Management of Transfusion Reaction

Management of Adverse Transfusion reaction:



Mild reaction:
1.     Slow the transfusion
2.     Administer antihistamine
3.    If no clinical improvement within 30 minutes or if signs and symptoms worsen, treat moderately severe.



 Moderately severe:
1.     Stop transfusion, replace the giving set and keep I.V line open with normal saline.
2.     Notify the doctor responsible for the patient and blood bank immediately.
3.    Send blood unit with giving set, fresh blood samples (1 clotted and 1 EDTA) from vein opposite infusion site with appropriate reaction form to blood bank for investigations. .
4.    Administer antihistamine andantipyretic.
5.    Give I.V corticosteroids and bronchodilators if there are anaphylactoid features
6.    Collect urine for next 24 hrs for evidence of haemolysisand send to laboratory.




.










Life threatening
1.    Stop transfusion, replace the giving set and keep IV line open with normal saline.
2.   Maintain air floe and give high flow oxygen by mask
3.   Give adrenaline
4.   Give IV corticosteroid and bronchodilators
5.    Give diuretic
6.   Notify the doctor responsible for the patient and blood bank immediately.
7.   Send blood unit with giving set, fresh blood samples (1 clotted and 1 EDTA) from vein opposite infusion site with appropriate reaction form to blood bank for investigations –
8.   Check fresh urine specimen visually for signs of haemoglobinourea.
9.   Start at 24hr urine collection and fluid balance chart and record all intake and output. Maintain fluid balance. :
10.      Asses for bleeding from puncture sites or wounds. If there clinical or laboratory evidence of DIC transfuse platelet and fresh frozen plasma.
11.      If bacteraemia is suspected (rigors, fever, collapse, no evidence of a haemolytic reaction) start broad spectrum antibiotics.









Laboratory tests for transfusion reaction:

1.    The label on the blood container and all other record shall be checked.
2.    Determination of ABO & Rh on pre and pos-reaction blood samples from the patient and from the blood bag.
3.    Patient’s post-reaction serum or plasma shall be inspected for evidence of haemolysis, comparing with pre-transfusion sample.
4.    A direct antiglobulin test shall be done on the post transfusion specimen and on pre-reaction sample for comparison.
5.     Repeat test for unexpected antibodies.
6.    Determination of Bilirubin concentration on serum shall be obtained preferably 5 -7 hours after the transfusion.
7.     In case if suspected pyrogen reactions, the samples of the set shall be cultured.


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