Transfusion Reaction

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.

Collaborative Management

• Stop transfusion and run normal saline to maintain IV access. Do NOT use lactated Ringer's (LR) solution. It contains calcium and will clot blood in the tubing.
• Notify health-care provider and blood bank of reaction STAT.
• Recheck Pt ID and blood labels for possible errors.
• Return unused blood product to blood bank for analysis.
• Prepare to administer fluids and ordered medications:
• Anaphylaxis: Epinephrine, antihistamines, corticosteroids.
• Febrile, nonhemolytic: Acetaminophen; if Pt develops chills, cover with blanket unless temp. >102°F.
• Hemolytic: Furosemide, low-dose dopamine
• 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., dysrhythmias, abnormal lab values, CHF).