Comprehensive Nursing Pharmacology Q 52
A month after receiving a blood transfusion an immunocompromised male patient develops a fever, liver abnormalities, a rash, and diarrhea. The nurse would suspect this patient has:
A. An allergic response to a recent medication.
B. Graft-versus-host disease (GVHD).
C. Myelosuppression.
D. Nothing related to the blood transfusion.
Correct Answer: B. Graft-versus-host disease (GVHD)
GVHD occurs when white blood cells in donor blood attack the tissues of an immunocompromised recipient. This process can occur within a month of the transfusion. Options 1 and 4 may be a thought, but the nurse must remember that immunocompromised transfusion recipients are at risk for GVHD. Graft-versus-host disease (GvHD) is a systemic disorder that occurs when the graft’s immune cells recognize the host as foreign and attack the recipient’s body cells. “Graft” refers to transplanted, or donated tissue, and “host” refers to the tissues of the recipient. It is a common complication after allogeneic hematopoietic stem cell transplant (HCT)
Option A: Allergic reaction, often manifested as urticaria and pruritis, occurs in less than 1% of transfusions. More severe symptoms, such as bronchospasm, wheezing, and anaphylaxis are rare. Allergic reactions may be seen in patients who are IgA deficient as exposure to IgA in donor products can cause a severe anaphylactoid reaction. This can be avoided by washing the plasma from the cells prior to transfusion. Mild symptoms, such as pruritis and urticaria can be treated with antihistamines. More severe symptoms can be treated with bronchodilators, steroids, and epinephrine.
Option C: Another effect of receiving a blood transfusion, immunosuppression, causes a decreased immune response that compromises patients’ ability to fight off infection or tumor cells. These effects – sensitization and immunosuppression – are thought to be due largely to white blood cells present in the transfusion product.
Option D: There are multiple complications of blood transfusions, including infections, hemolytic reactions, allergic reactions, transfusion-related lung injury (TRALI), transfusion-associated circulatory overload, and electrolyte imbalance. According to the American Association of Blood Banks (AABB), febrile reactions are the most common, followed by transfusion-associated circulatory overload, allergic reaction, TRALI, hepatitis C viral infection, hepatitis B viral infection, human immunodeficiency virus (HIV) infection, and fatal hemolysis which is extremely rare, only occurring almost 1 in 2 million transfused units of RBC.