To help establish a diagnosis of hemolytic transfusion reaction, the nurse should assess the client for.. Flank pain

A client receiving a unit of packed red blood cells. Fifteen minutes following the start of the transfusion, nurse Marlyn notes the client is flushed, febrile, and having chills.

To help establish a diagnosis of hemolytic transfusion reaction, the nurse should assess the client for:
a- Headache
b- Anxiety
c- Urticaria
d- Flank pain

Answer D.

Flank pain and hematuria are classic manifestations of a hemolytic transfusion reaction.

As the kidneys work to excrete hemolyzed red blood cells, the client may progress to acute renal failure.
Other manifestations include headache, feelings of doom, tachycardia, and hypotension leading to shock.

Unless treated immediately, a hemolytic transfusion reaction will rapidly progress to coma and death.

Transfusion reactions are adverse events related to blood transfusions occurring in recipients.

They can go unnoticed or in the extreme being fatal.

They can occur during or within hours of transfusion (acute immediate reactions) or after several days or weeks (delayed reactions).

Their declaration is compulsory, and the evaluation of these undesirable effects in recipients is covered by the hemovigilance system which is regulations defined in France by law n ° 93-5 of January 4, 1993.

This makes it possible to define a level of severity (from 1 [not severe] to 4 [death]) and 5 levels of accountability (from 0 [exclusion] to 3 [certainty] with a non -assessable level).

Transfusion reactions can be immunological or non -immunological mechanisms and their diagnosis is sometimes difficult because there is no specific symptomatology.

The most frequent clinical signs are fever, chills, hives and pruritus.

Some disappear spontaneously or with symptomatic treatment.

However, others, such as hypotension, even a state of shock, hemoglo-binuria or respiratory distress, testify to a severe reaction.

Whether immediate or delayed, depending on their mechanism, the immunological, infectious or overload transfusion reactions are distinguished.

Epidemiology:

Some reactions are very frequent (minimal allergic reactions, non -hemolytic febrile reaction) while others are rarer (anaphylaxis, hemolytic or septic shock).

The incidence of adverse events in the receiver is estimated for 2016 at 216.2 per 100,000 transfused bloody products.

The first three diagnoses with a level of accountability of 1 to 3 declared are allo-immunization (85/100,000), non-hemolytic febrile reactions (56/100,000) and allergy (33/100,000).

Mortality is most often the fact of acute edema of the lung of overload, post-transfusion treble syndromes (Transfusion-Related Acute Lung Injury [Trali]), infectious shocks or a longer-term death linked to the transmission of infectious pathologies.

In 2016.2 Deaths were linked to 2 overload pulmonary edema, 2 allergies, and 1 bacterial infection transmitted by transfusion.

However, the prevention measures implemented for many years tend to reduce their occurrence more and more and in particular severe forms.

Immediate transfusion reactions:

Immunological causes:

Acute hemolysis:

It can be the result of an antigen-anticorps conflict leading to intravascular and/or intratuly destruction of the transfused red blood cell.

However, it should be noted that there are also non -immunological destruction of red blood cells transfused by mechanical, osmotic or thermal mechanisms.

The antibodies involved can be those of the ABO system (the most serious) or other HR, Kell, Duffy, Kidd, MNS, etc. systems, etc.

Clinical manisfests can be more or less noisy, ranging from a simple fever to hemolytic shock with lumbar pain, hemoglobinuria and discusminate intravascular coagulation.

The diagnosis is based on the highlighting of hemolysis stigmata (haptoglobin, lacticodeshydrogenase, bilirubin, etc.), awareness of hematies in vivo by the direct antiglobulin test (Direct Coombs test) and on identification of antibodies guilty by direct examination to antiglobulin.

Prevention is based on strict identity rules, respect for the compatibility of blood groups and on the performance of antibodies detection by the search for irregular agglutinins before transfusion.

Non -hemolytic feverish reaction:

It is most often linked to the injection of cytokines present in the products, in particular the platelets which relaar these mediators in the environment during their conservation.

It can also be the result of an antigen-antibody conflict in the HLA system generating the synthesis of cytokines.

This is a diagnosis of exclusion that must be retained after eliminating all other causes of fever.