8-20
a. Treatment for hemolytic reactions.
(1) Stop the transfusion immediately and change the IV tubing.
(2) Leave the needle in place and reconnect the new tubing to the needle.
(3) Send a sample of the patient’s fresh blood and urine to the laboratory for analysis, if possible.
(4) Start Ringers lactate or normal saline IV to correct hypotension.
(5) Monitor vital signs and urine output.
(6) Administer oxygen.
(7) Administer medications. To establish osmotic diuresis, start an infusion of mannitol 20gm IV (e.g.,
100 ml of 20% solution) at once and continue it at 10 to 15 ml/min until 1000ml (200 gm) have been
given. If diuresis ensues, mannitol should be continued to a maximum of 100gm/day, or volume may
be maintained with other IV fluids until hemoglobinemia and hemoglobinuria have cleared. Bicarb IV,
one ampule per liter of fluid given. Benadryl 50mg IM.
(8) Use blankets to relieve chills.
NOTE: Lasix may be substituted for mannitol to maintain urine output.
b. Treatment for febrile reactions: Febrile transfusion reactions can usually be managed with antipyretics
and gentle patient cooling. Change tubing, but keep the venous access open with normal saline.
Check the patient’s temperature every 30 minutes. Give Tylenol or ibuprofen for fever. Document the
episode, time, and IV fluid given. When symptoms recur with blood that is otherwise compatible,
further transfusions should consist of RBCs that have been washed or specially filtered to remove
WBCs.
c. Treatment for allergic reactions: Stop the transfusion and change the tubing. An antihistamine usually
controls mild cases (e.g., diphenhydramine 50mg IM or IV). Administer fluids such as Ringer's
Lactate or Normal Saline IV, to support BP. Give Tylenol or ibuprofen for pain. For more severe
reactions: Epinephrine 0.5 to 1ml of 1:1000 solution sq (or, in extreme emergencies, 0.05 to 0.2ml
of 1:1000 solution diluted to 1:10,000 and injected slowly IV) should be given. Give Benadryl
50mg IV STAT then 50mg po q4h. Start IV normal saline at a rate to support BP. A corticosteroid (e.g.,
dexamethasone sodium phosphate 4 to 20mg IV) may occasionally be required.
d. Treatment for circulatory overload. The transfusion should be discontinued immediately. Place the
patient in an upright position. Keep the IV line open with a slow infusion of normal saline. Use
diuretics (Lasix) and morphine if necessary.
e. Treatment for air embolism: stop the source of the air and bleed or replace the line. Turn the patient
on the left side, head down, to allow the air to escape a little at a time from the right atrium. Monitor the
patient for pulmonary or cerebral embolisms.
f. Treatment for arrhythmia or arrest due to infusion of cold blood: Stop the infusion. Manage the
arrhythmia or arrest. Warm the blood before resuming infusion.
- Explain to the patient that there are possible late complications of blood transfusions and that they
should notify medical personnel immediately if the develop signs or symptoms of late complications.
a. Serum hepatitis.
b. Malaria: Can be transmitted by asymptomatic donors. Patients may develop high fever and headaches
weeks after the transfusion.
c. Syphilis.
d. AIDS virus.
NOTE: All donated blood should be tested for antibodies to the AIDS virus.
NOTE: Storing blood for more than 96 hours at 4°C inactivates the spirochetes.
e. Delayed hemolytic reactions can occur from 1 to 2 weeks after transfusion. Signs are fever, mild
jaundice, gradual fall in hemoglobin level, positive Coombs’ test.
f. Bacterial infection: A few contaminating bacteria, particularly gram-negative, can grow in refrigerated
blood and may cause severe reactions and sepsis if transfused. Procedures that allow blood to
reach room temperature (prolonged transfusions or warming blood) may accelerate bacterial growth
and are potentially hazardous. - Record all treatment given.
- Recommend evaluation by a physician.