Clinical meaning
Intravenous fluid therapy and blood product administration require understanding of osmolarity, oncotic pressure, and immunological compatibility. Isotonic crystalloids (0.9% NaCl, lactated Ringer's) distribute primarily to the extracellular space with only about 25% remaining intravascular after one hour; colloids (albumin) exert oncotic pressure that retains fluid intravascularly. Transfusion of packed red blood cells restores oxygen-carrying capacity by providing functional hemoglobin; however, ABO incompatibility triggers a type II hypersensitivity reaction where recipient antibodies bind donor red blood cell antigens, activating complement and causing massive intravascular hemolysis, hemoglobinuria, DIC, and potentially fatal acute kidney injury. Febrile non-hemolytic reactions result from recipient antibodies against donor leukocyte antigens, while transfusion-related acute lung injury (TRALI) involves donor antibodies activating recipient neutrophils in the pulmonary vasculature, causing non-cardiogenic pulmonary edema. The nurse verifies blood product compatibility using two-nurse verification at the bedside, monitors vital signs at baseline, 15 minutes, 30 minutes, and completion of transfusion, recognizes early signs of transfusion reaction (fever, chills, flank pain, urticaria, dyspnea), and implements the transfusion reaction protocol (stop transfusion, maintain IV access with normal saline, notify physician and blood bank, send blood samples for workup).