Transfusion Reaction

Question 1

What are the signs of a transfusion reaction in an anaesthetized patient?

Answer 1

1. Fever, flushing
2. Hypotension, tachycardia
3. Bronchospasm, hypoxia
4. Anaphylactic shock
5. Haemoglobinuria (cola urine), Oliguria
6. Bleeding from IV sites, surgical ooze

Question 2

What are the goals of treatment in transfusion reaction?

Answer 2

1. Treatment is directed towards circulatory support
2. Alleviating respiratory symptoms
3. Anticipating and treating coagulopathy

Question 3

Outline an immediate management strategy

Answer 3

1. STOP the transfusion and keep the IV line open
2. Call for help
3. Check patient vital signs, and assess respiratory status
4. If severe reaction -> treat airway, breathing, circulation
5. Treat any bronchospasm
6. Support cardiovascular system - Adrenaline, Noradrenaline
7. Insert IAL, CVC and IDC

Question 4

Outline ongoing management once the immediate life threats are dealt with

Answer 4

1. Maintain urine output - targeted diuretic therapy
2. Treat a possible developing coagulopathy
3. Collect new blood samples for blood back to re-check
4. Collect blood for U&Es, FBC, Coags and haemolytic screen
5. Clamp the PRBC unit and giving set -> send to lab with pt blood tubes
6. Notify lab and ICU

Question 5

What would be the management if a patient has a fever and urticarial rash, but no other symptoms?

Answer 5

1. STOP the transfusion
2. Recheck the correct blood is being transfused
3. Give Paracetamol for the fever
4. Give antihistamine for the rash
5. Recommence transfusion at slower rate using a leukocyte depleting filter
6. Closely monitor the patient

Question 6

If the reaction occurs early is it likely to have a better or worse outcome?

Answer 6

Early major reaction most likely represent acute haemolytic reactions

This is likely to progress to DIC, renal failure, cardiovascular collapse

It requires very aggresive management