8-19
Procedure: Blood Transfusion Reaction
18D Skills and Training Manual
Reviewed by COL Warren Whitlock, MC, USAWhen: You have a patient who has received or is receiving a transfusion of whole blood or a blood
component. The patient is having a reaction to the transfusion. You must correctly identify the cause of the
blood transfusion reaction and manage it without causing further injury to the patient.
What You Need: Thermometer, blood pressure cuff, stethoscope, gloves, tourniquet, alcohol and Betadine
prep pads, IV catheters, tape, blood transfusion recipient sets (“Y” type), 500ml or 1000ml bag of 0.9%
normal saline, blood, IV stand, needles and syringes, Ringer’s lactate, Benadryl, epinephrine 1:1000 solution,
oxygen and related equipment, mannitol, bicarbonate, Tylenol or ibuprofen and the patient’s clinical
record.
What To Do:
NOTE: Patient has received or is receiving transfusions.
- Monitor the patient during and after transfusion.
- Compare baseline vital signs to current vital signs.
- Monitor the site of the infusion for edema, warmth, and urticaria.
- Examine the patient for systemic signs and symptoms of reaction.
- Identify the type of reaction based on the signs and symptoms.
a. Hemolytic reactions result in the lysis (destruction) of recipient or donor RBCs (usually the latter)
during or after administration of solutions, plasma, blood, or blood components.
NOTES: Hemolytic reaction is the rarest and most severe transfusion reaction. It usually starts within
the first 10 minutes of the transfusion. The most severe reaction occurs when donor RBCs are
hemolyzed by antibody (Ab) in the recipient’s plasma.
STOP THE TRANSFUSION IF A HEMOLYTIC REACTION IS SUSPECTED
Onset is usually acute, within 1 hour; it may occur during or immediately after a transfusion. Patient
complains of discomfort and anxiety, or may have no symptoms. They may have difficulty breathing,
precordial oppression, a bursting sensation in the head, facial flushing, and severe pain in the neck, chest,
or especially the lumbar area. They may have chills, fever, evidence of shock, a rapid feeble pulse, cold
clammy skin, dyspnea, drop in BP, nausea, and vomiting. Dark urine, free Hb may be found in the plasma
or urine, followed by elevated serum bilirubin and clinical jaundice.
NOTES: Group O whole blood can cause hemolytic reactions due to plasma anti-A and anti-B hemolytic
antibodies or IgG immunogloblins. It is dangerous when given in emergencies to a recipient with another
blood group. Remove the plasma, which contains most of the antibodies, first. Group O packed RBCs
should be used rather than whole blood.
b. Febrile reactions: signs and symptoms within 30 minutes. Chills & fever with a rise of at least 1° C in
body temperature, headache and back pain, stable vital signs, rarely progressing to cyanosis and
shock.
c. Allergic reactions are most common with multiple transfusions and in people with a history of allergies.
Signs and symptoms of mild reactions include rashes, urticaria, edema, occasional dizziness, fever,
and headache during or immediately after the transfusion. Signs and symptoms of severe reactions
include dyspnea, wheezing, and tracheal edema. Incontinence may be present, indicating generalized
smooth muscle spasms. Rarely, anaphylaxis may occur.
d. Circulatory overload: dyspnea, sudden anxiety, neck vein distention, crackles at the base of the lungs
(signs of pulmonary edema).
e. Transmission of large amounts of air into a vein can cause foaming of blood in the heart with
consequent inefficient pumping, leading to heart failure.
f. Rapid transfusion of cold blood can cause arrhythmia or cardiac arrest.
NOTE: Air embolism is largely a complication of pressure infusion of blood from rigid glass bottles, but it
can also happen when an IV set is changed or a plastic blood bag is erroneously vented. - Initiate the appropriate treatment for the transfusion reaction.