F00574 024 f017

Mild fever

Symptoms/signs of acute transfusion reaction

• Fever, chills. tachycardia. hyper- or hypotension. collapse, rigors. flushmg, urticaria, bonę. musde. chest and/or abdominal pain, shortness of breath, nausea. malaise. respiratory distress

Stop the transfusion

•    Measure temperaturę, pulse. BP. respiratory ratę. O2 saturation

•    Check identity of recipient. details on unit and compatibiiity form

Urticaria

Reaction involves mild fever or urticarial rash only?

Fcbrile non-haomolytic transfusion reaction		Mild allergic roaction
• if temperaturo nses by < 1.5^CC. observations are	©	• Give chlorphenamine 10 mg slowly i.v.
stable and patient is otherwise woli, give paracetamoi • Restart infusion at lower ratę and observe morę		• Restart transfusion at a siower ratę and observe morę freguently
freguently

Suspcctcd ABO incompatibility?

• Recheck pack and patient identity

ABO incompatibility

•    Take down unit and giving set; return mtact to blood bank

•    Commence i.v. salinę infusion

•    Monitor urine output/catheterise

•    Maintam urine output at > 100 ml/hr. give furosemide if output falls

•    Treat any OIC with appropriate blood components

•    Inform hospital transfusion department immediately

No

Scvcrc allergic reaction?

No

Othcr hacmolytic rcaction/bactcrial contamination?

Haemolytic reaction/bacterial infection of unit

•    Take down unit and giving set; return mtact to blood bank with all other used''unused units

•    Take blood cultures. repeat blood group/cross-match/ FBC. coagulation screen. błochemistry. urinalysis

•    Monitor urine output

•    Commence broad-spectrum antibiotics if suspected bacterial infection (Ch. 6)

•    Commence oxygen and fluid support

•    Seek haematological advice

©

Severe allergic reaction

(Bronchospasm. angioedema. abdominal pain. hypotension)

•    Return iniact to blood bank with all other used/unused units

•    Give chlorphenamine 10 mg i.v.

•    Commence O2

•    Give salbutamol nebuliser

•    If severe hypotension. give adrenalinę (epinephrine; 0.5 ml of 1 in 1000/0.5 mg i.m.)

•    Clotted sample to transfusion laboraiory

•    Saline-wash futurę blood components

Acute dyspnooa/hypotcnsion during or within 6 hrs of transfusion

•    Monitor blood gases

•    Perform chest X-ray

•    Measure central venous pressure (CVP)/ pulmonary capillary pressure

Fluid ovorload		Transfusion-related acute lung injury (TRALI)
• Give oxygen		• Give 100% oxygen
• Furosemide or venesection		• Treat as acute respiratory distress syndrome (ARDS) —veniilate if severely hypoxaemic

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