Adverse reactions

Question 1

Mild reactions

and what to do

Answer 1

localised rash
Isolated temperature rise less than 1.5 degrees Celsius

What to do:
Monitor IV access.
Monitor and record patients temperature and vital signs
Repeat all identity checks of the patient and blood pack
Contact medical staff immediately for further instructions

Question 2

Moderate to severe reactions signs (7) and what to do (7)

Answer 2

Signs
Temperature more than 1.5 above baseline
Hypotension/shock or hypertension
Tachycardia
Tachypnoea, wheeze or stridor
Rigors or chills
Nausea, vomiting 

Required actions
Stop transfusion immediately
Seek urget medical assistance (MET)
Maintain IV access but attach a new administration set
Do not discard blood line
Monitor and record the patients temperature and vital signs
Repeat all identity checks of the patient and blood pack
Monitor and record urine for signs of haemmaglobinuria
Report to the transfusion provider immediately for further instructions

Question 3

Documentation should include

Answer 3

a record of the conversation between patient and carer and prescriber resulting in consent or refusal of transfusion

the known transfusion history

the prescription, lab compatibility report and product details

time of transfusion commenscement and completion

evidence of patient observations during transfusion

Patient response to transfusion including occurence and management of any adverse events

discharge summary should include details of transfusion

Question 4

Relevant adverse events should be reported to

Answer 4

1. organisations risk management system

2. state haemovigilance incident reporting scheme

Question 5

What is happening

Localised urticaria, puriitis

Answer 5

Mild allergic

treated with antihistamines
transfusion may be started with caution

Question 6

What is happening

unexpected fever more than 1 degree above base line or if baseline is equal or below 37 degrees or temp of over 38, may be accompanied with chills and rigors

Answer 6

Febrile

usually respond to antipyretics ( drug that blockes hypothalamus)

Question 7

What is happening

Flushing, wheezing, hypotension, anaphylaxsis, generalised urticarial (hives) rash

Answer 7

Severe allergic

treated with adrenaline and/or steroids

support airway, maintain blood pressure. MET call

Question 8

What is happening

Rigors, fever, IV site pain, tachycardia, dyspnoea, hypotension, unexplained bleeding, disseminated intravascular coagulation (a condition in which blood clots form throughout the body, blocking small blood vessels), oliguria (low urine output, roughly less than 20ml per hour), haemoglobinuria (high levels of haemoglobin found in urine), haemoglobinaemia (excess of hemoglobin in the blood plasma. This is an effect of intravascular hemolysis, in which hemoglobin separates from red blood cells, a form of anemia)

Answer 8

Acute haemolytic

induce diuresis with fluids and diuretics. Notify transfusion lab and haematologist.

MET

Maintain airway and blood pressure.

Question 9

What is happening

Dyspnoea (shortness of breath), respiratory failure (a condition in which your blood doesn’t have enough oxygen), noncardiogenic pulmonary oedema (specific form of pulmonary edema that results from an increase in permeability of the normal alveolar-capillary barrier), hypotension, chills and fever

Answer 9

TRALI

Transfusion-related acute lung injury

administer o2, employ ventilation support if required

MET, maintain airway, support blood pressure.

Question 10

Fever, chills, rigors, nausea, vomiting, hypotension,

Answer 10

Bacterial sepsis

Obtain blood cultures and administer broad spectrum antibiotics. Send blood pack for urgent gram stain and culture.

Question 11

When responding to transfusion reactions always remember to:

Answer 11

stop the transfusion
check vital signs and continue to monitor
institute immediate management as needed. Use your hospital’s emergency medical procedures if indicated
maintain IV access – never flush the blood giving set
recheck the three Ps – the patient, prescription and pack details
notify the medical officer.

Question 12

Dyspnoea, tachypnoea, tachycardia, raised jugular venous pressure, fever, chills

later

• bilateral opacities throughout the lungs seen on chest X-ray
• respiratory compromise seen as reduction in oxygen saturation

Answer 12

TACO
Transfusion-associated circulatory overload (TACO). Consider also TRALI. Position the patient upright. Administer treatment for acute left ventricular failure including oxygen and diuretics.

Question 13

Preventing transfusion reactions

Answer 13

ensuring the indication for transfusion and the dose are appropriate
communicating to the laboratory any history of red cell antibodies, previous transfusion reactions or special requirements
strictly adhering to patient identification procedures
ensuring the patient receives premedication if indicated
maintaining appropriate handling, storage and transfusion times, eg 30-minute 4-hour rule
checking the product for signs of clots and bacterial contamination, eg discolouration, cloudiness
ensuring attention to patient’s fluid balance and monitoring cardiorespiratory function in patients at risk of volume overload. Administer diuretics if required
informing the patient and using an alert system when significant reactions occur, or when special requirements will be needed for future transfusions
timely reporting of transfusion reactions to the transfusion laboratory and Lifeblood to enable quarantine and testing of related components from the same donation
reporting any adverse or near-miss events.