What are the immediate steps to take in the event of a blood transfusion reaction?

Immediate Management of Blood Transfusion Reactions

In the event of a suspected blood transfusion reaction, immediately stop the transfusion and maintain intravenous access with normal saline. 1

Initial Steps

• STOP the transfusion immediately when any signs or symptoms of a reaction appear 1, 2
• Maintain IV access with normal saline at keep-vein-open rate 1
• Check patient identification and blood component compatibility labels for any discrepancies 1
• Notify the transfusion laboratory immediately 1, 3
• Assess ABCs (Airway, Breathing, Circulation) and level of consciousness 1
• Position the patient appropriately:
  • Trendelenburg position for hypotension
  • Sitting up for respiratory distress
  • Recovery position if unconscious 1
• Administer oxygen if needed 1
• Call for medical assistance 1

Vital Sign Monitoring

• Monitor heart rate, blood pressure, temperature, and respiratory rate closely 1
• Continue monitoring vital signs every 5-15 minutes until stabilized 3
• Assess for signs of respiratory distress, hypoxemia, and changes in urine output/color 3

Assessment and Classification

• Evaluate for signs of different reaction types:
  • Fever, chills (febrile non-hemolytic reaction)
  • Rash, urticaria, pruritus (allergic reaction)
  • Dyspnea, hypoxemia, pulmonary edema (TRALI or TACO)
  • Hypotension, tachycardia (anaphylaxis or septic reaction) 1, 4

Management Based on Reaction Type

For Anaphylaxis (severe reaction with hypotension, respiratory distress)

• Administer epinephrine 0.01 mg/kg (1 mg/mL dilution, maximum 0.5 mL) intramuscularly into lateral thigh 1
• May repeat every 5-15 minutes if needed 1
• Administer fluid resuscitation: 1-2 liters of normal saline at 5-10 mL/kg in first 5 minutes 1
• Give H1 and H2 antagonists: diphenhydramine 25-50 mg IV plus ranitidine 50 mg IV 1
• Consider corticosteroids: 1-2 mg/kg IV methylprednisolone every 6 hours 1

For Febrile Non-Hemolytic Reactions

• Administer antipyretics (acetaminophen) 1, 4
• Avoid steroids unless necessary, as they may suppress immunity 1

For Allergic Reactions

• Administer antihistamines (diphenhydramine) 1
• For severe reactions, follow anaphylaxis protocol 1

For Transfusion-Associated Circulatory Overload (TACO)

• Position patient upright 1
• Consider administering diuretics 1
• Provide respiratory support as needed 1

Laboratory Evaluation

• Collect post-reaction blood samples for:
  • Repeat crossmatch
  • Complete blood count
  • Coagulation studies
  • Blood cultures (if septic reaction suspected) 3, 4
• Send the blood component bag with administration set to the transfusion laboratory 1

Documentation

• Document pre-infusion assessments, description and grading of the reaction, and management steps taken 1
• Report the reaction to the hemovigilance system 4

Post-Reaction Monitoring

• Continue monitoring vital signs until resolution of symptoms 1
• For severe reactions, observe the patient for at least 24 hours 1
• Consider washed blood products for future transfusions if allergic reaction occurred 3

Prevention of Future Reactions

• Review patient's transfusion history before future transfusions 4
• Consider slower transfusion rates, especially in patients at risk for TACO 1, 3
• Use leukoreduced blood products if febrile reactions occurred 4

Remember that early recognition and prompt intervention are critical in managing transfusion reactions and can significantly improve patient outcomes 2, 4.