A patient is receiving a blood transfusion after a reoperative laparotomy for small bowel obstruction. The nurse notes that the blood has clotted in the tubing. What is the most likely cause?
|B||Minor blood group incompatibility|
|D||Transfusion through ringer’s lactate|
a. Immediate hemolytic reactions occur during transfusion of mismatched blood (usually ABO mismatch) and are characterized by intravascular destruction of red blood cells and consequent hemoglobinemia and hemoglobinuria.
b. Circulating haptoglobin is capable of binding 100 mg hemoglobin/dL plasma, and the complex is cleared by a specific hemoglobin-haptoglobin scavenger receptor on macrophages.
c. When the binding capacity is exceeded, free hemoglobin circulates, and the heme is released and combines with albumin to form methem-albumin.
d. When the free hemoglobin exceeds 25 mg/dL some is excreted in the urine, but in most individuals, hemoglobinuria occurs when the plasma level exceeds 150 mg/dl
e. If the patient is awake, the most common symptoms of immediate transfusion reactions are heat and pain along the vein into which the blood is being transfused, flushing of the face, pain in the lumbar region, and constricting chest pain.
f. The patient might experience chills, fever, respiratory distress, hypotension, and tachycardia. In patients who are anesthetized and have an open wound, the two dominant signs are diffuse bleeding and hypotension.
g. There is a sudden fall in the platelet count, an increase in fibrinolytic activity, and consumption of coagulation factors, especially factors V and VIII.
h. The mortality and morbidity rates are very high if the patient has received a full unit of incompatible blood.