to set up a blood transfusion and hopefully prevent these reactions from occurring. Thanks for watching Nursing School Explained. See you soon.