What measure would prevent a hypotensive reaction with hematuria and oliguria following allogeneic (blood donated by another individual) blood transfusion?

From the Guidelines

The most effective measure to prevent a hypotensive reaction with hematuria and oliguria following allogeneic blood transfusion is to ensure extended matched red cells, including C/c, E/e, K, Jka/Jkb, Fya/Fyb, and S/s, are used for transfusion, as recommended by the American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support 1. This approach helps minimize the risk of hemolytic transfusion reactions (HTRs), which can be life-threatening. The patient's symptoms, such as hypotension, hematuria, and oliguria, are indicative of a potential HTR, which can be caused by ABO incompatibility or other alloantibody reactions. Key considerations for preventing HTRs include:

• Using extended matched red cells to reduce the risk of alloantibody reactions
• Implementing strict patient identification protocols to prevent patient misidentification or sample mislabeling
• Verifying blood product compatibility before initiating transfusion
• Considering immunosuppressive therapy, such as IVIg, high-dose steroids, or eculizumab, in patients with a history of HTRs or those at high risk of developing HTRs 1
• Providing supportive care, including erythropoietin and IV iron, to patients experiencing HTRs The American Society of Hematology 2020 guidelines emphasize the importance of extended red cell matching and immunosuppressive therapy in preventing HTRs, particularly in patients with sickle cell disease 1. In contrast, the 2012 AABB clinical practice guideline on red blood cell transfusion provides information on the risks of transfusion-related complications, including transfusion-associated circulatory overload (TACO) and hemolysis, but does not specifically address the prevention of HTRs in the context of allogeneic blood transfusion 1.

From the Research

Preventing Hypotensive Reaction with Hematuria and Oliguria

To prevent a hypotensive reaction with hematuria and oliguria following allogeneic blood transfusion, several measures can be taken:

• Ensure accurate patient identification and blood product labeling to prevent ABO-incompatible transfusions, which can cause severe acute hemolytic reactions 2
• Implement a bar code-based positive patient identification system in phlebotomy to reduce specimen labeling errors 3
• Use electronic positive patient identification (ePPID) to minimize wrong blood in tube (WBIT) errors, which can result in ABO mistransfusions 4
• Maintain a transfusion-restrictive strategy and avoid unnecessary blood transfusions to reduce the risk of transfusion reactions 5
• Use electronic identification systems and explore human factors and ergonomics (HFE) to reduce errors in the transfusion process 6

Key Factors to Consider

• Protocol violations and slips/lapses are common contributing factors to WBIT errors 4
• Sample collection processes should be designed to minimize error opportunities, and staff should be educated on the importance of protocol compliance for patient safety 4
• Good teamwork and sufficient staffing are essential for preventing transfusion errors 6
• Regular training and education on HFE and transfusion protocols are necessary for all staff involved in the transfusion process 6