Page 76 - 2022 Ranger Medic Handbook

Blood Transfusion
WARNINGS
1. Confirmed O low titer is the only universally compatible FWB type. Second choice should be nontitered O. Other-
wise, transfusions of FWB must be an ABO match. All attempts should be made to transfuse blood from pre-identified
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
SECTION 2 3. Use only collection bags designed for the collection of whole blood (WB) and administration sets designed for the
identification and management of transfusion reactions.
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. Lactated 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.
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. 8. Anxiety, feeling of impending doom
2. Evidence of disseminated intravascular coagulopathy 9. Nausea and vomiting
(DIC) – oozing from blood draw, IV sites 10. Hypotension
3. Flushing, especially in the face 11. Pain, inflammation, and/or warmth at the infusion site
4. Fever, an increase in core temp of more than 2°F (1°C) 12. Red or brown urine (hemoglobinuria): The onset of red
5. Shaking, chills (rigor) urine during or shortly after a blood transfusion may
6. Flank pain or the acute onset of pain in the chest (retro- represent hemoglobinuria (indicating an acute hemo-
sternal), abdomen, and thighs lytic reaction) or hematuria (indicating bleeding in the
7. Wheezing, dyspnea lower urinary tract).
Febrile Nonhemolytic Reactions S/Sx: Fever not as severe with an acute hemolytic reaction; chills; dyspnea
Transfusion-Related Acute Lung Injury (TRALI) S/Sx: Development of ARDS following transfusion. 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
products and equipment used for administration and typing for follow-up testing.
Febrile Reaction: Diphenhydramine 25–50mg PO, PR, or IV for urticaria.
Anaphylactic Reaction: Treat IAW Anaphylactic Management Protocol.
1. Epinephrine 0.3mL of 1:1,000 IM or push dose 1:100,000 2. Airway maintenance and oxygenation.
epinephrine to maintain blood pressure. 3. Resuscitate hypotensive patients with IV fluids.
Acute Hemolytic Reaction:
1. Secure and maintain airway. 6. Administer 25–50mg of diphenhydramine IM or IV to
2. Begin IV infusion of crystalloids. treat the associated histamine release from AHTR. Anti-
3. Goal of fluid replacement is to infuse 100–200mL/hr in histamines should not be mixed with blood or blood
order to support a urine output of 1–2mL/kg/hr. products.
4. The patient should receive a foley catheter to monitor 7. SAVE the rest of the donor blood and any typing infor-
urine output. mation available and evacuate with the patient. This
5. Consider using Acetaminophen 1g PO, PR, or IV (q6hr to will allow for ABO and further diagnostic testing at the
treat discomfort associated with fevers. (Avoid the use of medical treatment facility.
aspirin or other NSAIDs).
Febrile Nonhemolytic Reactions: Treat with antipyretics. Acetaminophen 1g PO, PR, or IV (avoid the use of aspirin
and other NSAIDs). If symptoms abate and there is no evidence of an acute hemolytic reaction, consider restarting the
transfusion.
TRALI: Secure and maintain the airway. Administer supplemental oxygen and maintain continuous pulse oximetry moni-
toring. Use suction to remove secretions.
62 SECTION 2 PRIMARY TRAUMA PROTOCOLS