From the Guidelines
The treatment for a transfusion reaction begins with immediately stopping the transfusion while maintaining intravenous access, and a personalized approach is recommended, tailored to the patient’s symptoms and signs to distinguish between febrile and allergic reactions.
Key Considerations
- For febrile reactions, only intravenous paracetamol may be required 1.
- For allergic reactions, only an antihistamine should be administered 1.
- If a severe reaction and/or anaphylaxis is suspected, local anaphylaxis protocols should be followed 1.
Treatment Approach
- The blood product and administration set should be returned to the blood bank for investigation.
- Vital signs should be monitored frequently, and supportive care provided based on the type and severity of the reaction.
- Current recommendations advise against using steroids and/or antihistamines indiscriminately 1.
Management of Reactions
- Mild infusion reactions should be managed by stopping the infusion, switching the IV administration to hydration fluid to keep the vein open, and monitoring 1.
- Symptom-directed treatment can be administered in the form of a 5-HT3 antagonist for nausea or a second-generation antihistamine for urticaria 1.
- Administration of first-generation antihistamines and vasopressors should be avoided, as these medications have the potential to convert minor infusion reactions into hemodynamically significant serious adverse events 1.
From the Research
Treatment Overview
The treatment for a transfusion reaction typically involves stopping the transfusion immediately and reporting the reaction to the blood bank 2. The specific treatment approach may vary depending on the type and severity of the reaction.
Acute Transfusion Reactions
For acute hemolytic transfusion reactions, febrile nonhemolytic transfusion reactions, allergic and anaphylactic reactions, and transfusion-related acute lung injury, treatment may include:
- Hemodynamic stabilization and resuscitation with low doses of epinephrine, diuretics, and a high concentration of inspired oxygen in combination with bronchodilators 3
- Ventilatory assistance may be required in severe cases
- Administration of antihistamines, corticosteroids, or other medications to alleviate symptoms
Delayed Transfusion Reactions
For delayed transfusion reactions, such as erythrocyte and platelet alloimmunization, delayed hemolytic transfusion reactions, posttransfusion purpura, and transfusion-associated graft versus host disease, treatment may involve:
- Monitoring for signs and symptoms of the reaction
- Laboratory tests to confirm the diagnosis
- Supportive care, such as transfusions of compatible blood products or immunosuppressive therapy
Prevention and Management
To prevent and manage transfusion reactions, the following strategies can be employed:
- Careful screening of blood products and donors
- Use of washed platelets or other modified blood products to reduce the risk of allergic reactions 4
- Electronic verification systems and improved hemovigilance to detect and respond to transfusion reactions promptly 2
- Education and training of healthcare professionals to recognize and respond to transfusion reactions appropriately 5