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