Specific Transfusion Reaction Management

Question 1

How to manage a non hemolytic febrile reaction

Answer 1

1. Low-grade fever usually resolves in 15-3 minutes without treatment
2. If episode causes discomfort give acetaminophen
3. Continue transfusion monitoring
4. Use leukocyte washed transfusion products in the future

Question 2

How to manage a mild allergic reaction

Answer 2

1. Administer diphenhydramine (25-50 IV/PO/IM)
2. Resume transfusion only id the patient improve promptly
3. Pretreat with diphenhydramine known history of or in the future

Question 3

How to manage an anaphylactic reaction

Answer 3

1. Terminate transfusion
2. Give antihistamines (diphenhydramine 25-50mg IM/PO/IV)
3. Give corticosteroids (Methylprednisolone 125mg IV)
4. Give EPI
5. BP support with pressers as needed

Question 4

How to prevent anaphylactic reactions to a blood transfusion

Answer 4

1. Premedicate
   *antihistamines
   *Steroids
2. Use only leukocyte washed red cells for future transfusion

Question 5

How to manage transfusion treated acute lung injury (TRALI)

Answer 5

1. Hemodynamic support
   *treat hypotension
2. Provide ventilatory support as needed

Question 6

How to prevent TRALI

Answer 6

1. Collect plasma and platelets units from male donors or never pregnant female donors
2. Patients who recover from TRALI should not receive plasma-containing products from the implicated donor

Question 7

How to manage sepsis

Answer 7

1. Culture the transition product
2. Treat empirically by monitoring and administering persons and broad spectrum empiric antibiotics until cultures are returned

Question 8

How to prevent sepsis

Answer 8

1. Cleansing donor skin at time of phlebotomy
2. Visual inspection for discoloration of units before issuing

Question 9

How to manage transfusion associated circulatory overload (TACO)

Answer 9

1. Diuretics with furosemide

Question 10

How to prevent transfusion associated circulatory overload (TACO)

Answer 10

1. Use a slow rate of infusion
   *up to 4 hr if clinical circumstance permits

Question 11

How to manage acute intravascular hemolysis

Answer 11

1. Place Foley catheter, monitor urine output closely
2. Maintain brisk diuresis
   *D5W + mannitol + furosemide
3. Dopamine as needed
4. Alkaline the urine with bicarbonate
5. Pressure support
6. Monitor for DIC