Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Transfusion Reactions 1441

tests

Stop transfusion; send transfusion reaction report form and samples to

blood bank

Basic Blood & Urine Tests

■Repeat clerical check

■Visually inspect blood & urine samples for hemolysis

■Perform direct antiglobulin test; if positive, perform eluate

■Repeat ABO/Rh on pre- & post-transfusion samples & donor unit

■Repeat antibody screen on pre- & post-transfusion samples

■Repeat cross-match on pre- & post-transfusion samples

■Gram stain & culture component

■TRALI: look for antibodies against HLA, neutrophils

■Anaphylaxis: look for antibodies against IgA

differential diagnosis

■Presentation of transfusion reactions myriad; suspect transfusion

reaction when pt’s clinical status changes in temporal association

w/ transfusion

■Must integrate pt’s pretransfusion clinical status w/ intra- & post-

transfusion signs & symptoms & results of transfusion reaction

workup

■Signs & symptoms of transfusion reactions can mimic exacerbations

of transfusion recipient’s underlying disease processes

■Neither presence nor absence of any sign or symptom can exclude

hemolytic transfusion reaction

■If transfusion reaction is in DDx for pt’s signs & symptoms, stop

transfusion, send transfusion reaction report & samples to the blood

bank for workup

management

What to Do First

■Stop transfusion: keep IV open

■Record vital signs (T, BP, P, R)

■Treat pt as needed (fluids, pressors, O2, antihistamines, meperidine,

antimicrobials, etc)

■Perform clerical check of pt & component

■Obtain post-transfusion blood samples (red-top & purple-top tubes)

& urine sample

■Complete transfusion reaction report form