Page 78 - PJ MED OPS Handbook 8th Ed

3) Chills
4) Stomach cramps
5) Pressure in the chest
6) Hypotension and possible cardiac arrhythmia
7) Nausea and/or vomiting
8) Tetany
9) Laryngeal spasm
10) Seizures
11) Bradycardia
g. Treatment
i) Mild Toxicity – Slow or stop transfusion until symptoms subside. Ensure proper mixture
and concentration of citrate.
ii) Severe Toxicity – 10mL of a 10% solution of calcium gluconate SLOW IV push.

WARNING Do not rapidly infuse calcium nor give more than one dose without the ability to
monitor electrolytes. This may lead to cardiac arrhythmias.

Treatment of Immunologic Blood Transfusions Reactions
1. The first step in treating ALL transfusion related issues is to STOP the transfusion and save all
of the blood products and equipment used for administration and typing for follow-up testing.
a. Anaphylactic Reactions
i) Epinephrine 0.5mL of 1:1000 IM
ii) Airway maintenance and oxygenation
iii) Resuscitate hypotensive patients with IV fluids
iv) Diphenhydramine, dexamethasone, Pepcid
b. Acute Hemolytic Transfusion Reaction (AHTR)
i) Immediately STOP the transfusion.
ii) Initial Treatment:
1) Secure and maintain airway.
2) Begin an IV infusion of crystalloid if BP is stable, otherwise infuse a different unit
of blood. Treatment of hemorrhagic shock takes priority over crystalloid infusion to
flush the kidneys if the patient is still in hemorrhagic shock.

NOTE: DO NOT run any fluid through the line that was carrying blood. Replace the IV/IO site.

3) The goal of fluid resuscitation is to maintain a urine output of 100–200mL/hr until
the urine is clear of hemolyzed RBCs if infusing crystalloid.
4) However, if urine output is not obtained within 2–3 hours of administration of fluid,
consider the development of Acute Renal Failure and discontinue further fluids.
5) Consider using acetaminophen (Tylenol®, Ofirmev® [IV]) 1g PO, PR, or IV (q6hr to treat
discomfort associated with fevers. (Avoid the use of aspirin or other NSAIDs).
6) Administer 25–50mg of diphenhydramine (Benadryl®) IM, or IV to treat associated
histamine release from AHTR and help manage the chills/rigor.

76 n Pararescue Medical Operations Handbook / 8th Edition