What is the protocol for managing a hemolytic transfusion reaction (HTR)?

From the Guidelines

The protocol for managing a blood transfusion reaction begins with immediately stopping the transfusion while maintaining IV access with normal saline through a new administration set, as recommended by recent guidelines 1. This approach is crucial in preventing further complications and ensuring patient safety. The next steps involve notifying the physician and blood bank immediately, and checking vital signs every 15 minutes until stable.

• Sending the blood bag, tubing, and new patient blood samples to the blood bank for investigation is essential for identifying the cause of the reaction.
• Treatment depends on the reaction type, with mild allergic reactions requiring diphenhydramine 25-50mg IV/PO, and febrile non-hemolytic reactions requiring acetaminophen 650mg PO/PR.
• Severe reactions like anaphylaxis necessitate epinephrine 0.3-0.5mg IM, IV fluids, and corticosteroids, while acute hemolytic reactions require aggressive IV fluids to maintain urine output >100mL/hour, with furosemide 20-40mg IV if needed, and monitoring for DIC and renal failure 1.
• TACO (transfusion-associated circulatory overload) requires oxygen, diuretics, and sitting the patient upright, as it is now the most common cause of transfusion-related mortality and major morbidity 1.
• TRALI (transfusion-related acute lung injury) necessitates respiratory support and oxygen.
• Documentation should include reaction symptoms, timing, interventions, and patient response, as emphasized in the guidelines 1.
• Patient monitoring is essential to identify and manage adverse reactions, with dyspnoea and tachypnoea being typical early symptoms of serious transfusion reactions, and respiratory rate should be monitored throughout transfusion 1.
• Other observations including pulse, blood pressure, and temperature should be undertaken and documented for each unit transfused, with a minimum of observations completed and recorded before the start of the transfusion, 15 min after the start of each unit, and within 60 min of the end of transfusion 1.

From the Research

Protocol for Blood Transfusion Reaction

The protocol for blood transfusion reaction involves several steps to ensure patient safety.

• Stop the transfusion immediately if a reaction is suspected, as stated in the study 2.
• Report the reaction to the blood bank, as this can affect the patient's outcome 2.
• Use evidence-based algorithms of transfusion, newer blood screening methods, and donor policies and deferrals to minimize the risk of transfusion reactions 2.
• Implement electronic verification systems and improved hemovigilance to decrease the incidence of serious transfusion reactions 2.

Prevention of Transfusion Reactions

Several methods have been studied to prevent transfusion reactions, including:

• Leukoreduction, which has been shown to minimize febrile nonhemolytic transfusion reactions (FNHTRs) but not allergic transfusion reactions (ATRs) 3.
• Premedication with acetaminophen and diphenhydramine, which has been widely used but its benefit is not supported by research 3, 4, 5, 6.
• The use of acetaminophen and diphenhydramine may decrease the risk of febrile nonhemolytic transfusion reactions to leukoreduced blood products, but it does not decrease the overall risk of transfusion reactions 4.

Management of Transfusion Reactions

The management of transfusion reactions involves:

• Monitoring patients for symptoms of transfusion reactions, such as fever, chills, and allergic reactions 4, 5.
• Using medications such as acetaminophen and diphenhydramine to treat symptoms, but only when necessary and not as routine prophylaxis 6.
• Implementing measures to prevent future transfusion reactions, such as using leukoreduced blood products and improving hemovigilance 2, 3.