Steps for managing suspected transfusion reactions

Upon recognising a transfusion reaction, you should:

  1. Stop the transfusion immediately

  2. Check and monitor vital signs

  3. Maintain intravenous (IV) access (Do not flush existing line and use a new IV line if required)

  4. Check the right pack has been given to the right patient

  5. 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.

 

Common Adverse Reactions to Blood Products and Guide to Appropriate Clinical Action

Possible etiology Action Investigation
Febrile non-haemolytic transfusion reaction STOP transfusion. Exclude serious adverse events. Anti-pyretics.
Recommence cautiously if reaction subsides.
Reaction form to transfusion lab.
Possible etiology Action Investigation
Bacterial contamination or acute haemolytic transfusion reaction (may become medical emergency) STOP transfusion.
Check patient ID with label. IV antibiotics if septic. Maintain good urine output.
Cultures on patient & product, reaction form, Group & Screen (G&S).
If haemolysis suspected order full blood count (FBC), lactate dehydrogenase (LDH), bilirubin, haptoglobin, coagulation profile, electrolytes, urinalysis.
Possible etiology Action Investigation
Minor allergic reactions STOP transfusion. Antihistamine.
Recommence if reaction subsides.
None.
Possible etiology Action Investigation
Severe allergic reactions   STOP transfusion. Antihistamine.
+/- Corticosteroid.
Reaction form and Group & Screen (G&S). 
Possible etiology Action Investigation
Anaphylaxis
(consider IgA deficiency)
STOP transfusion.
Initiate basic life support.
Notify Blood Service            
Reaction form and Group & Screen (G&S).
Check haptoglobin & IgA levels.
Possible etiology Action Investigation
Transfusion associated circulatory overload STOP transfusion. Diuretics.
Oxygen.
Sit patient upright.
Reaction form and Group & Screen (G&S).
Possible etiology Action Investigation
TRALI (transfusion-related acute lung injury)
(may become a medical emergency)
STOP transfusion.
Assess chest Xray for infiltrates. Oxygen. Possible intubation, ventilation.
Notify Blood Service
Reaction form and Group & Screen. TRALI investigations: HLA and HNA antibodies and tissue typing.
Bacterial contamination or acute haemolytic transfusion reaction (may become a medical emergency) STOP transfusion.
IV antibiotics if sepsis. Check patient ID with label. Maintain good urine output.
Notify Blood Service
Cultures on patient & product, reaction form, Group & Screen (G&S).
If haemolysis suspected order full blood count (FBC), lactate dehydrogrenase (LDH), bilirubin, haptoglobin, coagulation profile, electrolytes, urinalysis.

 

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 transfusion transmissible infection, and TRALI; or
  • cause an alternative product to be requested eg washed red cells in patients with repeated anaphylactic reactions or IgA deficient products.

Clinical management must be tailored to the patient’s specific situation with the treating medical officer, haematologist or transfusion service provider.