Could this have been a blood transfusion reaction?

Background... still a new nurse, 1 year experience on surgical unit and still learning every day.

Situation... I was taking care of a total hip arthroplasty patient who had only been out of surgery for around 12 hours, and her hemoglobin was <9 so I received an order to transfuse 2 units of blood. Thankfully she had 2 units of autologous blood available for use. Her temperature normally runs in the 97 degree range on a normal day. Around an hour into her first unit, her temp went up to 100.5, then for the rest of the transfusion it was back to normal - 97ish. Keep in mind that orthopedic patients frequently run temperatures soon after surgery since it's the body's normal healing response to the new joint in the body. She didn't develop chills, her pulse stayed the same, and her BP was also consistent. She ended the transfusion with good vitals and normal temp. Her vitals were also steady throughout the 2nd unit of blood. A couple hours later her temp was up to 101.2. When I ended my shift 7 or so hours after both units had transfused, the patients temperature was back to 98.0 and all other vitals were great.

Could this have potentially been a transfusion reaction? At the time I kept telling myself this is autologous blood and these patients commonly develop temperatures the night of the surgery. However when i was giving report the nurse told me she had seen a patient develop a reaction to autologous blood in the past. I always love ending my shift with something in the back of my mind before I go to sleep . As I replay the night in my mind, if I could redo the situation I would stop the transfusion, call the dr. just to be safe and see if he wanted me to continue the transfusion.
It doesn't sound like it to me.

Yeah it could have been a reaction. Even though it was her "own blood" you never know for sure. It could have not been her blood. You need to look into your hospital policy. Ours states that any increase greater than 1.6C degrees can be a reacton. I ultimately think it wasnt a reaction. I think as a new nurse you shouldn't get into the habit of not reporting something because its "normal" for post-ops to run a temp. Regardless of the blood or not, any spike in temp especially 101.2 needs to be reported to the physican. You don't know if the temp is from the surgery, or an infection.

Quote from BacktoBasicsYeah it could have been a reaction. Even though it was her "own blood" you never know for sure. It could have not been her blood. You need to look into your hospital policy. Ours states that any increase greater than 1.6C degrees can be a reacton. I ultimately think it wasnt a reaction. I think as a new nurse you shouldn't get into the habit of not reporting something because its "normal" for post-ops to run a temp. Regardless of the blood or not, any spike in temp especially 101.2 needs to be reported to the physican. You don't know if the temp is from the surgery, or an infection.

Doesn't sound like a transfusion reaction, no SOB? You won't always see SOB and sometimes with a mild temp the doc will continue transfusion until more obvious sx are seen and/or give benadryl and Tylenol. I would have given the doc a heads up at the time of 1st temp spike just to cover all bases though.Did she use her IS at all during the blood transfusion or after? That could be a reason her temp would go down? Was she receiving abx's? Many variables with a post op and what it could be. It's good you're questioning and asking advice.

Quote from 09NewGradTrue, and I did report the 101.2 to the physician, however this was after the transfusion. The physician also said he wasn't alarmed because temps post op are frequent.

Hi, I am an extremely old nurse. I (no one) can remember everything. I really don't know the answer without looking it up our blood transfusion reaction form. When I hung (hang? I'm having trouble with my tenses here) blood, I would get our "transfusion reaction" form. I would tape it to the IV pole. It has on it the specific reactions, what to look for, and what to do. What I am saying is get your hospital policy/protocol. Make a copy, ? down load it? to your ??app? phone/computer thingy. Or (gasp) actually have the paper in front of you. You don't have to guess, wonder, the information will be right there.The older I get and the more I nurse the more I am extremely comfortable with saying. I don't know that answer, or I don't remember, "but I can look it up."

I've not had a full blown reaction myself, but have assisted other nurses with their pts having reactions. But like you, I'm always very concerned and self-conscious about reactions. But what I've been told enough, and told new nurses following behind me is, if it's a reaction, you'll know it's a reaction. There won't just be one little s/sx. But how did the patient feel during the slight temp increase? But +1 to reading up on your unit/hospital policy on reactions is.

Quote from simbokaI've not had a full blown reaction myself, but have assisted other nurses with their pts having reactions. But like you, I'm always very concerned and self-conscious about reactions. But what I've been told enough, and told new nurses following behind me is, if it's a reaction, you'll know it's a reaction. There won't just be one little s/sx. But how did the patient feel during the slight temp increase? But +1 to reading up on your unit/hospital policy on reactions is.

Whenever I have had pts with a transfusion rxn, they have had more than a a temp. I'm not saying it wasn't a reaction, I'm just saying I've always seen more: chills, rigors, rash, itching, etc. One woman had terrible rigors and her temp. went from 97 something to like 98 something, but she was shaking like I never saw anyone shake, other than like someone emerging from anesthesia and having rigors.

My one experience with suspected blood transfusion reaction was from an autologous infusion. I called the physician, who insisted the blood should continue. After conferring with the house supervisor, I followed protocol and stopped the infusion. After talking with the patient's husband, I realized the patient had an auto-immune condition. This is why she had elected to use her own blood. I've forgotten which part of the blood was involved now (this was probably five years ago) but by giving the patient her own blood, I increased the volume of the portion of the blood that her immune system reacted to. Thankfully, Benedryl and Tylenol were effective. And it was verified that it was her own blood.

This is a good learning thread. From what I have read it does not sound like the patient reacted to the transfusion. However what would the consequences be for the patient in the long run if her body did indeed react to this transfusion and received all of the blood? From what I have read some people have reactions weeks after a transfusion, even though this is rare.