Please refer to flowchart in the Transfusion Record inpatient, day patient and neonatal on the initial management of a suspected acute transfusion reaction as a quick reference guide.
Any adverse reaction experienced by a patient in association with a transfusion should be considered as a possible transfusion reaction. If any concern re-transfusion reaction, transfusion should be stopped and patient immediately assessed. The most commonly observed reactions are volume overload and allergic reactions. Severe transfusion reactions are usually as a consequence of anaphylaxis, haemolysis due to red cell incompatibility or septic shock.
When a transfusion reaction is suspected, stop the transfusion, inform medical staff and assess the patient's Temp, pulse, blood pressure, oxygen saturations. Temp rise <2 degrees and no other features of concern give paracetamol and consider restarting transfusion at slower rate.
Rash/pruritits and no other features of concern then IV chlorpheniramine 10mg should be given.
Common complications and mild transfusion reactions include:
- Fever (up to 2 degrees C above baseline temperature)
- Symptoms/signs of allergy - Urticaria, pruritis, rash
- Fluid overload
PLEASE NOTE: pyrexia may be the only signs of an acute transfusion reaction.
If symptoms progress then management should be as for a suspected severe acute transfusion reaction.
Severe life-threatening complications of transfusion include:
Acute haemolytic transfusion reaction* (due to ABO incompatibility or atypical RBC antibodies) Infusion of bacterially contaminated unit*
Transfusion associated lung injury* (TRALI) develops within 6 hours of the transfusion Severe allergic reaction or anaphylaxis*
Transfusion Associated Circulatory Overload (TACO)
Signs and symptoms of severe acute reactions include:
- Collapse*
- Feeling of apprehension/agitation
- Flushing
- Pain at cannula site* Loin pain*
- Hypotension/hypertension* Tachycardia
- Breathlessness, wheezing or respiratory distress* Pyrexia
- Urticaria Pruritus
- Uncontrollable bleeding (oozing from wounds or puncture sites)*
- Haematuria*
*In community Hospitals if a patient experiences an acute life-threatening event, suspected acute severe reaction or associated signs and symptoms (marked with an * above) urgent transfer may be required to Borders General Hospital. Dial 999, covering GP and on call Consultant Haematologist, transferring patient immediately to Accident & Emergency Department, Borders General Hospital.
In the event of a suspected anaphylaxis please refer to the NHS Borders Guidelines for the administration of adrenaline (epinephrine).
Please ensure Epinephrine is administered as a priority and prior to transfer to BGH.
PLEASE NOTE: Only staff who have received appropriate training can activate and implement the NHS Borders Guidelines for the administration of adrenaline (epinephrine).
A GP must assess all patients with a suspected transfusion related adverse event regardless of how mild. For day patients attending for a transfusion who experience mild complications, a GP must assess the patient prior to discharge. Advice must be provided on the signs and symptoms of a delayed transfusion reaction with contact details for further advice. If any day patient requires admission to hospital following a suspected transfusion reaction, please report event on Adverse Event Recording System.
Please follow procedure below on the management of suspected transfusion reactions for all patients.
If a severe transfusion reaction is suspected, the following actions must be taken:
- Stop transfusion immediately
- Repeat final bedside checks (check patient and component compatibility)
- Change blood administration set, keep IV access patent with slow 0.9% saline
- Repeat systemic observations, temperature, pulse, blood pressure, respiratory rate, oxygen saturation level. Follow SIR protocol.
- Contact medical team immediately and have patient assessed
- Instigate specific management depending on nature of reaction eg anaphylaxis Contact on call Haematologist for further advice as required
- Contact blood transfusion laboratory
- Return unit with administration set intact immediately to transfusion laboratory
- Complete NHS Borders Transfusion Reaction Investigation Form and return to transfusion laboratory with appropriate samples and any remaining units in the clinical area
The following blood samples from the recipient are required:
- FBC and coagulation screen (Red and Green tubes)
- Blood transfusion sample (large red tube)
- Blood cultures - Central and peripheral (Blood culture bottles)
- U&Es and LFTs including LDH (Brown Tube)
The Hospital Transfusion team are legally required to report any serious adverse events or serious adverse reactions associated with transfusion of blood and blood components to the Serious Adverse Blood Reactions and Events (SABRE) scheme governed by the MHRA. Additionally all clinical incidents and near miss events are required to be reported to the Serious Hazards of Transfusion (SHOT) haemovigilance scheme.
If you are involved in any clinical incidents, near miss events or a patient has suffered a suspected transfusion reaction please report via the Adverse Event Recording system under 'transfusion related event'. All incidents will be reviewed by the transfusion team.
Please refer to the Transfusion Record for further advice and guidance. Additionally, refer to the NHS Borders Incident Management Policy