A nurse is preparing a blood transfusion for an anemic toddler. Which of the following blood transfusion matches would cause a hemolytic reaction?

A-negative blood to a B-negative patient

Explanation

•A hemolytic reaction would occur with A-negative blood given to a B-negative patient due to an ABO incompatibility even though they are both Rh negative.

•A hemolytic reaction occurs with a Rh or ABO incompatibility.

•The Rhesus factor is the presence of proteins on the cell, which is what the body reacts to. Rh-negative blood can donate to Rh-positive blood if it's the same type because there are no proteins.

•O-negative is the universal donor because it does not have A or B properties, and A and B blood types do not have O antibodies.

•AB patients can receive either A or B blood types, as long as there is a Rh compatibility.

Acute hemolytic transfusion reactions are commonly caused by an ABO incompatibility and occur during the transfusion or within 24 hours after. The patient may report burning at the IV site, chills, and pain in the back and flank. Fever may be noted. Incompatible RBCs with antigens from the wrong blood group are attacked and destroyed by antibodies in the patient’s plasma, leading to widespread hemolysis. These antibodies activate complement, and tissue factor is released by RBC debris, triggering the clotting cascade. Disseminated intravascular coagulation (DIC) results, causing shock, acute renal failure, and even death.

Delayed hemolytic transfusion reactions occur between 1 day and 14 days after a transfusion. Donor RBCs are destroyed, but the hemolysis is "delayed" because the antibodies are only present in low amounts initially. The recipient's antibodies were formed during a previous sensitization, often from a previous transfusion. When the cross match was done, the level of antibody in the recipient's plasma was too low to cause agglutination, and during the transfusion, the level of antibody was too low to cause an acute transfusion reaction. However, when the patient re-encounters the antigen, the patient rapidly produces more antibodies (secondary stimulation). Over the following days, the antibodies bind to the donor RBCs, which are subsequently removed from the circulation by macrophages. This type of reaction is usually much less severe than acute hemolytic reactions.

Anaphylaxis is a life-threatening allergic reaction that can occur after only a few milliliters of blood have been transfused. The patient reports difficulty breathing, wheezing, and coughing. There may be nausea and vomiting, but no fever. Other signs include low blood pressure, loss of consciousness, respiratory arrest, and circulatory shock. Urgent treatment is essential and includes giving epinephrine. Usually the antigen that triggers the anaphylaxis is not known.

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