Occurring within 24 hours of transfusion.
REACTION/CAUSES |
MANAGEMENT |
CATEGORY 1: MILD REACTION |
Signs and symptoms
- Localised
cutaneous
reactions, e.g.
urticaria, rash
- Pruritus
Possible causes
|
- 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:
|
CATEGORY 2: MODERATELY SEVERE REACTIONS |
Signs and symptoms
- 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
|
If no clinical improvement within 15 minutes of restarting,
or condition worsens
|
CATEGORY 3: LIFE-THREATENING REACTIONS |
Signs and symptoms
- 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
|