ACUTE TRANSFUSION REACTIONS

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

  • 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
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

  • Treat as category 3
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