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EPA Training: Transfusion Reaction Reporting

Vignette One (1)

Dr. Hill calls you (the attending) about a transfusion reaction that was just reported to the blood bank. She is concerned because the signs and symptoms included rigors, an increase in temperature of 2°C, and gross hematuria. She is concerned that this might be an acute hemolytic transfusion reaction, and is nervous because she hasn’t dealt with one before.

Attending: Have you talked to the clinical team yet about this patient? Do they have any other symptoms?
Dr. Hill: No, the reaction workup order was just placed and I think from the symptoms it might be an acute hemolytic transfusion reaction (AHTR). I am not really sure what to ask about or recommend when I call, and since it could be serious, I wanted to get it right.
Attending: Thanks for checking in with me! Please do alert the team that this could be an AHTR. Ask about additional symptoms such as flank pain or bleeding. Also, what are the vital signs? Is the patient hypotensive? How is the renal function?
Dr. Hill: Ok. I didn’t think to look at the rest of the vital signs once I saw the fever.
Attending: Also, you might want to recommend a DIC panel and LDH, haptoglobin and bilirubin levels.
Dr. Hill: Do I need to recommend anything clinically?
Attending: They should monitor vital signs closely for hypotension. They should also keep the patient well hydrated to protect the kidneys. Hopefully, we can get the DAT completed ASAP and figure this out.

Follow up:
Dr. Hill: So, the DAT was negative and it turns out the patient was admitted this morning with neutropenic fever. They also have a platelet count of 3 and had hematuria on admission. I know I was worried about an acute hemolytic transfusion reaction, but I wrote it up as due to their underlying condition.
Attending: I agree that it is most likely their neutropenic fever, but we can’t definitively rule out a febrile non-hemolytic transfusion reaction (FNHTR), so we need to amend the diagnosis to include a possible FNHTR.
View Vignette One (1) Above,

Then please continue to the training report questions below, evaluating Dr. Hill on her performance of the following knowledge and skill statements:
Provides direction for complete laboratory evaluation of the adverse reaction:
Assesses and evaluates patient clinical history, signs and symptoms, radiology findings, and lab testing to determine the cause of the adverse reaction:
Provides appropriate recommendations for treatment interventions to manage adverse reactions as indicated:
Documents the adverse event and workup, classifying the reaction, providing guidance for additional transfusions, and documenting communication with clinical providers regarding the adverse reaction:
Understands the need for reporting the adverse event to the appropriate regulatory authority (ex. transfusion-transmitted infection reported to donor center):
Give at least 1 specific aspect of the EPA performed well based on review of the Formative Assessments:
Give at least 1 specific suggestion for improvement based on review of the Formative Assessments:
Based on your current observation of this resident, please rate the level of supervision that was needed to evaluate and report adverse events involving the transfusion of blood components:(Required.)
What component(s) of trust did the trainee demonstrate well? (select all that apply)(Required.)
What component(s) of trust does the trainee have an opportunity to improve on? (select all that apply)(Required.)
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