The present day nursing literature provides us with only minimal data on hemolytic transfusion reactions, that is why Johnson, Viviana’s article Emergency Transfusion of Incompatible Red Blood Cells is especially valuable, being based on one concrete case observation.
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The author describes a 62-year-old woman’s case with gastrointestinal hemorrhage, threatening her life. The woman had a delayed hemolytic transfusion reaction after having been transfused 2 units of red blood cells. When the patient was in semiconscious condition the clinicians had to act without delay and regarded transfusion of incompatible RBCs less dangerous than pausing the transfusing. They decided to infuse methylprednisolone (120 mg) and to transfuse 4 units of ABO/Rh (D)-matched, cross-match-incompatible (3+) RBCs. The clinicians realized that they were taking certain risk, that is why they monitored the patient’s vital signs carefully. One hour after the transfusion the woman felt much better, her urine did not change its colour, hematocrit increase was sustained, as it had been planned before. Several hours after the transfusions all the transfused RBCs were U+. Methylprednisolone was discontinued five days later.
Viviana comes to a conclusion that not every reaction of crossmatch-incompatible transfusion will occur immediately, it may be delayed under certain circumstances. Transfusion of incompatibility with anti-A or anti-B RBCs may be life-threatening, but other serologic incompatibilities may be even life-saving. Among the latter are autoimmune hemolytic anemia, not reacting at 37°C antibodies and antibodies that occur naturally. In the case described, for example, The RBCs were crossmatch-incompatible due to a strongly reacting alloantibody. The overall transfusing of serologically incompatible RBCs is out of the question, but in some cases it may lessen the risk. It is of crucial importance to collect materials about similar cases in order to share the experience.
The article in question is a very informative one and raises a serious problem. Dealing with the transfusion reactions is not easy to make the correct diagnosis, as they may be delayed or unrecognized. Very often there is only minor or no morbidity and they may be unnoticed, that may lead to serious transfusion reactions in future. It was very useful for me to learn about one more example about clinicians doing their work good enough to save the woman’s life. They managed to predict and analyze all possible reactions and consequences, though some of them even were delayed. It demonstrates a high professional level, as the correct diagnosing in the working atmosphere when a human’s life depends upon your decisions and there is no time to hesitate and there one have no right for a mistake. Most of the patients are much more afraid of the infectious diseases being transmitted through the transfusion, they do not even know that other transfusion reactions may be not less serious and though common enough very often may be left undetected.
Johnson, Viviana’ s article not only informs about the experience of transfusing incompatible RBCs to a 62-year-old woman and the successful outcome, but claims the potential readers’ attention to the fact that every case is unique and only a person making such decisions bears the full responsibility for the consequences. “Surely, we do not encourage a cavalier approach to transfusing serologically incompatible RBCs” (Johnson, 2009, p. 1515). I acknowledged the information with appreciation, it inspired me for further searches of guidelines on urgent transfusion and more theoretical material about transfusing serologically incompatible RBCs.
Johnson, V, Langeberg A., & Sandler, G. (2007). Emergency Transfusion of Incompatible Red Blood Cells. Arch Pathol Lab Med, Volume 131, 1515.