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Transfusion Reaction - hypotension or hypertension


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According to the Technical Manual, a sign of a transfusion reaction may include hypertension or hypotension. Does anyone have these defined? Our nursing form just states a "drop in blood pressure" with no clear guideline whereas for temperature we state an increase of 1C. I have looked through a few books and nothing gives a clear guideline.

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According to the Technical Manual, a sign of a transfusion reaction may include hypertension or hypotension. Does anyone have these defined? Our nursing form just states a "drop in blood pressure" with no clear guideline whereas for temperature we state an increase of 1C. I have looked through a few books and nothing gives a clear guideline.

· Temperature: A ≥1˚ C rise, or ≥ 2˚ F rise, in temperature above 37˚ C or 98.6˚ F

· Hypertension (blood pressure increase of ≥ 50 mmHg)

· Hypotension (blood pressure decrease of ≥ 30 mmHg)

· Respiratory Distress with Hypotension

· Bronchospasm

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That is one parameter that we had defined in the past (like rise in temp), but on one of our last revisions of the vitals form, we left it up to the transfusionist to determine what was significant. We have it on the form as "marked hypotension".

Scott

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I chased this idea pretty hard a view years back but it is really hard to pin down. BP may increase just because the patient is getting blood volume, not to mention the effects of pressor drugs, pain and exertion etc. I concluded that if I tried to be too precise I might be wrong in either direction at various times. The patient that starts with a BP of 70 over nothing but is resuscitated back to 130/70 certainly isn't hypertensive.

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· Temperature: A ≥1˚ C rise, or ≥ 2˚ F rise, in temperature above 37˚ C or 98.6˚ F

· Hypertension (blood pressure increase of ≥ 50 mmHg)

· Hypotension (blood pressure decrease of ≥ 30 mmHg)

· Respiratory Distress with Hypotension

· Bronchospasm

clarify that are you talking about systolic BP

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The problem with having a "solid number" is that if the "professional judgement" of the transfusionist determines that it is OK to ignore it, you would have a documented instance of a guideline not being followed. If an inspector ever sees such as transfusion record, can you be sure that the documentation is adequate to ignore the guidline set by the blood bank service?

For this reason we dropped the precise definition for high or low BP (to indicate a possible transfusion reaction) on our transufion vitals documentation. I believe it was suggested by an inspector years ago.

Scott

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Scott,

I review all transfusion records myself. When there is an outlier for any reason (rise or drop in BP, temp spike, heartrate increase, etc.) I route a copy of the record to the nursing part of the equation that delves into these aspects described by the "solid numbers". Upon chart review the documentation either explains the reason or not. Either way the information is reviewed at transfusion committee and any followup with nursing regarding the outliers is addressed as well. Inspectors seem to be fine with it (and they have dug into it on several occassions). As with everything inspection wise it is subject to inspector interpretation to some degree.

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