Page 79 - PJ MED OPS Handbook 8th Ed

NOTE: Antihistamine (IV administration) must never be mixed with blood or blood products
in the same transfusion lines.

iii) SAVE remaining donor blood and any typing information available and evacuate with
patient. This will allow for ABO/further diagnostic testing at the MTF.
c. Febrile Non Hemolytic Reactions
i) Treat with antipyretics. Acetaminophen (1g PO, PR, or IV, avoid the use of aspirin and
other NSAIDs).
ii) If symptoms abate and there is no evidence of an acute hemolytic reaction consider
restarting the transfusion.
iii) Pretreatment with antipyretics and antihistamines is recommended in this protocol and
commonly done although there is no evidence that is decreases the incidence of fever
and urticaria associated with transfusions.
d. Urticarial Reactions
i) Treat with 25–50mg diphenhydramine (Benadryl®) IM or PO.
ii) If symptoms abate and there is no evidence of an acute hemolytic reaction consider
restarting the transfusion.

Indications for a Blood Transfusion
1. The patient is in shock from a known cause of hemorrhage.
2. One or more major amputations with or without signs of shock – administer 1 unit of whole
blood or 1 unit each of PRBCs and plasma.
NOTE: The amputation patterns above are the only traumatic injuries that constitute a STAND
ALONE IMMEDIATE FIELD INDICATOR for transfusion that requires no confirmation with vital
sign parameters. An amputation is defined as any severe trauma to a limb that involves com-
plete or partial loss of the limb (to include severely mangled but not severed). However, if the
patient has signs of shock transfuse to reverse signs of shock.

CAUTION: Control external bleeding before or simultaneously (if another PJ or Medic is there)
with initiation of blood product transfusion.
a. Traumatic Arrest: patient with exsanguination who had signs of life when received from
ground forces and has since become pulseless, apneic and unresponsive should receive im-
mediate transfusion (transfusion is more important than chest compressions in cases of
exsanguination and should take priority, it is controversial if it is worth doing chest com-
pressions for a traumatic cardiac arrest, i.e., loss of pulse after bleeding but other signs of
life present).
b. Initiate transfusion with TXA and 2 units of blood product (Combat Shock Protocol). Give
additional units if clinically indicated.
i) Traumatic injuries where early blood transfusions are most likely to be needed:
1) Penetrating thoracic/abdominal/junctional (junctional includes axilla/inguinal/cervi-
cal) injury

Chapter 7. Blood Administration and Protocol n 77