Blood Transfusion Reactions

Question 1

Incompatibility of ABO blood type or Rh factor
Usually occurs within the first 15 minutes of transfusion
S/S: Chills, Dyspnea, Fever, Flushing, Infusion site pain, Low back pain, Shock, Tachycardia, Tachypnea
Interventions:
* Immediately stop transfusion
* Administer diuretics
* Infuse IV normal saline to maintain urine output of at least 1 mg/kg/hr
* Insert urinary catheter if needed
* Prepare to treat shock and DIC if needed

Answer 1

Acute hemolytic transfusion reaction

Question 2

Some degree of hemolysis occurs during or shortly after transfusion but is not widespread
S/S: Back pain, Chest pain, Hypertension, Joint pain
Interventions:
* Administer medication to manage pain

Answer 2

Acute pain transfusion reaction

Question 3

Plasma protein sensitivity
S/S: Flushing, Periorbital edema, Pruritus, Rash, Urticaria
Interventions:
* Administer antihistamine
* Prepare to administer bronchodilators, steroids, and epinephrine if symptoms progress to bronchospasm, wheezing, and anaphylaxis (very rare)

Answer 3

Allergic transfusion reaction (mucocutaneous)

Question 4

Plasma protein sensitivity
S/S: Anxiety, Angioedema, Bronchospasm, Cyanosis, Dyspnea, Stridor, Shock, Urticaria
Interventions:
* Administer epinephrine as the priority
* Be prepared to administer antihistamines, bronchodilators, steroids, and epinephrine if needed
* Prepare to perform CPR and treat shock if needed

Answer 4

Allergic transfusion reaction (anaphylactic transfusion reaction)

Question 5

Occurs most often in patients with anti-WBC antibodies
S/S: Chills, Fever (>1°C increase), Headache, Rigors, Tachycardia, Tachypnea
Interventions:
* Administer acetaminophen
* Administer diphenhydramine, if indicated
* Administer meperidine for rigors, if indicated
* Recognize that transfusion may begin (based on health care provider’s order) at a reduced rate of infusion; acetaminophen and diphenhydramine may be ordered prior to next transfusion

Answer 5

Febrile reaction (nonhemolytic)

Question 6

Can occur when a blood product is infused too quickly, especially in an older adult
Pulmonary reaction that may be difficult at first to differentiate from transfusion-related acute lung injury (TRALI)
S/S: Bounding pulse, Cardiogenic fluid overload, Cough, Cyanosis, Decreased oxygen saturation (<90%), Dyspnea, Hypertension, Neck vein distention, Pulmonary edema, Respiratory distress, Tachycardia
Interventions
* Apply oxygen
* Administer diuretics
* Collaborate with health care provider regarding number of transfusions, timing of administration, and administering diuretics before or between transfusions
* Elevate head of bed to facilitate gas exchange
* Monitor intake and output
* Recognize that symptoms can occur 6 to 12 hours after transfusion

Answer 6

Transfusion-associated circulatory overload (TACO)

Question 7

Occurs most often in immunocompromised patients when donor T lymphocytes attack host tissues
Usually occurs 1–2 weeks after transfusion
Donor T lymphocytes attack host tissues
S/S: Anorexia, Chronic Hepatitis, Infection, Thrombocytopenia, Vomiting, Weight loss
Interventions:
* Administer irradiating blood products to destroy most T cells and their cytokine products

Answer 7

Transfusion-associated graft-versus-host disease (GvHD)