What is the immediate management for a suspected transfusion reaction?

Immediate Management of Suspected Transfusion Reaction

When a transfusion reaction is suspected, immediately stop the transfusion, maintain IV access with normal saline, and notify the transfusion laboratory. 1, 2

Initial Assessment and Actions

1. Stop the transfusion immediately

   • Disconnect the blood component but maintain IV access with normal saline at keep-vein-open rate 1, 2
   • Do not discard the blood component or administration set 2

2. Perform rapid clinical assessment

   • Check vital signs (heart rate, blood pressure, temperature, respiratory rate)
   • Assess for specific symptoms:
     • Respiratory: shortness of breath, wheezing, stridor
     • Skin: rash, urticaria, flushing
     • Cardiovascular: tachycardia, hypotension
     • Other: fever, chills, back/chest pain, nausea/vomiting 1, 2

3. Notify

   • Contact the physician/medical team immediately
   • Report to the transfusion laboratory 1, 2

4. Verify documentation and patient identification

   • Double-check all documentation for administration errors
   • Confirm patient identity matches blood component labels 1

Specific Management Based on Reaction Type

Febrile Non-Hemolytic Transfusion Reaction

• Administer intravenous paracetamol (not steroids) 1, 2
• Monitor vital signs every 15 minutes until stabilized 2

Allergic Reaction

• For mild-moderate symptoms: administer antihistamine only 1, 2
• For severe reactions: follow local anaphylaxis protocol 1

Severe Reaction/Anaphylaxis

• Position patient appropriately (Trendelenburg for hypotension)
• Administer epinephrine (adrenaline) 0.01 mg/kg IM into lateral thigh for anaphylactic features 2
• Consider combined H1 and H2 antagonists 2
• For hypotension: administer NS bolus of 1000-2000 mL 1, 2
• For hypoxemia: administer oxygen via mask or nasal cannula 1, 2

Transfusion-Associated Circulatory Overload (TACO)

• Position patient upright
• Consider administering diuretics
• Provide supplemental oxygen if needed 1, 2

Laboratory Investigations

1. Send samples to laboratory

   • Post-transfusion blood samples
   • Urine sample
   • Return blood component and administration set to blood bank 2

2. Request appropriate tests

   • Complete blood count
   • Coagulation studies
   • Biochemistry panel including renal function
   • Blood cultures if sepsis suspected 2

Monitoring and Follow-up

• Continue close monitoring of vital signs every 15 minutes until stable 2
• Document all observations, interventions, and the patient's response 2
• Monitor for at least 12 hours after transfusion for delayed reactions 2

Prevention of Future Reactions

• For patients with previous reactions, consider:
  • Pre-medication with antihistamines for allergic reactions
  • Leukoreduced blood products for febrile reactions
  • Slower transfusion rates in high-risk patients 1, 2

Common Pitfalls and Caveats

• Do not indiscriminately use steroids for transfusion reactions 1
• Do not restart the transfusion if a severe reaction is suspected 1, 2
• Do not delay treatment while waiting for laboratory confirmation 2
• Do not transfer patients during active transfusion unless absolutely necessary 1
• Recognize that TACO is now the most common cause of transfusion-related mortality and major morbidity 1
• Symptoms of different transfusion reactions often overlap, making immediate identification of specific reaction type challenging 3

Remember that prompt recognition and management of transfusion reactions significantly reduces morbidity and mortality. The first 15 minutes after recognizing a reaction are critical for appropriate intervention.