Page 54 - 2021 Advanced Ranger First Responder Handbook

Blood Transfusion
WARNINGS
1. Confirmed O low titer is the only universally compatible fresh whole blood (FWB) type. Second choice should be non-
titered O. Otherwise, transfusions of FWB must be an ABO match. ARFRs should transfuse blood from preidentified
ROLO donors. For female casualties, do not delay transfusion for Rh– blood if needed.
2. Blood and blood components should only be administered by personnel who are trained in the proper procedure and
the identification and management of transfusion reactions.
3. Use only collection bags designed for the collection of whole blood (WB) and administration sets designed for the
administration of blood and blood components. Failure to do so may lead to fatal thromboembolic events.
4. 0.9% normal saline (NS) is the IV fluid of choice for administering with blood or blood components. Ringer’s solution
can be used if normal saline is unavailable. Colloids (Hextend) or dextrose-based fluids should NOT be used at any
time.
5. Great care should be taken to practice aseptic technique when performing transfusions in the field to prevent sub-
sequent infection.
6. The largest bore IV catheter should be used. An IO device may be used. Ensure that a strong flush is done, and good
flow is obtained prior to using an IO infusion.
7. ONLY CONFIRMED ROLO DONORS FROM THE MOST CURRENT LIST CARRIED BY RANGER MEDICS
SIGNED BY THE REGIMENTAL SURGEON AND BATTALION SURGEON CAN BE USED.

Signs/Symptoms (S/Sx) of Reactions
Allergic Reaction S/Sx: Diffuse, itchy rash most common. Anaphylaxis may also occur.
Anaphylactic Reaction S/Sx: Shock, hypotension, angioedema, respiratory distress.
Acute Hemolytic Reaction S/Sx:
1. Acute hemolytic reaction usually has onset within 1 hour.
2. Evidence of disseminated intravascular coagulation (DIC) – oozing from blood draw, IV sites.
3. Flushing, especially in the face.
4. Fever, an increase in core temp of > 2°F (1°C).
5. Shaking, chills (rigor).
6. Flank pain or the acute onset of pain in the chest (retrosternal), abdomen, and thighs.
7. Wheezing, dyspnea.
8. Anxiety, feeling of impending doom.
9. Nausea and vomiting.
10. Hypotension.
11. Pain, inflammation, and/or warmth at the infusion site.
C
12. Red or brown urine (hemoglobinuria) – the onset of red urine during or shortly after a blood transfusion may represent
hemoglobinuria (indicating an acute hemolytic reaction) or hematuria (indicating bleeding in the lower urinary tract).
Febrile Non-hemolytic Reactions S/Sx: Fever not as severe with an acute hemolytic reaction; chills; dyspnea.
Transfusion Related Acute Lung Injury (TRALI) S/Sx: Development of Acute Respiratory Distress following trans-
fusion. Often presents with hypoxemia, hypotension, and frothy, pink pulmonary secretions. Avoid female donors to
reduce chances of TRALI.
Management of Reactions
The first step in treating ALL transfusion related issues is to STOP the transfusion and save all of the blood prod-
ucts and equipment used for administration and typing for follow-up testing.
Febrile Reaction: Diphenhydramine 25–50mg PO, per rectum (PR), or IV for urticaria.
Anaphylactic Reaction: Treat IAW Anaphylactic Management Protocol. Get help from a Ranger Medic.
Acute Hemolytic Reaction: Get help from a Ranger Medic.
Febrile Nonhemolytic Reactions: Get help from a Ranger Medic.
TRALI: Get help from a Ranger Medic.

44 SECTION 5 CIRCULATION