NON INFECTIOUS

TRANSFUSION
REACTIONS

CLASSIFICATION
Transfusion reaction

acute

Immunologic Nonimmunologic

delayed

Immunologic Nonimmunologic

A. Hemolytic transfusion
reactions (HTR)
Accelerated clearance or lysis of red cells in the

Accelerated clearance or lysis of red cells in the

transfusion recipient. Usually d/t immunological

incompatibility b/w blood donor and the recipient
A. C LASSIFICATION WITH RESPECT TO TIME OF
OCCURRENCE

Acute (AHTRs )
During or within 24 hours of transfusion

Delayed ( DHTRs )
After 24 hours of transfusion.( 5-7 days )

Signs and Symptoms of Acute HTR

Conscious patient
Abrupt onset

Nausea, Vomiting

Anxiety

Shock

Facial flushing

Oliguria

Fever, chills

Hemoglobinuria
Inder
GA

Pain in back or flanks

Bleeding

Dyspnoea

Under GA
Hypotension
Hemoglobinuria

(This may be masked in patients

undergoing GU surgeries due to hematuria)
Undue bleeding from surgical site

Complications of AHTRS
Renal failure :- 36 %
Thrombus formation in renal
arterioles
DIC :- 10 %

Immediate Mx of
suspected AHTRs
A. Action for nursing staf
In presence of fever > 38 0 C and / or any S/s

Stop the transfusion

Check the pt identity and unit transfused

Save any urine the pt passes

Monitor pulse, BP and temp at 15 min interval

Immediate Mx of
suspected
AHTRs
B. Action
for medical staf
1. Isolated fever / fever & shivering,
stable observations, correct unit given
:- FNHTR = Paracetemol 1 g orally ,
observe P, BP and T every 15 min for
1 hr, then hourly. If no improvement
call hematology medical staf

Immediate Mx of
suspected
AHTRs
2. Fever with pruritis, urticaria :- Allergic
transfusion reaction = Chlorpheniramine
10 mg iv
3. Any other s/s, hypotension, incorrect
unit :- AHTR = discontinue transfusion, N
saline to maintain urine output 1ml
/kg / h. full and continuous monitoring

Mx of AHTRs

Take immediate note and inform blood bank

Seek help immediately from skilled anaesthetist

anaesthetis
or emergency team

Complete the transfusion reaction form and

appropriately record the following
Type of transfusion reaction
Time after the start of transfusion to the occurrence
of reaction
Unit No. of component transfused
Volume of the component transfused

Investigation of suspected AHTRs

Send the following lab investigations:
Immediate post transfusion blood samples (clotted and EDTA)
for:
Repeat ABO & Rh (D) grouping
Repeat antibody screen and crossmatch
Direct antiglobulin test
Complete blood count (CBC)
Plasma hemoglobin
Coagulation screen
Renal function test (urea, creatinine and electrolytes)
Liver function tests (bilirubin, ALT and AST)

Blood culture in special blood culture bottles

Blood unit alongwith BT set
Specimen of patients first urine following reaction

Other reactions
characterized by
1. Pts with autoimmune hemolytic anemia
hemolysis
2. Donor units m/b hemolysed due to

Bacterial contamination

Excessive warming

Erroneous freezing

Addition of drugs or iv fluids

Trauma from extracorporeal devices

Red cell enzyme deficiency

Mx of confirmed AHTRs
Maintain adequate renal perfusion by
- Fluid challenges
- Frusemide infusion
- If hypovolumic dopamine infusion
Transfer to high dependency area
Repeat coagulation and biochemistry screens ever
2- 4 hrly
If urinary output not maintained seek expert renal
advice
Hemofiltration or dialysis m/b required for acute
tubular necrosis
DIC development component therapy may be
required

DELAYED HEMOLYTIC TRANSFUSION

REACTIONS
Due to secondary immune responses
following re-exposure to a given red
cell antigen
- Ab most commonly involved Rh ,
Kidd, Duffy and Kell
- No clinical signs of red cell destruction
but positive DAT
- Rarely fatal

DELAYED HEMOLYTIC TRANSFUSION

REACTIONS
Sign and symptoms
- fever
- fall in Hb concentration
- Jaundice and hemoglobinuria
Mx
- Requires no Tt.
- Hypotension & renal failure may
require expert medical advice

Diagnosis & Management

Routine examination
Stop Tx immediately
Monitor vital signs, urine out put
Verify identification of the patient
IV line kept open with NS
Evaluate for evidence of HTR, septic shock,
anaphylaxis
TRALI other D/D fever
Report and send transfusion set to B/B
Diagnosis of exclusion

Blood Bank:

Recheck the records for clerical error

check for identification error

Visual check for hemolysis, appearance of returned

unit

Evidence of bloodPre
group
incomparability
Tx sample
Post Tx
sample

ABO,Rh group
DCT
ICT
Repeat CxM
Gram
HLA,

stain, culture

Plt, Granulocyte specific Abs in recipient

Treatment
Antipyretics

acetaminophen ; 325-650mg orally

(adult) 10-15mg/kg
(children)
Meperiedine
severe chills - 25-50mg IV
contraindication: renal failure
Pts on MAO inhibitors
Antihistaminics: not indicated
Tx should not be restarted for 30 min.

D. URTICARIAL AND
ANAPHYLACTIC REACTIONS
- Usually mild allergic reactions
Treatment
- Non systemic reaction = focal urticaria /
angioedema : Antihistamine
- Mild systemic = chest tightness, generalized
urticaria / angioedema : Antihistamine,
salbutamol and / or inhaled steroid

URTICARIAL AND ANAPHYLACTIC

REACTIONS
Moderate systemic = wheeze /
breathlessness / obstructive laryngeal
oedema : All above including prednisolone
, consider adrenaline
Severe systemic = Severe breathing
difficulty, shock arrhythmias, loss of
consciousness : Adrenaline im and all
above

E. BACTERIAL CONTAMINATION

Most common microbiological

complication of transfusion
Higher incidence after platelet
transfusion

Apparent infrequency of
clinical events of bacterial

Non pathogenic
bacteria
contamination
Insufficient no. of bacteria
Premedication with steroides
Pts already on antibiotics
Immunosuppressed pts
underinvestigated

Clinical features
-

- usually appear immediately during transfusion

S/t symptoms delayed until after the end of
transfusion
- fever ( inc > 2 o C )
- chills / rigors
Hypotension, collapse, shock
Nausea, vomitting
DIC, intravascular hemolysis, renal failure

Management
- Stop transfusion. Retain unit for
investigation
- Give general supportive Tt (iv fluids ,
inotropic agents , diuretics to maintain
urine output )
- Broad spectrum antibiotics until blood
culture report comes
- Assess need for intensive care bed

How to Prevent Errors in the Transfusion

Chain

Where in the process do errors occur?

Sample Error
Wrong Blood
Issued
Patient
Misidentification

Technical Error
Storage Error
Administrative
Error

Who is making the errors?

Why are the errors occuring which elements

of good transfusion practice are failing

Error Prevention in the Transfusion

Services
Adherence to Standard Operating Procedures
(SOPs) for pre-transfusion testing
Antibody screen in patients at risk of
alloimmunization; preferably universal screen
Antibody identification when required
Appropriate storage and transfusion
instructions on labels
Clerical checks prior to issue

Prevention of transfusion
reaction
Education

and training of nurses health care

assistants, doctors at every level
Proper

communication at all level should be

appropriate, timely and effective.
Promoting

the knowledge in hospital, raising

awareness by having more educational
sessions and poster available to hospital