Transfusion Reaction Algorithm

Does the Patient have NEW onset signs and symptoms?

Temperature rise greater than 1°C Chills Jaundice
Version 2016- 1. Do not discard product
STOP THE TRANSFUSION
5. Perform visual assessment of product
Shortness of breath (dyspnea) Rigors Hemoglobinuria 2. Maintain IV with normal saline. 6. Check for clerical discrepancy
Tachycardia Rash Bleeding at IV site Use new IV set. 7. Notify blood bank/lab
Hypertension Urticaria Pain (back, chest, 3. Contact MD/Designate for medical
Hypotension Pruritus bone, abdomen) assessment/ treatment
Hypoxemia 4. Do vital signs at least every 15 minutes until stable

Proceed as follows: Minor symptoms ONLY: Clerical Discrepancy Check

1. MD/Designate may order medication Rash/urticaria/pruritus 1. Confirm patient identification
2. Resume transfusion with caution if 2. Confirm patient demographics and all
Temperature rise greater than 1°C AND NO
ordered by MD/Designate documentation matches:
3. Direct observation for first 15 minutes temperature less than 39°C AND no DISCREPANCY a. ID band/health card
following transfusion re-establishment associated Major symptoms AND onset b. Physician order in chart
4. For IVIG, if transient mild symptoms greater than 10 minutes into transfusion c. Tag on product
resolve with decreased flow rate, do not d. Label on product
complete Transfusion Reaction e. Transfusion Medicine Results Report
Investigation Form (CM105)

OR Clerical DISCREPANCY

Major symptoms:
Hypotension/shock STOP/DO NOT CONTINUE TRANSFUSION
Has the patient Severe allergic reaction 1. Notify the MD/Designate
developed major YES Back/chest pain 2. Return the following to blood bank STAT:
symptoms? Hypoxemia o Product and product tags
Hemoglobinuria Note: Remove blood set and clamp off port on component
Severe Respiratory Distress o Complete Transfusion Reaction Investigation Form (CM105)
Tachycardia/arrhythmias and collect post transfusion sample
NO Temperature greater than o If additional blood components are required, complete
requisition and collect new sample for crossmatch
39°C
3. Consider laboratory testing and imaging (CBC, biochemistry,
Bleeding at IV site
coagulation, urinalysis, chest X-ray)
1. Continue the transfusion with vigilance Note: consult Transfusion 4. Consider Bacterial Contamination and culture patient if:
2. Complete the Transfusion Reaction Medicine MD on call if
Investigation Form (CM 105) and submit to o Temperature rise more than 1°C AND greater than 39°C
replacement blood products
blood bank o Temperature rise greater than 1°C and between 38 and 39°C
are required urgently
with rigors, hypotension, tachycardia, dyspnea and/or shock
o Temperature rise not responding to antipyretic and/or
suspicion of sepsis in absence of fever

Additional resources:
www.bestbloodmanitoba.ca Version 2 (2016 11 02)