Mild reactions

Moderate and severe reactions

A mild febrile reaction has:

• Temp up: < 1.5 °C
• Stable haemodynamics
• No respiratory distress
• and no other symptoms

A mild allergic reaction will have:

• Occasional urticarial spots
• and no other symptoms

May include any of -

• Fever: >1.5 °C from baseline; or fever with rigors / chills
• Unexpected tachycardia
• Unexpected change of BP
• Acute breathlessness, stridor or cyanosis
• Pharyngeal or laryngeal oedema
• Extensive erythematous or urticarial rash; pain up transfusion arm
• JVP acutely elevated
• Loin pain; haemoglobinuria
• Severe apprehension

Action

Action

Action for first mild reaction:

1. Check labels & recipient ID
2. If IV infusion, slow transfusion
3. Consider giving medication:
• Antipyretic for pyrexia, e.g. paracetamol
• Antihistamine for urticaria
• Hydrocortisone - not usually needed
4. If IV infusion, continue transfusion at a slower rate with increased monitoring, e.g. BP/P/T 15-30 mins
5. If symptoms increase, treat as a moderate or severe reaction
6. Send adverse reaction notification form to Blood Bank.
7. Samples and the bottles of the product are not required for mild reactions but will be tested if you would like to send them.

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Action if a moderate or severe reaction is suspected:

1. If IV infusion, stop transfusion and review
2. Check label and recipient ID information is correct
3. If IV infusion, replace IV set; give saline to keep vein open and, or maintain BP
4. Call for medical assessment
5. Obtain specimens:
• FBC and Serum biochemistry
• And consider need for:
• Blood gases if respiratory distress present
• Urine to check for haemoglobinuria
• Coagulation screen if bleeding
• Blood cultures if sepsis suspected
6. Send Notification Of Suspected Adverse Reaction To A Fractionated Blood Product form, bottles of the product with IV set attached (in plastic bag) to Blood Bank and specimens to relevant labs.
7. Notify Blood Bank by phone: discuss urgency of follow up tests and further transfusion needs.
8. Discuss with NZBS Transfusion Medicine Specialist if severe reaction present
9. Further treatment - depends on cause:
• Anaphylaxis/anaphylactoid reaction: adrenaline sc/im (See NZ Formulary guidance on treating anaphylaxis)
  Adverse reaction recurs: discuss use of an alternative product with Transfusion Medicine Specialist / Haematologist
• Other: based on clinical state, test results & Transfusion Medicine Specialist consultation

FOR ANY SEVERE TRANSFUSION REACTION:
Contact the On-call Transfusion Medicine Specialist, Haematologist or Blood Bank immediately. Contact details are here.

More Info

• Transfusion Medicine Handbook
• Adverse reaction reporting and management
• Haemovigilance Program
• NZBS Clinical Compendium