From the Guidelines
Blood transfusion reactions should be managed promptly with cessation of the transfusion, maintenance of IV access, and monitoring of vital signs, as recommended by the Association of Anaesthetists guidelines 1. When a transfusion reaction is suspected, it is crucial to stop the transfusion immediately and maintain IV access with normal saline. The patient's vital signs should be checked, and the physician and blood bank should be notified promptly.
Common Reactions
- Febrile non-hemolytic reactions can be treated with intravenous paracetamol, as per the current recommendations from SHOT 1.
- Allergic reactions should be managed with an antihistamine, such as diphenhydramine, without the indiscriminate use of steroids and/or antihistamines 1.
- Acute hemolytic reactions require aggressive fluid resuscitation with normal saline.
Prevention Strategies
Prevention of transfusion reactions is key, and this can be achieved through:
- Careful patient identification, including the use of patient identification bands and minimum patient identifiers on the transfusion request form and sample 1.
- Proper blood product handling, including the maintenance of the cold chain during transport 1.
- Thorough pre-transfusion compatibility testing, including the use of historical samples where available 1.
Monitoring and Management
Patient monitoring is essential during the transfusion episode to identify and manage adverse reactions. This includes monitoring of respiratory rate, pulse, blood pressure, and temperature, as recommended by the National Institute for Health and Care Excellence (NICE) 1. A personalized approach to managing transfusion reactions is recommended, taking into account the patient's symptoms and signs to distinguish between febrile and allergic reactions 1.
From the Research
Types of Transfusion Reactions
- Acute hemolytic transfusion reaction, which can be prevented by conducting a cross-matching test 2, 3
- Nonhemolytic transfusion reactions, which are difficult to predict 3
- Febrile non-hemolytic transfusion reactions, which are one of the most common types of transfusion reactions 4, 5
- Allergic transfusion reactions, which can range from mild to severe 4, 6, 5
- Transfusion-related acute lung injury (TRALI) 4
- Transfusion-associated circulatory overload (TACO) 4, 3
- Septic transfusion reactions, which are less frequent but can be serious 4
- Transfusion-associated graft-versus-host-disease (TA-GVHD), which can be prevented by using irradiated blood 3
Management of Transfusion Reactions
- Immediate interruption of the transfusion when a reaction is suspected 2, 4
- Early identification and reporting of transfusion reactions to the hemovigilance reporting system 4
- Fluid resuscitation and consultation with hematologic and ICU departments 4
- Use of evidence-based algorithms and guidelines for transfusion and management of reactions 2, 4
- Avoidance of unnecessary blood transfusions and maintenance of a transfusion-restrictive strategy 4
Prevention of Transfusion Reactions
- Use of premedication, such as antihistamines, to prevent allergic transfusion reactions, although its effectiveness is still debated 6, 5
- Implementation of evidence-based guidelines for transfusion premedication 6
- Reduction of transfusion-associated bacterial infections through proper blood handling and storage 3
- Introduction of nucleic acid amplification tests to decrease the incidence of transfusion-transmitted hepatitis 3