Adverse Transfusion Reaction - Reaction Types

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  • STOP TRANSFUSION IMMEDIATELY!
  • Maintain IV access with 0.9% sodium chloride.
  • Assess recipient and check vitals signs (Q15 min until stable).
  • Perform clerical check.
  • Notify health care provider; request assessment if indicated.
  • Notify TML.
Type of Reaction Suspected Transfusion Reaction Signs & Symptoms Timing of Symptoms Actions & Suggested Treatment / Investigations
ACUTE (< 24 hours)
Minor Allergic Reaction Intensely pruritic localized/or widespread urticaria less than 2/3 of the body; generalized erythema or flushing During transfusion up to 2-3 hours from start Consult with Physician–diphenhydramine hydrochloride 25-50 mg PO/IM or IV; proceed with CAUTION
Anaphylactic Angioedema–localized non-pitting deep edema; upper airway obstruction–laryngeal edema, hoarseness, stridor, 'lump in the throat;' lower airway obstruction–bronchospasm, wheeze, chest tightness, dyspnea, cyanosis; profound hypotension 1-45 minutes after start of infusion; majority within 5 minutes Epinephrine 0.3 - 0.5mg S/C or IV (up to 3 doses); fluid bolus; vasopressors if intractable hypotension;
DO NOT RESTART TRANSFUSION
Hypotension Abrupt onset of clinically significant hypotension–facial flushing with or without mild respiratory symptoms Within 5 minutes after start of infusion Supportive therapy;
DO NOT RESTART TRANSFUSION
Febrile Non-Hemolytic Cold sensation, rigors, nausea, vomiting with/without temperature greater than 1°C above baseline. Usually within 30 minutes after start of infusion; up to one (1) hour after completed Consult with Physician–Acetaminophen 325-500 mg PO; proceed with CAUTION
Acute Hemolytic (AHTR) Temperature ≥ 39°C, hypotension, tachycardia, rigors/chills, anxiety, dyspnea, anemia, hyperbilirubinemia, hemoglobinuria/oliguria, bleeding at IV site, nausea/vomiting, DIC, pain–back/chest/head/flank/abdomen/groin/IV site Usually within first 15 minutes; up to 24 hours following transfusion. Usually within first 15 minutes; up to 24 hours following transfusion. Serologic testing: group and screen, cross-match, DAT, LDH, BUN, creatinine, TB; IV Fluids
DO NOT RESTART TRANSFUSION
TACO Dyspnea, orthopnea, cyanosis, hypoxemia, tachycardia, hypertension, pulmonary/pedal edema, elevated JVP Within 1-2, up to 6 hours following start of transfusion Oxygen, diuretics, elevate head of bed, chest x-ray
DO NOT RESTART TRANSFUSION
Transfusion Related Acute Lung Injury (TRALI) Acute respiratory distress, dyspnea, cyanosis, severe hypoxemia, severe bilateral pulmonary edema, bilateral infiltrates on chest x-ray, hypotension unresponsive to fluid bolus Within 1-2 hours during transfusion or within 6 hours post-transfusion Oxygen, chest x-ray, intubation and ventilation, vasopressors
DO NOT RESTART TRANSFUSION
Bacterial Contamination Temperature ≥ 38.5°C, chills, hypotension, shock, nausea/vomiting, tachycardia, hypotension During or within 4 hours of transfusion Treatment of shock, DIC, renal failure, product and recipient cultures, antibiotics–broad spectrum initially; anti-pseudomonas if red cells implicated
DO NOT RESTART TRANSFUSION
DELAYED (> 24 hours)
Delayed Hemolytic Weakness, unexplained fall in post-transfusion hemoglobin, elevated serum bilirubin Within 3-7 days post-transfusion and up to 21 days post-transfusion Provide antigen negative blood products for subsequent transfusions
Transfusion Associated Graft Versus Host Disease Fever, erythematous cutaneous pruritic rash which progresses to generalized erythroderma, watery/bloody diarrhea, pancytopenia, liver dysfunction, anorexia, nausea/vomiting Within 2-50 days of transfusion (usually 1-2 weeks) Largely ineffective–Immunosuppressive therapy, cyclosporine/OKT3, cyclophosphamide/antithymocyte, T cell monoclonal antibodies, HPC transplants, irradiated components. Mortality is greater than 90%
Post Transfusion Purpura Purpura, bleeding, platelet count less than 10X109/L 1-24 days post transfusion IVIG
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