Adverse Reaction to Transfusion

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ADVERSE REACTIONS TO TRANSFUSION

  • Suspect an adverse reaction if any of the following occurs:
    • Severe pain at transfusion site or in the back, loin and/or chest
    • Rise in temperature of 1 Degree Celsius above the baseline
    • Increase in pulse rate of >20/minute above baseline
    • Fall in systolic BP < 20 mm Hg
    • Urticaria
    • Rigors
    • Hemoglobinuria
    • Shortness of breath
    • Wheezing
  • Treatment depends on the severity of the transfusion reactions.

Mild Reactions

SIGNS AND SYMPTOMS:

  • Itchy rash

Possible cause: hypersensitivity (mild)

TREATMENT:

  • Stop the transfusion
  • Administer antihistamine IM/IV or PO
  • Chlorpheniramine 0.1 mg/kg IM or IV for children; 10mg IM/IV for adult alternatively Chlorpheniramine 4mg PO or
  • Promethazine 6.25-12.5mg for children aged 5-12 yrs and 25mg for adults.
  • If no clinical improvement within 30 minutes or if signs and symptoms worsen, treat as Category 2.

Moderate Reactions 

SIGNS AND SYMPTOMS:

  • Anxiety, pruritus, palpitations, mild dyspnea, headache, rigors, fever, tachycardia

Possible causes:

  • Hypersensitivity {moderate to severe}
  • Febrile non-haemolytic transfusion reaction Contamination with pyrogens and / or bacteria.
TREATMENT
  • Seek help immediately from the anaesthetic, emergency team or whoever is available and skilled to assist
  • Stop the transfusion
  • Replace the infusion set and keep IV line open with normal saline.
  • Administer antihistamine IM/IV or PO
    • Chlorpheniramine 0.1 mg/kg IM or IV for children; 10mg IM/IV for adult or Chlorpheniramine 4mg PO.
    • Promethazine 6.25-12.5mg for children aged 5-12 years and Promethazine 25mg for adults.
  • Give oral or rectal antipyretic (e.g., Paracetamol 10 mg/kg or 0.5g - 1g in adults. DON’T give Aspirin.
  • Give IV corticosteroids (e.g., Hydrocortisone 200mg IV stat) and bronchodilators (e.g. salbutamol 5mg nebulization or salbutamol inhaler 2 puffs (if nebule not available) STAT or Aminophylline 100mg STAT} if there are anaphylactoid features (e.g. bronchospasm, stridor).
  • If there is clinical improvement, restart transfusion slowly with new blood unit and observe carefully. May need to redo group and crossmatch

If no clinical improvement within 15 minutes or if signs and symptoms worsen, treat as Category 3.

Life-Threatening Reactions

SIGNS AND SYMPTOMS
  • Anxiety, chest pain, pain near infusion site, respiratory distress, loin or back pain, headache, dyspnea, rigors, fever, restlessness, hypotension, tachycardia, hemoglobinuria, unexplained bleeding

Possible causes:

  • Acute intravascular haemolysis
  • Bacterial contamination and septic shock
  • Fluid overload
  • Anaphylaxis
  • Transfusion Associated Acute Lung Injury (TRALI)
TREATMENT
  • Seek help immediately from the anaesthetist, emergency team or whoever is available and skilled to assist.
  • Stop the transfusion. Replace the infusion Set and keep IV line open with normal saline.
  • Infuse normal saline {initially 20- 30 ml/kg} to maintain systolic BP, if hypotensive, give over 5 minutes and elevate patient's legs.
  • Maintain airway and give high flow of oxygen by mask.
  • Give Adrenaline {as 1:1000 solutions} 0.01 mg/kg body weight by slow intramuscular injection.
  • Give IV corticosteroids {Hydrocortisone 200mg IV stat} and bronchodilators {salbutamol nebulization 5mg or salbutamol inhaler 2 puffs (if nebule not available), aminophylline 100mg stat} if there are anaphylactoid features {e.g., bronchospasm, stridor}.
  • Give a diuretic: e.g., Frusemide 1 mg/kg IV or equivalent {if there is fluid overload}
  • Assess for bleeding from puncture sites or wounds. If there is clinical or laboratory evidence of a DIC treat accordingly.
  • Maintain fluid balance accurately.

If bacteremia is suspected {rigors, fever, collapse, no evidence of a haemolytic reaction}, start broad-spectrum antibiotics IV and send blood product bag to the laboratory for culture of contents.

ALTERNATIVES FOR TRANSFUSINON 

  • IV Iron and Erythropoietin which can be used as substitutes to blood transfusion in chronic anaemia if available
  • Acute anaemia due to bleeding or haemolysis cannot be adequately treated by giving these products.
  • When available, cell salvage machines can be used in acute anaemia due to bleeding.