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Management of
Acute Transfusion Reactions
Immediate Steps for All
Reactions:
Stop Transfusion
Keep IV Open With 0.9% NaCl.
Verity correct unit was given to correct patient.
Notify Attending Physician and Blood Bank.
After Transfusion Is
Terminated (except mild allergic, see below):
Send Freshly Collected Blood and Any Necessary Urine Samples with Blood Unit and
Administration Set to Blood Bank
Reaction Type |
Signs and Symptom |
Etiology |
Clincical
Action |
Allergic
(Mild) |
Pruritus,
urticaria (hives) |
Antibodies to plasma
proteins |
Steps 1‑3 above; administer
antihistamines (P0, IM, or IV); resume transfusion if improved; if
no improvement in 30 minutes treat as
below.
|
Allergic
(Moderate to Severe) |
Hives, Dyspnea,
abdominal pain, hypotension, nausea, anaphylaxis |
Antibodies to plasma proteins,
including IgA |
Steps 1‑5 above; administer
antihistamines, epinephrine, vasopressors,
and corticosteriods as needed; avoid
future reactions by premedication and
use of washed red cells.
|
Febrile (mild to moderate) |
Fever, chills, rigors, anxiety, mild
dyspnea |
Antibodies to leukocyte antigens,
(Mostly HLA), cytokines |
Steps 1‑5 above; mild‑administer
antipyretics as needed; leukocyte antigens, avoid
future reactions by premedication and
use of leukocyte‑reduced red cells and platelets. |
Acute Lung Injury |
Fever, chills,
dyspnea, respiratory failure |
Antibodies from donor plasma to
recipient WBC |
Supportive therapy for respiratory
failure, oxygen, mechanical ventilation, leukocyte‑reduced blood
components until etiology is clear (donor vs
recipient antibody).
|
Acute Hemolytic |
Anxiety, chest pain, flank pain,
dyspnea, chills, fever, shock,
unexplained bleeding, hemoglobinemia /
hemoglobinuria, cardiac arrest |
Hemolytic transfusion reaction;
usually due to ABO incompatibility |
Steps 1‑5 above; treat shock with
vasopressors, IV fluids,
corticosteriods
as needed; maintain airway; increase renal blood flow (IV fluids;
furosemide); maintain a brisk
diuresis; monitor renal status for acute
renal failure. Monitor coagulation status for DIC; administer blood
components as needed after etiology is clear. |
Septic / Toxic |
Chills, fever, hypotension |
Bacteria from contaminated blood |
Steps 1‑5 above; treat shock with
vasopressors, IV fluids. Culture
patient and bag. |
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