Transfusion Reaction

Text A
INVESTIGATING ACUTE TRANFUSION REACTIONS

1. Immediately report all acute transfusion reactions with the exceptions of mild hypersensitivity
and non-haemolytic febrile transfusion reactions, to the appropriate departments.
2. Record the following information on the patient’s notes:
• Type of transfusion reaction
• Length of time after the start of the transfusion and when the reaction occurred
• Volume, type and pack numbers of the blood components transfused
3. Take the samples and send them to the appropriate laboratory
• Immediate post-transfusion blood samples from a vein in the opposite arm:
- Group & Antibody Screen
- Direct Antiglobulin Test
- Blood unit and giving set should contain residues of the transfused donor blood
4. Take the following samples and send them to the Haematology/ Clinical Chemistry Laboratory
for: • Full blood count • Urea
• Coagulation screen • Creatinine
• Electrolytes • Blood culture in an appropriate blood culture bottle
5. Complete a transfusion reaction report form.
6. Record the results of the investigations in the patient’s records for future follow-up, if required.

Text B
RELEVANT EFFECTS DRUGS & DOSES NOTES
Name Route & Dosage
Oxygen 60-100% 1st line
Bronchodilator Adrenaline 500 micrograms im 1st line
vasopressor repeated after 5 mins
if no better, or worse
Expand blood volume 0.9% - Saline, If patient hypotensive, 1st line
Gelufusine 20ml/kg over 5
minutes
Reduce fever and Paracetamol Oral or rectal 2nd line
inflammatory 10mg/kg Avoid aspirin
response containing products if
patient has low
platelet count
Inhibits histamine Chlorphenamine IV 0.1 mg/kg 2nd line
mediated responses (Chlorpheniramine)
Inhibits immune Salbutamol 5mgnebuliser
By 5ml nebuliser 2nd line
mediated
bronchospasm Aminophylline Use under expert
guidance
Vasopressor Adrenaline 6mg in 5-10ml/hr Use only under expert
bronchodilator 100ml guidance
5% dextrose (6%)
Text C
Guidelines for recognition and management of acute transfusion reactions

Text D
Immediate Reaction - Life Threatening Situations
 Maintain airway and give high concentration oxygen by mask
 STOP the transfusion. Replace the giving set and keep the IV line open
 Manage as anaphylaxis protocol and ensure help is coming: stridor, wheeze and
hypotension require treatment with oxygen and adrenaline. Critical Care admission.
 Notify consultant haematologist and Hospital Transfusion Laboratory immediately.
 Send the blood unit with the giving set, freshly collected blood samples with appropriate
request form to the Hospital Transfusion Laboratory for investigations.
 Check a fresh urine sample visually for signs of haemoglobinuria.
 Commence urine collection (24 hours) and record all intake and output. Maintain fluid
balance.
 Assess for bleeding from puncture sites or wounds.
 Reassess: 1. treat bronchospasm and shock as per protocol. 2. Acute renal failure or
hyperkalaemia may require urgent renal replacement therapy.