A 6-year-old child with β-thalassemia major is admitted for routine blood transfusion. The child has been receiving regular transfusions every 3-4 weeks since age 2. Which nursing intervention is most important to implement before administering the blood transfusion?
A 6-year-old child with β-thalassemia major requires regular blood transfusions to manage severe anemia and prevent complications.
1Administer prescribed iron supplements to enhance red blood cell production
2Assess for signs of iron overload including cardiac function and liver enlargement✓ 정답
3Encourage increased dietary intake of iron-rich foods before transfusion
4Obtain baseline hemoglobin level to determine transfusion volume needed
해설
Children with β-thalassemia major who receive chronic blood transfusions are at high risk for iron overload (hemosiderosis) because each unit of blood contains significant amounts of iron that accumulates in organs over time.
β-thalassemia major is a serious inherited hemoglobinopathy that requires lifelong transfusion therapy. Transfusions are essential for survival, but they carry a serious risk, particularly iron overload (hemosiderosis).
Each unit of transfused blood contains approximately 200-250 mg of iron, and the human body has a limited ability to excrete excess iron. Over time, iron gradually accumulates in vital organs such as the heart, liver, and endocrine glands. Iron overload can cause cardiomyopathy, liver fibrosis, diabetes, and growth delay.
Before each transfusion, nurses should assess for signs of iron overload, including hepatomegaly, splenomegaly, cardiac arrhythmias, and signs of heart failure. Monitoring serum ferritin levels and regular cardiac function assessment are important components of nursing care. Iron chelation therapy is typically initiated when ferritin levels exceed 1000 ng/mL.
Nursing assessment should include vital signs with special attention to cardiac rhythm and rate, abdominal examination for organ enlargement, and review of recent laboratory results including ferritin levels. This comprehensive assessment helps identify early signs of iron toxicity and guides treatment decisions.
Regular monitoring and early intervention can prevent or minimize the devastating complications of iron overload, making these assessments the highest priority nursing intervention before transfusion therapy.
Clinical Judgment
This question assesses the importance of Preventive Monitoring in chronic disease management. The patient is a child with β-thalassemia major receiving long-term regular blood transfusions. While the transfusions themselves sustain life, they cause the major treatment complication of Iron Overload. Therefore, a prerequisite for proceeding with transfusion 'safely' is to evaluate whether organ damage from previously accumulated iron is progressing before administering new iron. The assessment of cardiac function and hepatomegaly in option 2 is a key intervention focusing on the most serious target organs (heart, liver) of iron overload.
Memory Tip:
Thalassemia + Transfusion = Think Toxicity (Iron).
For thalassemia patients receiving regular transfusions, iron toxicity must always be kept in mind. The core of pre-transfusion assessment is the "Fe-Overload Check."
KR vs US
While a relatively rare disease in Korea, it is more commonly encountered in the United States due to its multiethnic society. In US clinical practice, regular cardiac MRI (T2*), liver biopsy, and serum ferritin testing for monitoring iron overload are established as standard protocols, so the nurse's assessment is conducted in conjunction with these objective test results.
Clinical Practice GuideThe nursing assessment before regular blood transfusion in patients with β-thalassemia major should be systematic.1. Assessment of iron overload signs: vital signs (especially heart rate/rhythm), dyspnea, fatigue, abdominal distension/pain (hepatomegaly, splenomegaly), and skin pigmentation.2. Review of test results: review recent serum ferritin, liver function tests (LFTs), echocardiogram or MRI T2* results.3. Assessment of iron chelator compliance: check whether prescribed iron chelators such as deferasirox are being taken and any side effects.
Caution* Pitfall: Options 1 and 3 are interventions that add iron. This can worsen iron overload and is absolutely contraindicated. Patients with β-thalassemia major should follow an iron-restricted diet.* Pitfall: Option 4 (measuring baseline hemoglobin) is important for determining the need for and amount of transfusion, but this is the step of assessing the indication for transfusion. The question asks for the "most important intervention before administering the transfusion," and option 2, which assesses the risk (iron overload) from transfusion, has higher priority.
β-thalassemia major — Severe form of hereditary hemoglobinopathy with a defect in beta-globin chain synthesis. It causes severe anemia, and regular blood transfusions are essential for survival.
Iron Overload — A condition where iron excessively accumulates in the body and deposits in organs (heart, liver, pancreas, etc.), causing toxicity. It is a major complication of chronic transfusion therapy.
Transfusion — A treatment that involves infusing blood or blood components into a recipient through a vein. In β-thalassemia major, it is used to maintain hemoglobin and prevent anemia complications.
Ferritin — A protein that reflects the body's iron stores. Serum ferritin levels are used as a key indicator to monitor iron overload.
Iron Chelation Therapy — Treatment that uses iron chelators (e.g., deferoxamine, deferasirox) to bind and remove excess iron from the body. It prevents organ damage caused by iron overload.