Page 20 - 2026 SMOG

BLOOD TRANSFUSION REACTIONS
Treatment
• STOP THE TRANSFUSION!
• If a blood transfusion reaction is suspected
˚ Apply O (if hypoxic), IV/IO, and a cardiac monitor
2
˚ Establish an advanced airway per individual competencies, contraindications, and/or attempt
failures. Maintain SpO >93%
• Anaphylaxis 2
˚ Epinephrine 0.3mg IM (0.3mL of 1:1000)
˚ Diphenhydramine 25mg IV/IO/IM
˚ Maintain airway
˚ Administer IV fluids as needed
Consider Methylprednisolone 125mg IV/IO
˚
• Acute Hemolytic Reaction (AHTR)
˚ Diphenhydramine 25mg IV/IO/IM
˚ Consider osmotic diuresis
20g Mannitol 20% or 250mL 3% NaCl
■
• Febrile Non-Hemolytic Transfusion Reaction (FNHTR)
˚ Consider Acetaminophen 500mg PO or 1g IV
• Continue to reassess the patient and ensure to document on SF 518
• Notify the blood bank of all transfusion reactions
Notes, Cautions, Warnings
• General rules
˚ Stop the transfusion
˚ Keep the intravenous line open with saline
˚ Identify and treat the cause of the reaction
˚
If deemed clinically essential, re-institute the transfusion
• Before initiating the IVF bolus, ensure the IV tubing is new. DO NOT USE existing Y-tubing
from the blood administration set.
• The most common transfusion reaction is a febrile, non-hemolytic transfusion reaction.
These are mostly benign with no lasting sequelae. Treatment consists of antipyretics.
• TRALI is the leading cause of transfusion-related mortality, a concern in patients who
have undergone recent surgery, massive transfusion, or have an active infection. The goal of
treatment is supportive: maintain oxygenation, reduce respiratory distress.
• TACO is essentially pulmonary edema secondary to congestive heart failure occurring in the
elderly, small children, and those with compromised cardiac function. Large volumes of fluid
given rapidly are a common precursor. The goal is to develop diuresis and treat the underlying
condition. Both TACO and TRALI require immediate resuscitation.
Reference: CPG ID #18 (Damage Control Resuscitation), CPG ID #82 (Prehospital Blood Transfusion)

12 • GENERAL