Transfusion Reaction Investigation Immunohematology Review 478
Signs & symptoms of possible
transfusion reaction
Specimens needed
Immediate steps
Signs of hemolytic reaction
Further steps if signs of possible
hemolytic reaction
Fever; chills; respiratory distress; hyper- or hypotension; back, flank, chest, or abdominal
pain; pain at site of infusion; hives (urticaria)*; jaundice; hemoglobinuria; nausea/vomiting;
abnormal bleeding; oliguria/anuria.
Pre-tf blood.
Post-tf blood.
Post-tf urine.
Segment from unit.
Blood bag with administration set & attached IV solutions.
Stop tf.
Check all IDs & labels.
Repeat ABO on post-tf sample.
Visual check of pre- & post-tf samples for hemolysis.
DAT on post-tf sample. If pos, perform on pre-tf sample.
Hemolysis in post-tf sample, but not in pre-tf sample. Mixed field agglutination in DAT on
post-tf sample, but not on pre-tf sample.
Check HGB in first voided urine after tf.
Repeat ABO & Rh on pre- & post-tf samples & unit.
Repeat antibody screen on pre- & post-tf samples.
AHG xmatch with pre- & post-tf samples.
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