Transfusion Reactions 

 

 

General Management

 

  • Stop transfusion

  • Support blood pressure with IV fluids, vasoactive medications if needed

  • Notify blood bank of all possible reactions

  • Determine diagnosis

 

 

Acute hemolytic reaction 

 

  • Signs:

    • Awake: chills, fever, nausea, chest & flank pain

    • Anesthetized: hyperthermia, tachycardia, hypotension, hemoglobinuria, diffuse oozing in surgical field

  • Management:

    • Stop transfusion & notify blood bank

    • Support hemodynamics

    • Recheck unit against blood slip & patient’s identity bracelet

    • Draw bloodwork to identify hemoglobin in plasma, repeat compatibility testing, obtain coagulation studies & platelet count

    • Insert urinary catheter & check urine for hemoglobin

    • Initiate osmotic diuresis with IV fluids +/- mannitol

    • Monitor for hyperkalemia, DIC

 

 

Febrile nonhemolytic reaction

 

  • Signs:

    • Fever

    • No evidence of hemolysis

  • Management:

    • Antipyretics

    • Transfusion may be continued if reaction mild

    • Use leukoreduced transfusions in the future

 

 

Anaphylaxis

 

  • Signs:

    • Rash/hives

    • Angioedema    

    • Hypotension

    • Tachycardia

    • Hypoxemia

    • Bronchospasm/wheezing

    • Increased peak inspiratory pressure

  • Management:

    • ​Stop transfusion 

    • Epinephrine

    • IV fluids

    • Antihistamines, corticosteroids

    • See "Anaphylaxis" page for further details

 

 

Transfusion-associated circulatory overload (TACO)

 

  • Signs:

    • Respiratory distress, hypoxia

    • ↑ BP

    • Acute or worsening pulmonary edema

    • Positive fluid balance

  • Management:

    • Stop transfusion 

    • Supplemental oxygen

    • Diuretics

 

 

Transfusion-related acute lung injury (TRALI)

 

  • Signs:

    • Acute hypoxia & noncardiac pulmonary edema within 6 hours of transfusion (usually plasma)

    • ↓ BP

  • Management:

    • Supplemental oxygen, endotracheal intubation / ventilation

    • Similar treatment to acute respiratory distress syndrome (ARDS)

    • Hemodynamic support

 

 

Urticarial reaction

 

  • Signs:

    • Erythema, hives, itching

    • No fever

  • Management:

    • Antihistamines, steroids

    • Transfusion may be continued if reaction mild

 

 

Complications of Massive Transfusion 

 

  • Dilutional coagulopathy

  • Hypothermia

  • Hyperkalemia

  • Complications of citrate infusion:

    • Hypocalcemia

    • Metabolic acidosis or alkalosis