Steps for managing suspected transfusion reactions
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Suspected transfusion reactions require appropriate clinical actions |
Upon recognising a transfusion reaction, you should:
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Stop the transfusion immediately
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Check and monitor vital signs
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Maintain intravenous (IV) access (Do not flush existing line and use a new IV line if required)
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Check the right pack has been given to the right patient
- Notify your Medical Officer and Transfusion Service Provider
After the transfusion is terminated (except for some types of mild reaction), you may be required by the Transfusion Service Provider to send freshly collected blood and urine samples along with the blood pack and IV line.
Follow Occupational Health and Safety Standards at all times; for instance, do not transport IV line with insertion spike (sharp end) exposed.
Note that this is a guide only. You must follow your hospital guidelines. Inform the Blood Service of any adverse reaction that may
- relate to the quality of the product which will prompt the Blood Service to recall any associated products, eg bacterial contamination, anaphylaxis and TRALI; or
- cause an alternative product to be requested eg HLA matched platelets in a patient with antibodies and poor platelet count increments.
Clinical management must be tailored to the patient’s specific situation with the treating medical officer, haematologist or transfusion service provider.
| Common Adverse Reactions to Blood Products and Guide to Appropriate Clinical Action | |||
| Signs & symptoms | Possible diagnosis | Investigation | Clinical actions |
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Fever >1 oC over baseline or >38 Chills, rigors |
Bacterial contamination | Blood and bag culture |
Stop transfusion Provide supportive care Give IV antibiotics |
| Febrile non-haemolytic | Exclude other causes |
Give antipyretics |
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| Rash, hives, wheeze, dyspnoea, hypotension | Allergy | Nil |
Slow transfusion Give antihistamine |
| Anaphylaxis |
Patient IgA level Anti-IgA antibodies |
ABC resuscitation Give adrenaline and steroid Consider IgA-deficient or washed components (particularly red cells) in future |
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Chills, hypotension, back pain Haemoglobinuria Ooze from IV sites |
ABO incompatibility |
Check ABO Type DAT IAT |
Stop transfusion Emergency (code or MET) call Maintain BP and renal function |
| Haemolysis |
EUC, Coag, Hb Haemolysis tests |
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| Bacterial contamination | Blood and bag cultures | Give IV antibiotics if sepsis possible | |
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Dyspnoea, productive cough Pink frothy sputum Pulmonary oedema Hypotension with TRALI |
Circulatory overload | Clinical |
Slow or stop transfusion Give oxygen, diuretics Position your patient upright |
| TRALI* occurs within 6 hours of transfusion | HLA granulocyte antibody tests |
Stop transfusion Provide supportive care |
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| Notes: *TRALI = Transfusion-related acute lung injury | |||
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