What is the treatment for a blood transfusion reaction?

Management of Blood Transfusion Reactions

The first step in managing a blood transfusion reaction is to immediately stop the transfusion and maintain IV access with normal saline. 1

Initial Management

• Immediately stop the transfusion if signs of a reaction are observed (tachycardia, rash, breathlessness, hypotension, fever) 1
• Maintain intravenous access with normal saline for medication administration and fluid resuscitation 1
• Contact the transfusion laboratory immediately and send the blood unit with administration set for investigation 1
• Monitor vital signs closely, including heart rate, blood pressure, temperature and respiratory rate 1
• Check for signs of hemolytic reactions including hypotension, tachycardia, hemoglobinuria, and microvascular bleeding 1
• Assess urine output and color to monitor for hemolytic reactions 1
• Monitor peak airway pressure to detect potential transfusion-related acute lung injury (TRALI) 1

Specific Interventions Based on Reaction Type

Mild Allergic Reactions

• Administer antihistamines for urticaria or mild allergic symptoms 1
• Consider slowing transfusion rates for future transfusions if allergic reactions occur 2

Severe Reactions (Anaphylaxis)

• Administer intramuscular/intravenous adrenaline if the reaction is life-threatening 1
• Consider hydrocortisone for severe allergic reactions (FDA-approved for transfusion reactions) 3
• Provide supportive care including oxygen therapy and fluid resuscitation as needed 2

Transfusion-Related Acute Lung Injury (TRALI)

• Provide critical care supportive measures focusing on respiratory support 4, 2
• No specific therapy other than stopping transfusion and instituting critical care measures 1
• Most patients recover within 96 hours, though TRALI is among the top three most common causes of transfusion-related deaths 1

Transfusion-Associated Circulatory Overload (TACO)

• Administer diuretic therapy 2
• Position patient upright to improve respiratory mechanics 2
• Consider slower transfusion rates for future transfusions 2

Bacterial Contamination

• Consider broad-spectrum antibiotics if bacterial contamination is suspected 4
• Collect blood cultures from the patient 2
• The risk of bacterial overgrowth is related to storage temperature above 20-24°C, particularly in platelet products 1

Documentation and Reporting

• Double-check all documentation for administration errors 1
• Perform appropriate diagnostic testing including crossmatch, complete blood count, and coagulation studies 1, 2
• Report the reaction according to local hemovigilance protocols 5
• Inform the patient's general practitioner about the transfusion reaction 1
• Inform patients who experience reactions that they should be removed from the donor pool 1

Prevention of Future Reactions

• Consider washed blood products for future transfusions if allergic reactions occurred 2
• Use slower transfusion rates if TACO is suspected 2
• Implement weight-based dosing of blood products to prevent volume overload 2
• The best way to prevent transfusion reactions is to avoid unnecessary blood transfusions 5

Common Pitfalls and Caveats

• General anesthesia may mask the symptoms of both hemolytic and nonhemolytic transfusion reactions 1
• Signs of hemolytic reactions (hypotension, tachycardia, hemoglobinuria, microvascular bleeding) may be erroneously attributed to other causes in anesthetized patients 1
• Diagnosis of a transfusion reaction during ongoing hemorrhage may be difficult; if concerns arise, double-check documentation for administration errors 1
• Any symptom occurring within 24 hours of a blood transfusion should be considered a potential transfusion reaction 5
• Symptoms of different transfusion reactions often overlap and are nonspecific, making immediate cessation of transfusion critical when a reaction is suspected 6

The evidence strongly supports immediate cessation of the transfusion as the critical first step in managing any suspected transfusion reaction, followed by appropriate supportive care based on the specific type of reaction identified.