Page 77 - PJ MED OPS Handbook 8th Ed

Reactions
1. When performing any administration of blood or blood components the patient should be con-
tinuously monitored for signs and symptoms of an immunologic blood transfusion reaction. The
first 10–15 minutes of any transfusion are the most critical.
a. Anaphylactic Reaction (occurs 1: 20,000–50,000)
i) Shock
ii) Hypotension
iii) Angioedema (red, swollen face/lips/tongue)
iv) Respiratory distress
b. Acute Hemolytic Transfusion Reaction
i) Acute Hemolytic (RBCs break) Reaction usually has onset within 1 hour
ii) Evidence of disseminated intravascular coagulopathy (DIC) – oozing from blood draw,
IV sites
iii) Flushing, especially in the face
iv) Fever and increase in core temp of >2°F (1°C)
v) Shaking, chills (rigor)
vi) Flank pain or the acute onset of pain in the chest (retrosternal), abdomen and thighs
vii) Wheezing, dyspnea
viii) Anxiety, feeling of impending doom
ix) Nausea and vomiting
x) Hypotension
xi) Pain, inflammation, and/or warmth at the infusion site
xii) Red or Brown Urine (hemoglobinuria) – The onset of red urine during or shortly after
a blood transfusion may represent hematuria (indicating bleeding in the lower urinary
tract or hemoglobinuria indicating an acute hemolytic reaction).
c. Febrile Non Hemolytic Reactions
i) Fever not as severe as with an acute hemolytic reaction
ii) Chills
iii) Dyspnea
d. Urticarial Reactions – Urticaria
e. Other transfusion related signs and symptoms
i) Flushing (especially in the face), urticaria or edema
ii) Increased pulse or respiratory rate
iii) Nausea, vomiting or diarrhea
iv) Pain and/or edema at the infusion site
v) Headache
vi) Feeling of impending doom
f. Citrate Toxicity
i) Mild
1) Perioral and periorbital paresthesia
2) Metallic taste in the mouth
3) “Tingling” sensation around the mouth or in the extremities
ii) Severe
1) Carpo-pedal spasms
2) Twitching

Chapter 7. Blood Administration and Protocol n 75