Page 240 - 2023 SMOG Digital

BLOOD TRANSFUSION RELATED
REACTIONS

Differential Diagnosis: Signs and Symptoms:
Anaphylaxis reaction Rapid onset of shock, hypotension (<100mmHg systolic),
angioedema, and respiratory distress
Acute hemolytic transfusion reaction (AHTR) Fever (>100.4°F), chills, flank pain, red/brown urine
Febrile non-hemolytic transfusion reaction (FNHTR) Fever (>100.4°F) or temperature increase of (1°C or 2°F) from
baseline, chills, possible dyspnea
Transfusion-related acute lung injury Hypoxemia (SpO 2 <94%), Fever (>100.4°F), hypotension
(TRALI) (<100mmHg systolic), cyanosis, tachypnea (>24 breaths per
minute), tachycardia (>100bpm)
Transfusional volume/circulatory overload Dyspnea, orthopnea, tachycardia (>100bpm), wide pulse
(TACO) pressure, hypertension (>140mmHg systolic), hypoxemia (SpO 2
<94%), headache, possible seizure
Mechanical-caused hemolysis Varies with each device. Fever (>100.4°F), chills, possible
dyspnea
Transfusion-transmitted bacterial infection Fever (>102.2°F or >3.6°F change after transfusion), rigors,
tachycardia (>120bpm or >40bpm increase following
transfusion), rise or fall of systolic blood pressure (>30mmHg)

Pearls:
• GENERAL RULES:
o Stop the transfusion
o Keep the intravenous line open with saline
o Identify and treat cause of the reaction
o Re-institute the transfusion only if it is deemed to be clinically essential
• Before initiating IVF bolus, ensure IV tubing is new. DO NOT USE existing Y-tubing from blood administration
set.
• The most common transfusion reaction is a febrile, non-hemolytic transfusion reaction. These are mostly benign
with no lasting sequelae. Treatment consists of antipyretics. (Acetaminophen 500mg PO q4hr.)
• TRALI is the leading cause of transfusion-related mortality and commonly occurs is patients who have
undergone recent surgery, massive blood transfusion, or who have an active infection. Goal of treatment is
supportive and aimed at maintaining oxygenation and reducing respiratory distress.
• TACO is essentially pulmonary edema secondary to congestive heart failure usually occurring in elderly, small
children and those with compromised cardiac function. Large volumes of fluid given rapidly are a common
precursor to this reaction. Goal is aimed at mobilizing fluids (diuretics) and treating underlying condition. Both
TACO and TRALI require immediate resuscitation by an advanced level practitioner.
o A unit of packed cells should be given at a rate of 2.5-3.0mL/kg/hr.
• Mechanical-caused hemolysis is commonly caused by rapid transfusion, poor collection and storage, or heating
the blood above 42°C during transfusion.

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