From the Research
The patient is likely experiencing a transfusion reaction, possibly an allergic or anaphylactic reaction to either the tranexamic acid (TXA) or components in the blood product. Immediate management should include stopping the transfusion, maintaining the IV access with normal saline, and monitoring vital signs. Treatment typically involves administering diphenhydramine 25-50mg IV for mild reactions, with addition of hydrocortisone 100mg IV and epinephrine 0.3-0.5mg IM (1:1000 solution) for more severe reactions. Oxygen and airway management may be necessary if respiratory symptoms develop. The reaction occurs because foreign proteins in blood products or the TXA itself can trigger mast cell degranulation and histamine release, leading to the classic symptoms of itching (pruritus), increased heart rate (tachycardia), and nausea. TXA-related reactions are less common but can occur, while blood transfusion reactions happen in approximately 1-3% of transfusions, as noted in a review of transfusion reactions and adverse events 1. Some studies have investigated the use of TXA in various settings, including its efficacy and safety in major non-cardiac surgeries at high risk for transfusion 2, and its use in prehospital settings for patients at risk for hemorrhage 3. However, the most relevant information for this patient's situation comes from the understanding of transfusion reactions and the appropriate management strategies. Future transfusions should be approached with caution, possibly with premedication and slower infusion rates, and the reaction should be documented in the patient's medical record to guide future care. It's also worth noting that while TXA has been shown to reduce the need for blood transfusion in certain contexts, its effectiveness can vary depending on the specific condition being treated, as seen in a study on its use in lower gastrointestinal bleeding 4. Given the potential for transfusion reactions, it is crucial to prioritize the patient's safety and adjust treatment plans accordingly. Key considerations include:
- Stopping the transfusion immediately if a reaction is suspected
- Administering appropriate treatment for the reaction, such as diphenhydramine, hydrocortisone, and epinephrine
- Monitoring the patient's vital signs and providing supportive care as needed
- Documenting the reaction and adjusting future treatment plans to minimize the risk of similar reactions.