Adverse Transfusion Reactions
Any adverse symptom or physical sign during transfusion of blood or its components should be initially considered as a potential life-threatening reaction. The clinical personnel must take the following actions:
1. Stop the transfusion immediately to limit the amount of blood infused.
2. Notify the responsible physician.
3. Keep the intravenous line open with infusion of 0.9% normal saline.
4. At the patient’s bedside, check all the transfusion tags, forms, and patient identification to determine if the transfused component was intended for the recipient.
5. Report the suspected reaction to Transfusion Medicine staff immediately.
6. Document the reaction on the patient's Health Record Chart.
7. If an investigation is required, one 6 mL EDTA tube (smaller volumes of post transfusion samples are appropriate for pediatric patients), carefully drawn to avoid mechanical hemolysis is required to be drawn and transcribed with the RTSIS number from the patient's RTSIS wrist band. Write the RTSIS number from transfusion ID band on the specimen label. For suspected TRALI reactions, additional specimens will be required. Follow the directions of the Transfusion Medicine staff.
8. Send specimens to Transfusion Medicine as soon as possible, together with the discontinued blood component bag with transfusion tag attached, the administrative set without the needle, attached intravenous solutions and all related forms and labels. NOTE: The above is also stated in the Nursing Procedure Manuals. Investigations are usually only performed for reactions to red cell products.
9. Send other blood or urine samples for evaluation of acute hemolysis as directed by the Transfusion Medicine Division Head or patient’s physician.
10. Reactions occurring after the completion of the transfusion must also be reported and investigated the same as those occurring during transfusion.
11. If the reaction occurred as a result of events in administration of the product, iniate a CHR Incident Report form (100420).
Transfusion reaction investigations are conducted in the following cases:
- Upon request from a physician
- When the transfusion of a red cell product is required to be discontinued because of adverse reaction
- In the event of a patient receiving unit(s) for which they were not the intended recipient, whether or not a clinical reaction is observed.
- In the event that TM staff become aware that a serological incompatibility exists
- At the discretion of the TM Division Head or Senior Technologist
Special Notes
- Bacterial contamination is rare but such reactions may be fatal.
- Cases of suspected transfusion transmitted infection must be reported to the Transfusion Medicine Division Head.
Transfusion Reaction Signs, Symptoms & Causes
|
Type |
Signs and Symptoms |
Causes |
Hemolytic |
Fever, chills, chest pain, hypotension, nausea, dyspnea, flushing, tachycardia, anxiety, generalized bleeding, DIC, back pain, oliguria, anuria, pain at infusion site, hemoglobinuria, shock, rigors |
Immediate intravascular hemolysis most often due to ABO incompatibility due to clerical error
Delayed intravascular or extravascular hemolysis due to antibodies unrelated to the ABO system |
|
Febrile |
Fever (>2°C rise in temperature without other explanation) chills, rigors, headache, nausea, vomiting |
Leukoagglutinins
Platelet antibodies, pyrogens bacterial contamination |
|
Allergic |
Local erythema, hives, itching |
Patient allergy to soluble product in donor plasma |
|
Anaphylactic |
Coughing, bronchospasms, abdominal cramps, vomiting, diarrhea, shock, loss of consciousness |
Anti-IgA antibodies in IgA deficient patients |
|
Circulatory Overload |
Coughing, cyanosis, dyspnea, tightness in chest, headache |
Hypervolemia due to excess volume or speed of infusion |
|
Non-cardiogenic pulmonary edema (TRALI: transfusion related acute lung injury) |
Pulmonary edema |
WBC aggregates due to donor leuko-agglutinins vs. recipient
WBC’s |
|
