| Table 16-2 | Transfusion Reactions |
| REACTION | SIGNS AND SYMPTOMS | NURSING ACTIVITY |
|---|
| Allergic reaction: allergy to transfused blood | Hives, itching Anaphylaxis | - Stop transfusion immediately and keep vein open with normal saline.
- Notify health care team immediately.
- Administer antihistamine parenterally as necessary.
|
| Febrile reaction: fever develops during infusion | Fever and chills Headache Malaise | - Stop transfusion immediately and keep vein open with normal saline.
- Notify health care team.
- Treat symptoms.
|
| Hemolytic transfusion reaction: incompatibility of blood product | Immediate onset Facial flushing Fever, chills Headache Low back pain Shock | - Stop infusion immediately and keep vein open with normal saline.
- Notify health care team immediately.
- Obtain blood samples from site.
- Obtain first voided urine.
- Treat shock if present.
- Send unit, tubing, and filter to lab.
- Draw blood sample for serologic testing and send urine specimen to lab.
|
| Circulatory overload: too much blood administered | Dyspnea Dry cough Pulmonary edema | - Slow or stop infusion.
- Monitor vital signs.
- Notify health care team.
- Place in upright position with feet dependent.
|
| Bacterial reaction: bacteria present in blood | Fever Hypertension Dry, flushed skin Abdominal pain | - Stop infusion immediately.
- Obtain culture of patient's blood and return blood bag to lab.
- Monitor vital signs.
- Notify health care team.
- Administer antibiotics as ordered.
|