What treatment is indicated for a patient experiencing a transfusion reaction?

From the Guidelines

If a patient experiences a transfusion reaction, immediately stop the transfusion, maintain IV access with normal saline through a new line, and notify the physician and blood bank. For mild allergic reactions (hives, itching), administer diphenhydramine 25-50 mg IV/PO, as suggested by 1. For more severe reactions, give hydrocortisone 100 mg IV and consider epinephrine 0.3-0.5 mg IM (1:1000 solution) for anaphylaxis, as indicated by the management of infusion reactions to systemic anticancer therapy guidelines 1. Some key points to consider in the management of transfusion reactions include:

• Monitoring vital signs until resolution, with 24-hour observation recommended for severe reactions 1
• Administering antihistamine or steroid drugs, or intramuscular/intravenous adrenaline if life-threatening, as suggested by 1
• Collecting post-reaction blood samples, urine for hemoglobinuria testing, and returning the blood product bag to the blood bank for investigation
• Monitoring vital signs, urine output, and laboratory values (CBC, coagulation studies, renal function) closely, as indicated by 1 The specific treatment depends on the type of reaction, with the primary goal being to stop the offending product and provide appropriate supportive care to prevent complications. Key considerations for specific types of reactions include:
• Febrile non-hemolytic reactions may require acetaminophen 650 mg PO/IV and meperidine 25 mg IV for rigors
• Acute hemolytic reactions require support of blood pressure with IV fluids, maintenance of urine output with furosemide 20-40 mg IV if needed, and monitoring for DIC
• TRALI (transfusion-related acute lung injury) requires oxygen support and possibly mechanical ventilation.

From the FDA Drug Label

Allergic states: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, serum sickness, transfusion reactions. If a patient had a transfusion reaction, hydrocortisone (IV) may be given to control the severe or incapacitating allergic condition.

• The use of hydrocortisone (IV) is indicated for the treatment of transfusion reactions when oral therapy is not feasible 2.
• Hydrocortisone (IV) is used to control severe or incapacitating allergic conditions, including transfusion reactions.

From the Research

Transfusion Reactions

• Transfusion reactions can be life-threatening and require immediate attention 3
• Symptoms of transfusion reactions can be overlapping and nonspecific, making diagnosis and management critical 3

Management of Transfusion Reactions

• When a reaction is suspected, it is critical to stop the transfusion immediately and report the reaction to the blood bank 3
• Intramuscular epinephrine is the immediate treatment for anaphylaxis, a potentially life-threatening allergic reaction that can occur during transfusion 4
• Airway obstruction must be recognized, and early intubation may be necessary in cases of anaphylaxis 4

Medications for Transfusion Reactions

• Acetaminophen and diphenhydramine are sometimes used as premedication to prevent febrile nonhemolytic and allergic reactions, but their use is not universally recommended due to potential toxicity and lack of efficacy in preventing reactions 5
• The benefits and risks of routine prophylaxis with acetaminophen and diphenhydramine must be carefully considered, particularly in light of the low reaction rates reported at many institutions 5

Education and Awareness

• Healthcare workers must be aware of the risks of adverse transfusion reactions, including transfusion-associated circulatory overload and transfusion-associated graft-versus-host-disease (TA-GVHD) 6
• Education on the risk of TA-GVHD is important, particularly in facilities where nonirradiated blood is supplied 6

Blood Product Transfusions

• Blood product transfusions are an essential component of emergency medicine, and familiarity with individual blood products and their indications for transfusion is crucial 7
• Emergency physicians must be fully familiar with both the individual blood components and the potential reactions and complications of these transfusions 7