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Guidelines / Advice
Transfusion Reactions
TYPE - DIAGNOSIS - ACTION
- TREATMENT
A transfusion reaction may be defined as "any
potentially adverse sign or symptom which occurs after the
start of any transfusion of blood or blood products".
It stands to reason therefore that in order to notice any
adverse effect, the patient's condition prior to, during
and after the transfusion must be monitored.
Bearing in mind that "caution saves lives", it
is good medical practice to be suspicious and to take action
fast. The steps to be taken if there is any sign that a
reaction may be occurring are simple and apply in all instances.
- Stop the transfusion immediately.
- Keep the vein open with normal saline in
a new drip set.
- Contact the transfusion service for advice.
Whilst the investigation of the transfusion
reaction proceeds, the vein should be kept open with crystalloid
solution which allows venous access for:
- Further transfusion therapy if required.
- Suitable therapy to combat the effects
of the reaction.
Monitoring
The basic monitoring of the patient prior
to the initial transfusion and during subsequent transfusion
should cover:
- Pulse.
- Blood pressure.
- Temperature
- Respiration rate.
- General visual observation.
- Verbal enquiry as to the patient's well
being.
Any abnormal symptoms existing at the
start of transfusion should be noted e.g. dyspnoea, chills,
oliguria, etc. Changes in intensity of these symptoms may
also indicate the potential for a transfusion reaction and
should be assessed clinically. In cases of severe haemorrhage
the rate of transfusion precludes monitoring individual
units at specific intervals, and the effect of one unit
may only be seen at the time of the transfusion of the second
or third unit. These patients are however usually closely
monitored for changes in their primary condition and transfusion
reactions are readily detected. Extra care must be taken
in the unconscious patient to monitor and react to changes
in vital signs. Excessive oozing from the operative site
or venous access points and unexplained hypotension may
indicate that a haemolytic transfusion reaction is occurring.
Investigation
The investigation of a reaction is primarily to exclude
severe or life threatening situations. The transfusion service
has a specific set of instructions for investigating reactions
and it is the legal responsibility of the clinician to assist
in this undertaking:
Send appropriate samples,
clearly labelled - a minimum requirement will include:
- Clotted blood sample.
- EDTA tube.
- Post transfusion urine sample - depending
on the nature of the reaction.
- Return the suspect unit/s and drip set
to the nearest blood bank. If it is suspected that the
reaction is due to bacterial contamination ensure that
blood bank is informed so that cultures and gram stains
are performed. Obtain blood for blood culture from the
patient.
- Complete the reaction report form specifying
patient details, reason for transfusion, pre- and post
transfusion signs and symptoms.
Types of Reactions
The list of potential reactions is lengthy, and there are
many different ways of classification. Reactions include
those due to incompatibility, transmissible disease, bacterial
contamination and storage lesions due to the age of the
transfused blood products. However, for most practical purposes,
the following are the most serious or the most frequently
observed and are described fully.
Download
Untoward Reaction Report (PDF format)
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