MANAGEMENT OF COMMON ADVERSE

REACTION TO BLOOD TRANSFUSION

1. IMMEDIATE REACTIONS
Febrile non-haemolytic transfusion reaction
The transfusion is stopped temporarily. The condition senles after a few hours. If severe
it is investigated to exclude a hemolytic reaction, septicemia or malaria . Aspirin or
paracetamol brings down the temperature. Future transfusions should be with
leucocyte-depleted blood products.
Allergic Reaction
• The transfusion should be stopped and antihistamines and corticosteroids given.
• If symptoms are severe adrenaline should be administered intravenously.
• In future, such patients should have premedication with antihistamines before
transfusion or be given a plasma-free components e.g. washed packed RBC for
treatment of anaemia
Hemolytic reaction
(i) The blood should be stopped and the remainder and the patient's blood taken for further
grouping and cross- matching. Bedside clerical checks should also be done
(ii) Some blood is taken for culture as bacterial contamination may be the cause of the symptoms.
(iii) Laboratory confirmation: Haemoglobinaemia. Methaemalbumin in the plasma, Plasma bilirubin
is elevated, agglutinated red cells.
(iv) Diuresis should be established to flush the renal tubules of haemoglobin and prevent their
blockage. Given as intravenous frusemide 40- 80mg or 50ml of 25% (or 100mJ of 10%) mannitol
intravenously in 5 minutes and continuing the infusion with normal saline. Established acute tubular
necrosis is treated by peritoneal-or haemo-dialysis until tubular function is restored.
v) The urine is rendered alkaline by administering sodium bicarbonate intravenously to make the
haemoglobin soluble and prevent its deposition in the tubules as insoluble acid haematin .
• Fresh compatible blood may be necessary to correct shock. Low doses of dopamine 4-
5ug/kg/minute may also be given to increase the cardiac output in hypotensive patients.
• If the patient is undergoing surgery and oozing of blood is severe, fresh frozen plasma
and platelets should be given to reverse the DIC.

 Bacterial Contamination
• The drip is stopped and a sample of donor blood is taken for culture and gram's stain.
• The recipient’s blood is also cultured.
• Broad-spectrum antibiotics are administered intravenously.
• Intravenous fluids , steroids and vasopressors such as dopamine are given to combat
shock.
 Circulatory Overload
• The transfusion is stopped and the patient propped up.
• IV frusemide removes the excess fluid.
• In an emergency, phlebotomy is done to relieve the overload.
• Digitalization is done to improve myocardial function.
 Cardiac Arrest
• Early cardiopulmonary resuscitation and defibrillation, circulatory support, and temperature therapy
 Air Embolism
• Oxygen is administered, the patient turned on the left side and the foot of the bed raised. The air in
the heart is then aspirated.
 Non-cardiogenic Pulmonary Oedema
• Treatment includes oxygen therapy. iv steroids and ventilation assistance in refractory cases. Most
patients recover within 12-24h.
B. DELAYED REACTIONS
Thrombophlebitis
• Analgesics are administered for the pain and the affected limb rested.
A sample is taken from the tip o f the needle or cannula for culture
and sensitivity and appropriate antibiotics given if there is fever.
Delayed Haemolytic Reaction
• No treatment is indicated but the cause should be investigated. It is
commoner in patients who have received multiple transfusions
Post-transfusion Thrombocytopaenic Purpura:
• There is usually spontaneous recovery but prednisolone or
intravenous immunoglobulin may be given in severe cases.
Plasmapheresis maybe tried in those who don’t respond to medical
treatment. Transfused platelets will also be destroyed by the
circulating antibody and replacement therapy should be avoided as
much as possible during the period of thrombocytopaenia .
Transmission of Disease: Viral hepatitis A, B, C, D, Malaria, Syphilis ,
Cytomegalovirus infection , Trypanosomiasis, Toxoplasmosis,
brucellosis, Infectious mononucleosis, Variant Creutzfeldt-lacob
Disease (vC1D), AIDS, Parvovirus ( Treatment according to infection)
Immunosuppression
• There is some evidence that leucocyte-depleted blood transfusion
does not have the same effect on immunosuppression as blood
containing leucocytes.
Transfusion-Associated Graft-versus-Host Disease
• Corticosteroid, TA-GVHD is prevented by irradiation of blood before
transfusion.
In conclusion for a successful blood transfusion, all necessary protocol
should be implemented such as:
• proper check of all records to ensure the correct unit of blood is
transfused to the right patient. (patients details, blood requisition
form, compatibility report, appropriate labels)
• Examine the patient pre-transfusion and post transfusion.
• Ensure availability of proper medication and protocol incase of any
transfusion reaction.
• Always be readily available for any complications that may occur.