Transfusion Reactions
What to do for a Transfusion Reaction?
- STOP the transfusion!
- Perform a clerical check in the presence of the patient. Ensure the correct patient received the correct unit by checking pt name & pt ID numbers.
- Fill out a electronic request for transfusion reaction workup and send to the Blood Bank.
- Send a Type and Screen specimen to the Blood Bank.
- Send the unused unit of blood product without the infusion needle to the Blood Bank.
- Send a specimen for complete Urinalysis to the Chemistry Lab.
Common Transfusion Reactions
| Reaction | When it Occurs? | Presentation | Treatment |
|---|---|---|---|
| Urticarial (mild allergic) | Usually early during the transfusion | Localized or diffuse hives / redness, itching |
Benadryl 25-50 mg orally (NOT for fevers). If hives are on the neck or face consider IV Benadryl or IV steroids |
| Febrile Nonhemolytic | Usually during or 1-2 hrs after transfusion | Fever (2 F or 1 C increase), rigors, chills, headache, vomiting |
Tylenol 650 mg orally. DO NOT use Benadryl for fevers. If severe rigors -> Demerol 12.5-50 mg slow IV push q20 minutes until resolution of symptoms. |
Uncommon Transfusion Reactions
| Reaction | When it Occurs? | Presentation | Treatment | Prevention |
|---|---|---|---|---|
| Acute Hemolytic | Usually during transfusion | Fever, chills, back pain, “impeding doom” | Blood Pressure & volume support | Detailed history, Correct patient identification |
| Bacterial Contamination | Usually during or 1-2 hrs after transfusion | Fever (rapid, very high) chills/rigors, hypotension, GI symptoms, flushed skin | Blood Culture, Antibiotics & ICU monitoring | Prompt transfusion |
| TRALI (Transfusion Related Acute Lung Injury) | During or within 6 hrs of transfusion | Respiratory Distress (Shortness of breath), Diffuse bilateral pulmonary infiltrates on Chest X-ray | Supportive | None |
| Anaphylactic | Early or Immediately after transfusion | Severe hypotension, GI symptoms some report fever | Epinephrine & pressure support | IgA deficient blood products if sec to IgA antibodies |
| Anaphylactoid | Early or Immediately after transfusion | Similar to anaphylactic rxn but milder form; may be limited to respiratory symptoms | Epinephrine & pressure support if needed | If assc with mild IgA deficiency, give IgA deficient blood products |
| Circulatory Overload | During or after transfusion | Respiratory Distress (shortness of breath) | Diuretics & slower or small aliquot infusion | Pretransfuion diuretics, Small aliquots, Slow Infusion |
| Delayed Hemolytic | Usually 3-10 days after transfusion | Fever & Anemia | Supportive care | Detailed history |
| Post Transfusion Purpura | Usually 1 week after transfusion | Profound thrombocytopenia (Plt count <20 K) | IVIG, then plasmapheresis AVOID platelet transfusion | Antigen negative platelets, Detailed History |
| Transfusion Associated GVHD (graft vs host disease) | Usually 4 to 30 days after transfusion | Fever, diarrhea, skin rash | Supportive care | Irradiation |