SYMPTOMS/SIGNS OF ACUTE TRANSFUSION REACTION
F E V E R , C H I L L S , R I G O R S , TA C H Y C A R D I A , H Y P E R - O R H Y P O T E N S I O N , C O L L A P S E , F L U S H I N G ,
U RT I C A R I A , B O N E / M U S C L E / C H E S T / A B D O M I N A L PA I N , PA I N AT V E N I P U N C T U R E S I T E ,
G E N E R A L LY F E E L I N G U N W E L L , R E S P I R AT O RY D I S T R E S S , D A R K C O L O U R E D U R I N E
OUTLINE MANAGEMENT OF
ADVERSE TRANSFUSION REACTION
ATTEND PATIENT IMMEDIATELY
I . D I S C O N T I N U E T R A N S F U S I O N A N D I N F O R M D O C T O R
I I . R E C O R D V I TA L S I G N S : T E M P E R AT U R E , P U L S E R AT E , B L O O D P R E S S U R E , R E S P I R AT O RY
R AT E A N D O 2 S AT U R AT I O N
I I I . V E R I F Y R I G H T PAT I E N T : C H E C K C A S E N O T E , W R I S T B A N D A N D A S K PAT I E N T / R E L AT I V E
I V . V E R I F Y R I G H T B L O O D / C O M P O N E N T : C H E C K A B O A N D R H B L O O D G R O U P, B A R C O D E
N U M B E R O N E A C H O F T H E B L O O D / P R O D U C T A G A I N S T T H E B L O O D R E Q U E S T F O R M ,C O M PAT I B I L I T Y C A R D A N D PAT I ENT ’ S I D ( )
FEBRILE NON-HAEMOLYTIC
TRANSFUSION REACTION
I. SUDDEN RISE IN TEMPERATURE OF >1.0C,
II. STABLE VITAL SIGNS AND PATIENT IS OTHERWISE
WELL
III. TEMPORARY STOP THE TRANSFUSION
IV. GIVE PARACETAMOL 1G PO
V. REVIEW AFTER 30 MINUTES
VI. MAY CONTINUE IF SETTLE – SLOW RATE: RED CELL
OVER 4 HOURS AND PLATELET 2 HOURS
MILD FEVER OR
URTICARIAL RASH
ONLY ?
JABATAN PERUBATAN TRANSFUSI HSAJB 2012 - drzk
MILD ALLERGIC REACTION
I. TEMPORARY STOP THE BLOOD
II. GIVE CHLORPHENIRAMINE 10 MG
IV SLOWLY
III. REVIEW AFTER 30 MINUTES
IV. MAY CONTINUE IF SETTLE
MILD
FEVER URTICARIA
SUSPECT ABO
INCOMPATIBILITY ?
SEVERE ALLERGIC REACTION
(Acute Bronchospasm, angioedema,
circulatory collapse, hypotension)
I. DISCONTINUE TRANSFUSION
(DO NOT RESUME !)
II. INFORM MO/SPECIALIST BLOOD BANK
III. RETURN USED BLOOD BAG TO BLOOD
BANK ALONG WITH ALL OTHER
USED/UNUSED UNITS
IV. GIVE CHLORPHENIRAMINE 10 mg SLOWLY
AND HYDROCORTISONE 50-100 mg IV
V. HIGH CONCENTRATION O2
VI. SALBULTAMOL NEBULIZER 5 mg
VII. IF SEVERE HYPOTENSION, GIVE
ADRENALINE 0.5-1.0 ml SC AND REPEAT
EVERY 10 MINUTES AS NECESSSARY
VIII. SEND INVESTIGATIONS OF ADVERSE
REACTION TO BLOOD BANK – REFER N.B
ABO INCOMPATIBILITY
I. DISCONTINUE TRANSFUSION
(DO NOT RESUME !)
II. INFORM MO/SPECIALIST BLOOD BANK
III. RETURN USED BLOOD BAG TO BLOOD BANK
ALONG WITH ALL OTHER USED/UNUSED UNITS
IV. COMMENCE 0.9% SALINE INFUSION
V. MONITOR URINE OUTPUT
VI. MAINTAIN URINE OUTPUT >30ml/hr
VII. IF RENAL OUTPUT CANNOT BE MAINTAINED AT
1ml/kg/hr SEEK EXPERT RENAL ADVICE.
VIII. TREAT DIC WITH APPROPRIATE BLOOD
COMPONENTS
IX. SEND INVESTIGATIONS OF ADVERSE REACTION
TO BLOOD BANK – REFER N.B
OTHER HAEMOLYTIC
REACTION/BACTERIAL
CONTAMINATION ?
NO
YES
NO
SEVERE ALLERGIC
REACTION ?
YES
NOOTHER HAEMOLYTIC
REACTION/BACTERIAL CONTAMINATION
OF UNIT
I. DISCONTINUE TRANSFUSION
(DO NOT RESUME !)
II. INFORM MO/SPECIALIST BLOOD BANK
III. RETURN USED BLOOD BAG TO BLOOD BANK
ALONG WITH ALL OTHER USED/UNUSED UNITS
IV. MONITOR URINE OUTPUT
V. GIVE O2 AND FLUID SUPPORT
VI. COMMENCE BROAD SPECTRUM AND ANTIBIOTICS
IF SUSPECTED BACTERIAL INFECTION
VII. SEND INVESTIGATIONS OF ADVERSE REACTION
TO BLOOD BANK (MUST INCLUDES BLOOD
CULTURES) – REFER N.B
ACUTE DYSPNOEA/HYPOTENSION
I. MONITOR ARTERIAL BLOOD GASES
II. CHEST X-RAY
III. MEASURE CVP AND/OR PULMONARY
CAPILLARY PRESSURE
FLUID OVERLOAD
I. DISCONTINUE TRANSFUSION
II. GIVE HIGH CONCENTRATION O2
III. INFORM MO/SPECIALIST BLOOD BANK
NO
RAISED
CVP
NORMAL
CVP
TRANSFUSION RELATED LUNG
INJURY (TRALI)
I. CLINICAL FEATURES OF LVF WITH FEVER
AND CHILLS
II. OCCUR DURING OR WITHIN 6 HOURS
AFTER COMPLETION OF TRANSFUSION
III. BILATERAL LUNG INFILTRATION
IV. NOT ASSOCIATED WITH CIRCULATORY
OVERLOAD/ CARDIOGENIC LUNG
OEDEMA
MANAGEMENT:
I. DISCONTINUE TRANSFUSION
II. TREAT AS ARDS – CONSIDER
VENTILATION
III. INFORM MO/SPECIALIST BLOOD BANK
IV. SEND INVESTIGATIONS OF ADVERSE
REACTION TO BLOOD BANK – REFER N.B
N.B
1. Preserve the blood bag and giving set with all attached labels, CLOSING IT SECURELY so that cultures can be taken. SEND
IMMEDIATELY TO BLOOD BANK.
2. Send 10 ml of blood to Blood Bank for Investigation. Label as “Post Transfusion 1”.
3. Send the next urine specimen 20 cc to Pathology Laboratory for haemoglobinuria.
4. Blood Bank may requires another 10 ml blood after 24 hours (depends on reaction) and label as “Post Transfusion 2”.
YES
