Clinical Findings
Neuro: Anxiety, restlessness.
Resp: SOB, dyspnea, tachypnea, bronchospasm.
CV: Chest pain, tachycardia, hypotension.
Skin: Urticaria, pruritus, erythema, burning at infusion site.
GI/GU: Nausea, vomiting, diarrhea, hematuria, oliguria, anuria.
MS: Flank, back, or joint pain.
Metabolic: Fever, chills.
Reaction-Specific Findings
Acute Hemolytic Transfusion Reactions (AHTR): Fever that spikes dramatically within first 15 min of transfusion of ABO-incompatible blood, chills, rigors, flank pain, hypotension, vascular collapse.
Allergic: Itching, hives, facial flushing, anxiety, dyspnea.
Circulatory Overload: HA, dyspnea, JVD, edema, increased BP.
Febrile—Nonhemolytic: Temp increase of 1°C (2°F), chills, HA, CP.
Transfusion-related Lung Injury (TRALI): Hypoxemia, bilateral lung infiltrates (pulmonary edema) within 6 hr of transfusion.
Transfusion-related Sepsis (TRS): Early onset fever, abdominal cramps, rigors, and shock.
Collaborative Management
- Stop transfusion and run NS to maintain IV access. Do NOT use lactated Ringer’s (LR) solution. It contains calcium and will clot blood in tubing.
- Notify HCP and blood bank of reaction STAT.
- Recheck Pt ID and blood labels for possible errors.
- Return unused blood product and tubing to blood bank for analysis.
- Prepare to administer fluids and ordered medications:
- Acute Hemolytic: Admit to ICU for treatment of hypotension, DIC, renal failure.
- Febrile, Nonhemolytic: Antipyretics; leukocyte-poor blood products and premedication with acetaminophen and diphenhydramine for subsequent transfusions.
- Allergic: Antihistamines, aminophylline, steroids, epinephrine.
- Septic: Blood cultures, antibiotics, fluids, steroids, vasopressors.
- Circulatory Overload: IV diuretics and O2.
- Acute Lung Injury: Oxygen, ventilator support, fluids, vasopressors.
- Assess urinary catheter for output, color, and clarity of urine. If Pt does not have urinary catheter in place, prepare to insert one for monitoring UO.
- Continue IV fluids to maintain minimum UO of 30 mL/hr.
- Monitor for early detection of any hemodynamic instability (e.g., arrhythmias, abnormal lab values, CHF).
Types of Transfusion Reactions
| Reaction | Clinical Findings | Treatment |
|---|---|---|
| Acute hemolytic reaction—clumping of blood in circulation | Fever spikes dramatically in first 15 min of transfusion, chills, rigors, flank pain, CP, tachycardia, hypotension, vascular collapse, itching, flushing, respiratory distress, restlessness, anxiety, nausea, hypotension or hypertension, tachycardia, shock. Severity correlates to amount of blood transfused. | Admit to ICU for treatment of hypotension, DIC, renal failure. |
| Febrile, nonhemolytic reaction | Fever, chills, rigors, no respiratory distress or hypotension, shock. | Antipyretics; leukocyte-poor blood products, and premedication with acetaminophen and diphenhydramine for subsequent transfusions. |
| Allergic reaction | Wheezing, stridor, dyspnea, throat tightness, cyanosis, hives, itching, flushing, hypotension, GI distress, shock, loss of consciousness, cardiac arrest (rare). | Antihistamines, aminophylline, steroids, epinephrine. |
| Septic | Fever, chills, rigors, SOB, hypotension. | Blood cultures, antibiotics, fluids, steroids, vasopressors. |
| Circulatory overload | SOB, hypertension. | IV diuretics and O2. |
| Acute lung injury | Respiratory distress, cyanosis, hypoxemia (O2 sat  90%), hypotension or hypertension, fever, tachycardia. | Oxygen, ventilator support, fluids, vasopressors. |