The patient receiving chemotherapy for breast cancer develops a fever of 39.8°F and heart rate of 121 bpm. Within hours, the blood pressure drops from 128/89 mmHg to 91/54 mmHg, capillary refill time increases to 5 seconds, and urine output drops to less than 0.5 mL/kg/hour. Right-sided weakness, slurring of the words, and confusion occurs rapidly and subsides within 2 hours. Hemoptysis is also noted and the gums are oozing. Multiple transfusions are ordered. Which blood product does the nurse administer first?

Question

The patient receiving chemotherapy for breast cancer develops a fever of 39.8&deg;F and heart rate of 121 bpm. Within hours, the blood pressure drops from 128/89 mmHg to 91/54 mmHg, capillary refill time increases to 5 seconds, and urine output drops to less than 0.5 mL/kg/hour. Right-sided weakness, slurring of the words, and confusion occurs rapidly and subsides within 2 hours. Hemoptysis is also noted and the gums are oozing. Multiple transfusions are ordered. Which blood product does the nurse administer first?

Accepted Answer

Cryoprecipitate. Cryoprecipitate contains clotting factors that are vital for the patient in disseminated intravascular coagulation. The patient receiving chemotherapy is immunosuppressed and begins showing signs of sepsis (fever and tachycardia followed by hypotension and poor perfusion). The right-sided weakness that appeared suddenly and resolved quickly indicates a transient ischemic attack, which is an early sign of disseminated intravascular coagulation (DIC). The hemoptysis and bleeding gums indicate the patient is entering the hemorrhagic stage of DIC; cryoprecipitate is the treatment of choice for this stage. The patient will likely require platelets, fresh frozen plasma, and packed red blood cells, also, but cryoprecipitate is the most important to be given first.

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