ACUTE TRANSFUSION REACTIONS

• Localised
  cutaneous
  reactions, e.g.
  urticaria, rash
• Pruritus

Possible causes

• Hypersensitivity

• Slow the transfusion
• Give antihistamine, e.g.
  promethazine 25-50 mg by
  deep IM or slow IV
• Child 1-5 years: 5 mg by deep IM
  Child 5-10 years: 6.25-12.5 mg
  by deep IM

If no clinical improvement within
30 minutes, or if condition
worsens:

• Treat as category 2

• Flushing
• Urticaria, pruritis
• Rigors
• Fever
• Restlessness,
  palpitations
• Tachycardia
• Mild dyspnoea
• Headache

Possible causes

• Hypersensitivity
• Febrile non
  haemolytic reaction
• Possible
  contamination with
  pyogens/bacteria

• Stop the transfusion
• Replace the infusion set and
  keep the IV line open with
  sodium chloride 0.9 % infusion
• Notify the medical officer in
  charge and the blood bank
  immediately
• Send blood unit with infusion
  set, freshly collected urine,
  and new blood samples (one
  clotted and one anticoagulated)
  from the vein opposite the
  infusion site, together with the
  appropriate request form to
  the blood bank for laboratory
  investigations.
• Give antihistamine IM (see
  category 1 above)
• Give antipyretic: Paracetamol
  15 mg/kg (adult: 1 g)

If there are anaphylactic features
(e.g. bronchospasm, stridor):

• Give hydrocortisone 4 mg/
  kg IV and salbutamol 2.5-5 mg
  nebulisation
• Collect urine for the next 24
  hours for volume output and
  evidence of haemolysis
• If there is clinical improvement,
  restart transfusion slowly with
  a new blood unit and observe
  carefully

• Treat as category 3

• Rigors
• Fever
• Anxiety,
  restlessness
• Hypotension (fall
  of >20% in systolic
  BP)
• Tachycardia (rise of
  >20% in heart rate)
• Haemoglobinuria
• Unexplained
  bleeding (DIC)
• Pain in chest, or
  near infusion site,
  or in loin/back,
  headache
• Respiratory
  distress, shortness
  of breath, dyspoea

Possible causes

• Acute intravscular
  haemolysis
• Bacterial
  contamination and
  septic shock
• Fluid overload
• Anaphylaxis

• Stop the transfusion
• Give sodium chloride 0.9% IV
  infusion 20-30 mL/kg over 5
  minutes to maintain systolic BP
• Raise patient’s legs
• Maintain airway and give high
  flow oxygen by mask
• Give adrenaline (epinephrine)
  injection 1 mg/mL, 0.01 mg/kg
  slow IM
• If there are anaphylactic
  features (e.g. bronchospasm,
  stridor): Give hydrocortisone
  4 mg/kg IV and salbutamol
  2.5-5 mg nebulization or
  aminophylline 6 mg/kg IV
• Give diuretic: Furosemide
  1 mg/kg IV
• Notify the medical officer
  in charge and blood bank
  immediately
• Send blood unit with infusion
  set, freshly collected urine, and
  new blood samples (one clotted
  and one anticoagulated) from
  the vein opposite infusion site,
  with appropriate request form
  to blood bank for laboratory
  investigations
• Check fresh urine specimen for
  haemoglobinuria
• Start a 24–hour urine collection
  and fluid balance chart, and
  record all intake and output
• Maintain fluid balance
• If signs/symptoms of
  bacteraemia and no evidence
  of haemolysis, start braod
  spectrum antibiotics
• Refer for further management
  where necessary