Transfusion Reaction – Immediate Action
Each blood product transfused carries a small risk of acute or delayed adverse effect.
It is important to recognise, respond to, and report adverse events.
Speed is essential because of the possible life-threatening nature of acute transfusion reactions.
The most common immediate adverse reactions to transfusion are fever, chills and urticaria.
The most potentially significant reactions include acute and delayed haemolytic transfusion reactions, bacterial contamination of blood products, anaphylaxis and Transfusion-Related Acute Lung Injury (TRALI). During early stages of a reaction it may be difficult to ascertain the cause.
Management of Suspected Acute Transfusion Reactions
Note: this is a guide only – individual hospital guidelines should be followed.
Clinical management must be tailored to the patient’s specific situation with the treating medical officer, haematologist or transfusion service provider.
Steps for Suspected Transfusion Reactions
- 1. Stop the transfusion immediately
- 2. Check vital signs
- 3. Maintain IV access (do not flush existing line – use a new IV line if required)
- 4. Check the right pack has been given to the right patient
- 5. Notify the medical officer and Transfusion Service Provider.
After the transfusion is terminated (except for some types of mild reactions)
- 6. Send freshly collected blood and urine samples along with the blood pack and IV line as required by Transfusion Service Provider.
Follow occupational health and safety Standards e.g. do not transport IV line with insertion spike (sharp end) exposed.
Mild Allergic Reaction
Localized urticaria, pruritis, rash.
Clinical Actions
- Consult attending medical officer and follow hospital protocol
- Stop transfusion – see steps 1 – 5 above
- Antihistamines may be administered
- If reaction subsides, transfusion may be completed within 4 hours of commencement taking into account any fluid balance issues for the individual patient.
Severe Allergic Reaction
Flushing, wheezing, hypotension, anaphylaxis.
Clinical Actions
- Consult attending medical officer and follow hospital protocol
- Stop transfusion – see steps 1 – 6 above
- Adrenaline and/or steroids may be indicated as may ABC resuscitation
- CAUTION: may become medical emergency; support blood pressure and maintain open airway. Consult a haematologist before administering additional blood packs.
Febrile Reaction
Unexpected fever (e.g. rise >1ºC from baseline), which may be accompanied by chills and rigors.
Clinical Actions
- Consult attending medical officer and follow hospital protocol
- Stop transfusion – see steps 1 – 6 above
- Febrile reactions usually respond to antipyretics – but avoid aspirin in thrombocytopenic and paediatric patients. Rule out a haemolytic reaction, septic reaction and TRALI.
- CAUTION: Fever alone may be the first manifestation of a life threatening reaction – see below.
Acute Haemolytic Reaction
Rigors, fever, flank or IV site pain, tachycardia, dyspnoea, hypotension, unexplained bleeding, oliguria, haemoglobinuria, haemoglobinaemia.
Clinical Actions
- Consult attending medical officer and follow hospital protocol
- Stop transfusion – see steps 1 – 6 above
- Induce diuresis with fluids and diuretics
- CAUTION: May become a medical emergency; support blood pressure and maintain open airway
- Do not administer additional blood packs until cleared by haematologist/Transfusion Service Provider.
Transfusion-Related Acute Lung Injury (TRALI)
Dyspnoea, tachypnoea, respiratory failure, noncardiogenic pulmonary oedema, chills, fever.
Clinical Actions
- Consult attending medical officer and follow hospital protocol
- Stop transfusion – see steps 1 – 6 above
- Administer supplemental oxygen and employ ventilation support as necessary
- CAUTION: May become a medical emergency; support blood pressure and maintain open airway
- Notify Transfusion Service Provider to contact Australian Red Cross Blood Service to ensure quarantining and testing of related components from the same donation/donor.
Septic Reaction
Fever, chills, rigors, nausea, vomiting, hypotension.
Clinical Actions
- Consult attending medical officer and follow hospital protocol
- Stop transfusion – see steps 1 – 6 above
- Administer broad spectrum antibiotic coverage after obtaining blood cultures from the patient
- CAUTION: May become medical emergency; support blood pressure.
- Send blood pack to the Transfusion Service Provider for urgent culture and Gram stain
- Notify Transfusion Service Provider to contact Australian Red Cross Blood Service to ensure quarantining and testing of related components from the same donation/donor.