CRNI Blood Component Transfusion Questions and Answers 1 — Questions and Answers
Question 1: A patient receiving a unit of packed red blood cells (PRBCs) begins to complain of flank pain, chills, and shortness of breath 20 minutes after the transfusion was initiated. The CRNI notes the patient's temperature has risen to 101.5°F (38.6°C). What is the CRNI's PRIORITY action?
- Notify the provider of the symptoms.
- Stop the transfusion immediately and disconnect the tubing. (Correct answer)
- Administer an ordered antipyretic for the fever.
- Increase the rate of the concurrent normal saline infusion.
Correct answer: Stop the transfusion immediately and disconnect the tubing.
The patient is exhibiting classic signs of an acute hemolytic transfusion reaction (AHTR), a life-threatening emergency. The absolute first priority is to stop the infusion of the incompatible blood to prevent further hemolysis and end-organ damage. After stopping the transfusion, the nurse should maintain IV access with normal saline, notify the provider and blood bank, and monitor the patient closely.
Question 2: A CRNI is preparing to administer a blood component. Which intravenous solution is the only one considered compatible for priming blood administration tubing and infusing concurrently with packed red blood cells?
- Lactated Ringer's solution
- 5% Dextrose in Water (D5W)
- 0.9% Sodium Chloride (Correct answer)
- 0.45% Sodium Chloride
Correct answer: 0.9% Sodium Chloride
0.9% Sodium Chloride (Normal Saline) is the only solution compatible with blood components. It is an isotonic solution that will not damage the red blood cells. Dextrose solutions (like D5W) can cause hemolysis, and solutions containing calcium (like Lactated Ringer's) can chelate the citrate anticoagulant in the blood product, leading to clot formation in the tubing.
Question 3: An elderly patient with a history of congestive heart failure is receiving a unit of PRBCs. The nurse assesses the patient and notes new onset of a dry cough, dyspnea, and bilateral crackles in the lung bases. The patient's blood pressure is 160/92 mmHg, an increase from 134/80 mmHg pre-transfusion. The CRNI should suspect which transfusion-related complication?
- Febrile non-hemolytic reaction
- Anaphylactic reaction
- Transfusion-Associated Circulatory Overload (TACO) (Correct answer)
- Transfusion-Related Acute Lung Injury (TRALI)
Correct answer: Transfusion-Associated Circulatory Overload (TACO)
The patient's clinical presentation, including dyspnea, crackles, cough, and hypertension, in the context of a history of heart failure, is classic for Transfusion-Associated Circulatory Overload (TACO). This occurs when the patient's cardiovascular system is unable to manage the additional fluid volume from the transfusion. TRALI typically presents with hypotension, not hypertension.
Question 4: To mitigate the risk of a febrile non-hemolytic transfusion reaction (FNHTR) in a patient who has a history of such reactions, which type of blood component modification is most appropriate?
- Irradiated
- Washed
- CMV-negative
- Leukoreduced (Correct answer)
Correct answer: Leukoreduced
Febrile non-hemolytic transfusion reactions are primarily caused by cytokines released from donor leukocytes (white blood cells) that accumulate during storage. Leukoreduction is the process of filtering out these leukocytes from the blood component before transfusion, thereby significantly reducing the risk of FNHTR. Irradiation prevents graft-versus-host disease, and washing removes plasma proteins to prevent severe allergic reactions.
Question 5: A CRNI is at the bedside with another licensed nurse to perform the final verification before starting a blood transfusion. They discover that the medical record number on the blood bag's compatibility tag does not exactly match the medical record number on the patient's identification band. What is the most appropriate action?
- Do not start the transfusion and immediately return the unit to the blood bank. (Correct answer)
- Ask the patient to state their name and birthdate to resolve the discrepancy.
- Begin the infusion at a very slow rate while a third nurse verifies the information.
- Correct the number on the compatibility tag with a pen and have both nurses co-sign.
Correct answer: Do not start the transfusion and immediately return the unit to the blood bank.
The bedside verification by two licensed professionals is the final critical safety check to prevent a potentially fatal ABO incompatible transfusion. Any discrepancy, no matter how small, is an absolute contraindication to starting the transfusion. The unit must not be spiked or administered and should be returned immediately to the blood bank for resolution of the discrepancy.
Question 6: Which of the following is a critical nursing consideration specific to the administration of platelets?
- Administering the component through a micro-aggregate filter (20-40 microns).
- Infusing the component slowly over a period of 3 to 4 hours.
- Using a dedicated administration set and infusing rapidly, typically over 30 to 60 minutes. (Correct answer)
- Ensuring the component is warmed to body temperature prior to infusion to activate the platelets.
Correct answer: Using a dedicated administration set and infusing rapidly, typically over 30 to 60 minutes.
Platelets are fragile and must be administered through a standard 170-260 micron filter, not a micro-aggregate filter. To maintain their viability and function, they should be infused relatively quickly, usually over 30-60 minutes. Platelet-specific administration sets with shorter tubing are often used to minimize component loss due to adherence to the tubing surface. Slow infusion can decrease platelet efficacy.
CRNI Blood Component Transfusion Questions and Answers 1
A patient receiving a unit of packed red blood cells (PRBCs) begins to complain of flank pain, chills, and shortness of breath 20 minutes after the transfusion was initiated.
The CRNI notes the patient's temperature has risen to 101.5°F (38.6°C).
What is the CRNI's PRIORITY action?