OUTLINE MANAGEMENT OF

ADVERSE TRANSFUSION REACTION

S Y M P TO M S / S I G N S O F AC U T E T R A N S F U S I O N R E AC T I O N
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 R T 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 P A I N , P A 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 L Y F E E L I N G U N W E L L , R E S P I R AT O R Y 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

AT T E N D PAT I E N T I M M E D I AT E LY
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 TO R
I I . R E C O R D V I T A 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 R Y
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 P AT 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 P AT 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
NU M BE R ON EACH O F T HE BL O OD /P ROD UC T AG A I N S T T HE B LO OD R EQ UE S T F O R M,
C O M P AT I B I L I T Y C A R D A N D P AT I E N T ’ S I D ( )

FEBRILE NON-HAEMOLYTIC
MILD ALLERGIC REACTION
TRANSFUSION REACTION MILD
FEVER MILD FEVER OR URTICARIA
I. TEMPORARY STOP THE BLOOD
I. SUDDEN RISE IN TEMPERATURE OF >1.0C,
II. STABLE VITAL SIGNS AND PATIENT IS OTHERWISE URTICARIAL RASH II. GIVE CHLORPHENIRAMINE 10 MG
IV SLOWLY
WELL
III. TEMPORARY STOP THE TRANSFUSION ONLY ? III. REVIEW AFTER 30 MINUTES
IV. MAY CONTINUE IF SETTLE
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
NO
SEVERE ALLERGIC REACTION
ABO INCOMPATIBILITY (Acute Bronchospasm, angioedema,
YES circulatory collapse, hypotension)
I. DISCONTINUE TRANSFUSION SUSPECT ABO
(DO NOT RESUME !) I. DISCONTINUE TRANSFUSION
II. INFORM MO/SPECIALIST BLOOD BANK INCOMPATIBILITY ? (DO NOT RESUME !)
III. RETURN USED BLOOD BAG TO BLOOD BANK II. INFORM MO/SPECIALIST BLOOD BANK
ALONG WITH ALL OTHER USED/UNUSED UNITS III. RETURN USED BLOOD BAG TO BLOOD
IV. COMMENCE 0.9% SALINE INFUSION NO BANK ALONG WITH ALL OTHER
V. MONITOR URINE OUTPUT USED/UNUSED UNITS
VI. MAINTAIN URINE OUTPUT >30ml/hr IV. GIVE CHLORPHENIRAMINE 10 mg SLOWLY
VII. IF RENAL OUTPUT CANNOT BE MAINTAINED AT YES AND HYDROCORTISONE 50-100 mg IV
1ml/kg/hr SEEK EXPERT RENAL ADVICE.
VIII. TREAT DIC WITH APPROPRIATE BLOOD
SEVERE ALLERGIC V. HIGH CONCENTRATION O2
VI. SALBULTAMOL NEBULIZER 5 mg
COMPONENTS REACTION ? VII. IF SEVERE HYPOTENSION, GIVE
IX. SEND INVESTIGATIONS OF ADVERSE REACTION ADRENALINE 0.5-1.0 ml SC AND REPEAT
TO BLOOD BANK – REFER N.B EVERY 10 MINUTES AS NECESSSARY
VIII. SEND INVESTIGATIONS OF ADVERSE
REACTION TO BLOOD BANK – REFER N.B
NO
OTHER HAEMOLYTIC
REACTION/BACTERIAL CONTAMINATION
OF UNIT YES OTHER HAEMOLYTIC
I. DISCONTINUE TRANSFUSION REACTION/BACTERIAL
(DO NOT RESUME !)
II. INFORM MO/SPECIALIST BLOOD BANK
CONTAMINATION ?
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
NO TRANSFUSION RELATED LUNG
IF SUSPECTED BACTERIAL INFECTION INJURY (TRALI)
VII. SEND INVESTIGATIONS OF ADVERSE REACTION NORMAL
TO BLOOD BANK (MUST INCLUDES BLOOD I. CLINICAL FEATURES OF LVF WITH FEVER
CULTURES) – REFER N.B CVP
AND CHILLS
ACUTE DYSPNOEA/HYPOTENSION II. OCCUR DURING OR WITHIN 6 HOURS
AFTER COMPLETION OF TRANSFUSION
I. MONITOR ARTERIAL BLOOD GASES III. BILATERAL LUNG INFILTRATION
FLUID OVERLOAD II. CHEST X-RAY IV. NOT ASSOCIATED WITH CIRCULATORY
III. MEASURE CVP AND/OR PULMONARY OVERLOAD/ CARDIOGENIC LUNG
I. DISCONTINUE TRANSFUSION CAPILLARY PRESSURE OEDEMA
II. GIVE HIGH CONCENTRATION O2 RAISED MANAGEMENT:
III. INFORM MO/SPECIALIST BLOOD BANK I. DISCONTINUE TRANSFUSION
CVP
II. TREAT AS ARDS – CONSIDER
VENTILATION
N.B III. INFORM MO/SPECIALIST BLOOD BANK
1. Preserve the blood bag and giving set with all attached labels, CLOSING IT SECURELY so that cultures can be taken. SEND IV. SEND INVESTIGATIONS OF ADVERSE
IMMEDIATELY TO BLOOD BANK. REACTION TO BLOOD BANK – REFER N.B
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”.
JABATAN PERUBATAN TRANSFUSI HSAJB 2012 - drzk