Can back and bilateral arm pain during a blood transfusion be a sign of a transfusion reaction in a patient with a history of anemia, thalassemia, and diabetes mellitus (DM) type 2?

From the Guidelines

Yes, back and bilateral arm pain during a blood transfusion can be a sign of a transfusion reaction in a patient with a history of anemia, thalassemia, and diabetes mellitus type 2. Given the patient's history of thalassemia and anemia, they are at a higher risk of developing alloantibodies due to repeated transfusions, which increases their risk of transfusion reactions 1. The symptoms presented, such as back and bilateral arm pain, are consistent with a possible transfusion reaction, and it is crucial to take immediate action to ensure the patient's safety.

Key Considerations

• The patient's transfusion should be stopped immediately, and medical attention should be sought.
• These symptoms may indicate an acute hemolytic transfusion reaction, which occurs when the recipient's antibodies attack the donor red blood cells.
• Other signs to watch for include fever, chills, hypotension, chest pain, shortness of breath, nausea, or skin rash.
• Management includes stopping the transfusion, maintaining IV access, supporting blood pressure, administering antihistamines or steroids if needed, and collecting blood samples for further testing.
• Patients with chronic conditions requiring multiple transfusions should be closely monitored during each transfusion, and pre-medication with acetaminophen and diphenhydramine may be considered for those with a history of mild reactions.

Next Steps

• Monitor the patient closely for any further symptoms or signs of a transfusion reaction.
• Consider consulting with a hematologist or a transfusion specialist to discuss the best course of action for the patient's ongoing transfusion needs.
• Develop a detailed transfusion plan to minimize the risk of future transfusion reactions, taking into account the patient's history of thalassemia and anemia 1.

From the Research

Transfusion Reactions and Adverse Events

• Blood transfusions can carry considerable risks, including transfusion reactions and adverse events 2
• Symptoms of transfusion reactions are often overlapping and nonspecific, making diagnosis and management critical 2

Delayed Hemolytic Transfusion Reactions

• Delayed hemolytic transfusion reactions can occur several days after transfusion, even with cross-matched compatible blood 3, 4
• These reactions can manifest as acute hemolysis, severe vaso-occlusive crisis, and profound anemia, often with reticulocytopenia 3
• Patients may experience symptoms such as back pain, fever, jaundice, and fatigue 3, 4

Clinical Presentation and Diagnosis

• The clinical presentation of delayed hemolytic transfusion reactions can be complex and mimic other complications of underlying conditions, such as sickle cell disease or thalassemia 3
• Laboratory tests, including anti-RBC antibodies, can help diagnose delayed hemolytic transfusion reactions 4
• A high index of suspicion is necessary to recognize and respond to these reactions appropriately 5

Management and Response

• When a transfusion reaction is suspected, it is critical to stop the transfusion immediately and report the reaction to the blood bank 2
• Nurses need to be able to recognize and respond to transfusion reactions, including delayed hemolytic transfusion reactions, to ensure patient safety 5
• In the case of the patient with a history of anemia, thalassemia, and diabetes mellitus (DM) type 2, the back and bilateral arm pain during the blood transfusion could be a sign of a transfusion reaction, and further evaluation and management are necessary 2, 3, 4