PART TWO

It is crucial for advanced nurse practitioners to understand the types of blood and the mechanisms that take place during transfusion reaction. The case study is about a patient who as experienced an accident and has suffered sustained injuries that require his spleen to be removed. The possibility is that the spleen ruptured in this accident and he is suffering from the internal bleed. Data also indicate that the patient is barely conscious, pale, and weak with thread pulse. The objective data shows that the vital signs are similar to a person experiencing blood loss. The increased pulse lowered pressure, increased temperature and respirations seem to point out an acute reaction from transfusion.

Though most complications are with fewer complications, there are some instances when they go wrong leading to serious medical complications. The common blood types are A, B, O and AB and every person can have either the Rh negative or RH positive blood. Before commencing on transfusion, it is crucial to know which blood type the patient has and his or her Rh status. Incorrect blood transfusion means that the antibodies in the blood will attack the new blood making the patient sick. It causes alloimmunity which is a reaction of the immune systems against the tissues from another person. Hemolytic transfusion reaction happens when symptoms, clinical and laboratory signs contribute to increased destruction of the red cell as a result of transfusion. In the case of acute hemolytic transfusion reactions (AHTRs) symptoms can show in just a few minutes of begin the transfusion. Some laboratory features are hemoglobinuria, haemoglobinemia, unconjugated hyperbilirubinemia, decreased serum haptoglobin, increased serum glutamic-oxaloacetic transaminase levels and Lactate dehydrogenase and a decrease of hemoglobin. The interaction of the preformed antibodies of the recipient with the red cells antigens of the donor result to immediate destruction of the red cells being transfused on the immunologic basis for AHTRs. Rarely does the ABO-incompatible plasma transfusion such as ABO palette transfusion mismatch causes the hemolysis of the red cells of the patient especially when the donor has a high tier of ABO antibodies. Reactions after blood transfusion can result from unintentional administration of blood group A and Group AB red cells when transfused to group O recipient (McCance, Huether, & Brashers, 2013).

 Basile and his colleagues (2012) indicate that the kidneys receive 25% of cardiac output. The maintenance of a normal GFR mainly relies on sufficient perfusion. Any deficiency in circulation such as hemorrhage both externally or internally will result in significant impact on renal perfusion. For the case study the patient is clearly suffering from decreased perfusion ( characterized by hypertensive, pale, thread pulse as well as tachycardia) and is in need of blood transfusion.

Thus the most likely organs facing severe damage in this patient are the kidneys. McCance and colleagues (2013) also show that “severe hypoxia results to stimulating the chemoreceptor of the aortic and carotid bodies and decreases the renal blood flow through sympathetic stimulation. Furthermore Epinephrine and Norepinephrine work in decreasing the renal blood flow and GFR and promote the afferent arteriolar vasoconstriction” (pp 278, 1327)). Disseminated intravascular coagulation (DIC) and kidney failures are the likely complications of blood transfusion reaction and the late signs. Some early signs of acute transfusion reaction can include chills, wheezing, and fever, vomiting, flushing and wheezing (Hemlata & Verma, 2014).

 If the patient survives the transfusion reaction and other complications of the car accident, the kidney is the organ that will be severely damaged. The scenario indicates that the spleen was removed after probably being lacerated or damaged from the abdominal trauma. The spleen is a highly vascular organ that holds 25% of the lymphoid tissue of the body and stores about 33% of blood circulation. The spleen has both the immunological and hematological functions. Thus due to the ischemia the first organs to be damaged are the kidneys (Khamechian et al., 2013).

         

References

 Hemlata S. & Verma A. (2014). Adverse events related to blood transfusion. Indian Journal of Anesthesia, 58 (5). Doi: 10.4103/0019-5049.144650

 Khamechian T, Alizargar, J., & Farzanegan M (2013). Pattern of SPlemectomy indications in Kasha Shahid-Bethesti Hospital: a five year study. Archives of Trauma Research 1 (4). Doi 10.5812/atr.8258

 McCance K. Huether S. Brashers V. and Rote N. (2013). Pathophysiology: the biologic basis for diseases in adults and children, p 78. St. Louis MO: Mosby

Sherry Roberts is the author of this paper. A senior editor at Melda Research in best nursing writing services if you need a similar paper you can place your order for custom nursing papers.