A client who received a blood transfusion 4 weeks ago now exhibits symptoms including fever, rash, diarrhea, and pancytopenia.
What complication might be responsible for these symptoms?
Delayed hemolytic reaction.
Graft-versus-host disease.
Transfusion-associated graft-versus-host disease (TA-GVHD)
Post-transfusion purpura.
The Correct Answer is C
Choice A rationale:
Delayed hemolytic reaction occurs more than 24 hours after a blood transfusion and is characterized by a drop in hemoglobin levels, jaundice, and a positive direct antiglobulin test (Coombs test)
It does not typically present with fever, rash, and pancytopenia, so it is not the best choice for the given symptoms.
Choice B rationale:
Graft-versus-host disease (GVHD) is a condition where donor T lymphocytes attack the recipient's tissues, often seen in bone marrow or stem cell transplant recipients.
While it can cause pancytopenia, it typically occurs within a few weeks of transplantation, not four weeks after a blood transfusion.
Therefore, it is less likely to be the cause in this scenario.
Choice C rationale:
Transfusion-associated graft-versus-host disease (TA-GVHD) occurs when viable T lymphocytes in the transfused blood attack the recipient's tissues.
Symptoms can include fever, rash, diarrhea, and pancytopenia.
TA-GVHD is a delayed complication of transfusion that typically presents about 1 to 6 weeks post-transfusion, making it the most likely cause of the symptoms described in the scenario.
Choice D rationale:
Post-transfusion purpura is a rare condition that occurs 5 to 12 days after a transfusion and is characterized by sudden severe thrombocytopenia (low platelet count) and bleeding, often in the form of purpura.
It does not typically present with fever, rash, and pancytopenia, so it is not the best choice for the given symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Transfusion-related acute lung injury (TRALI) is characterized by acute respiratory distress and is usually not associated with abdominal symptoms.
TRALI is more common in patients receiving plasma-containing blood products.
Choice B rationale:
Transfusion-associated circulatory overload (TACO) occurs when a patient receives a volume of blood or blood products that exceeds their circulatory system's capacity.
Symptoms include dyspnea, orthopnea, tachypnea, and crackles on lung auscultation, which match the symptoms described in the question.
This condition is more likely when blood products are transfused too rapidly or in excessive volume.
Choice C rationale:
Allergic reactions to blood transfusions typically present with symptoms like itching, hives, and flushing, rather than the respiratory symptoms and crackles on lung auscultation described in the question.
Choice D rationale:
Febrile nonhemolytic reactions are characterized by fever and chills and do not typically manifest as dyspnea, orthopnea, tachypnea, or crackles on lung auscultation.
Correct Answer is C
Explanation
Acute hemolytic reaction.
Choice A rationale:
A febrile nonhemolytic reaction typically presents with fever, chills, and rigors but is not associated with back pain, chest pain, dyspnea, or jaundice.
It is often caused by antibodies to leukocytes or platelets in the donor's blood.
This reaction is usually mild and self-limiting.
Choice B rationale:
Allergic reactions typically present with symptoms like urticaria, pruritus, flushing, and can include mild to moderate fever, but they do not cause back pain, chest pain, dyspnea, or jaundice.
These reactions are usually associated with sensitivity to plasma proteins or allergens in the blood product.
Choice C rationale:
Acute hemolytic reactions involve the rapid destruction of red blood cells, leading to the release of hemoglobin into the bloodstream.
This can cause fever, chills, back pain, chest pain, dyspnea, and jaundice, making it the most likely reaction in this case.
It is usually due to ABO incompatibility between the donor and recipient blood.
Choice D rationale:
Transfusion-associated circulatory overload (TACO) typically presents with symptoms related to volume overload, such as pulmonary edema, hypertension, and tachycardia.
It does not typically manifest with fever, chills, back pain, chest pain, dyspnea, or jaundice.
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