Blood

1. CASE PRESENTATION ON BLOOD
TRANSFUSION REACTION
Student Name : SRIDHAR P
Date:17.02.2025
Preceptor Name: Dr. G. K. SADAGOBAN
Ward : OBSTRECTICS AND GYNAECOLOGY

2. Introduction
A blood transfusion reaction is a harmful immune system response to donor blood.
Reactions can occur right away or much later, and can be mild or severe.
EPIDEMIOLOGY:
In India there is a transfusion reaction frequency of 0.27%. Allergic reactions were
the most common, accounting for 0.19% of cases, followed by febrile non-hemolytic
transfusion reactions (FNHTR) at 0.036%. The studies also noted that females
experienced a higher incidence of transfusion reactions compared to males.
Transfusion reactions accounted for 0.5% of transfusions. Febrile non-hemolytic
transfusion reactions were the most common reactions (51.4%) followed by allergic
reactions (40%), fluid overload (5.7%) and anaphylactic reactions (2.9%). Majority of
these reactions were seen with PRBC transfusions (74.3%) followed by platelet
transfusions (25.7%)
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3. Subjective
Evidence
Patient ID: 16574 Age : 26 years
Sex : Female
Date of Admission:27.12.2024
Date of Discharge: 2.1.2025
Weight: 53kg
Weight gain during pregnancy:
12 kg
Height: 153 cm
BMI:23
Blood group: B+ve
Lmp:29.3.24
Edd: 05.01.25
G2A1
EFW:2.7-2.9
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CHEIF COMPLAINTS:
C/O fever
C/O itching
C/O pruritus
C/O restlessness
PAST MEDICAL HISTORY:
H/O Anaemia
H/O G1 abortion 4 ½ weeks
PAST MEDICATION HISTORY:
2 Packs of PCT august 2024
Allergies
yes – dust ,pollen
Occupation
cotton mill
Family History
Anemia for Mother

4. Objective Evidence
ON EXAMINATION
FHR:152/min
EFW:2.7-2.9
5/10/2024 Arulmigu Kalasalingam College of Pharmacy - DPP 4
GENERAL EXAMINATION:
BP: 100/70 mmHg
PR : 98 bpm
RR : 30 bpm
Temp : 100.2°F
SYSTEMIC EXAMINATION:
CVS: S1S2 (+)
RS : Bilateral Air Entry (+)
CNS: NFND
P/A : Soft.

5. 5

6. 6
Signs/
symptoms
0-5min 15min 30min 45min 1hr
Temp 98.4° 98.4° 98.4° 98.4° 100.2°
pulse 88/m 88/m 89/m 87/m 86/m
BP 120/70 120/70 110/70 110/70 100/60
SKIN
RASHES/UTICA
RIA
NO NO NO NO YES

7. LABORATORY INVESTIGATION
7
PARAMETERS OBSERVED VALUE NORMAL RANGE
Hemoglobin 9.9 g/dL↓ 13-17 g/dL
Total RBC count 3.2 millions/mm³↓ 3.8-4.8 millions/mm³
WBC count 11500 cells/mm³↑ 4000-10000 cells/mm³
Platelet count 5.06 lakh/µL ↑ 2.0-4.5 lakh/µL

8. Other investigation
1.Mast cell tryptase test
17.5 ng/ml Normal range<11.4ng/ml
2.Serum IgA and IgE test:
IgE- 140IU/ml Normal range <100IU/ml
IgA-380mg/DL Normal range 70-400mg/dl
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9. 9
3.Repeat blood grouping and repeat crossmatch
Test Anti-A Anti-B
Anti-D (Rh
Factor)
Interpretation
Forward
Grouping (RBC
Test)
No Agglutination
(-)
Agglutination (+) Agglutination (+) B Rh-Positive (B )
⁺
(Recipient’s serum + Donor
RBCs)
No agglutination (-) Compatible (safe for
transfusion)

10. Assessment
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1.Patient has an history of allergies to dust and pollen in his life which in
turn increases the risk of IgE mediated histamine reaction and thus
potential risk for blood transfusion reaction.
2.Based on the history collected from the patient and the IgE antibody
investigation the patient is assessed to have allergic reaction [grade1]
and not ABO compatibility or haemolysis.

11. 11
SEVERITY( Ring and messmer Scale)
The patient is assessed to a Grade 1 allergic
symptoms

12. Therapeutic Goals
SHORT TERM GOALS
• To reduce fever.
• To reduce the itching and prurits
• To reduce the levels of serum IgE level from 140IU/ml to 100IU/ml
• LONG TERM GOALS
• To prevent the recurrence of the reaction as the patient is aneamic.
• To treat anaemia by improving hb level to 12mg/dl
• To monitor the reduce the risks too the fetus .
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13. Plan
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DRUG NAME BRAND NAME DOSE ROA FREQUENCY 27/
12
28
/1
2
29/
12
30
/1
2
31
/1
2
1/
12
5
Inj.cetrizine Quzyttir 10 mg IV OD    ✓
T. prednisolone Omnacortil 40 mg Oral OD    ✓
Inj.paracetamol Parapher 500 mg IV Q6H    
T.Ranitidine Rantac 50 mg Oral Q6H    
T.Ferrous sulphate Ferosol 200mg Oral BD      ✓
T.Folic acid Folvite 400 mg Oral OD    ✓ ✓ ✓

14. Drug-drug interaction
No drug-drug interactions were found.
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15. Dose calculation
Prednisolone normal dose for adults- 0.5-2 mg/kg/day
Prednisolone pregnancy safe Dose - <80mg/day
Patient weight= 53kg
Per kg Dose = 1mg kg
Dose = 53mg
Given dose = 40 mg
It is well between the therapeutic range
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16. Pharmacist Intervention
HEAMOVIGILANCE MONITORING AND REPORTING:
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17. 17
CAUSALITY ASSESSMENT
In this case the assessment made is that
the reaction is excluded with conclusive
evidence.

18. Therapeutic outcome
• Patient’s admission complaints were rectified.
18
PARAMETERS DAY OF ADMISSION DAY OF DISCHARGE
Temperature 101º F ↑ 98.6º F
Symptoms of
uticaria
(rashes,itching,
pruritus)
GRADE 1 symptoms Normal
Hb level 9.9 g/dL↓ 3.8-4.8 millions/mm³

19. Discharge medication
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DRUG NAME DOSE FREQUENCY
Tab. Ferrous sulphate 250 mg OD * 4 days
Tab.folic acid 400 mg OD* 4days
REVIEW AFTER 3 days

20. Patient counselling
Counselling was provided to patient.
• Advised as “Your reaction may have been due to a mild immune response. We’ve
given medications like antihistamines (for allergic reactions) or antipyretics (for
fever) to help manage it.”
• Avoid allergic triggering foods such as diary product ,Brinjal and nuts and wear
mask to avoid dust and allergen which could trigger another allergic condition.
• Monitor and report any allergic reactions such as rash,itching or any other
unpleasant sensations.
• As it is a grade 1 allergic reactions there is none to relatively very less effect on the
featus.
• Anaemia is treated with ferrous sulphate as long term because you have a allergic
reaction to blood transfusion.
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21. Clinical Pearls
21
1.I learnt about Haemovigilance in India
National Institute of Biologicals https://nib.gov.inHaemovigilance
Programme of India (HvPI)
2.I also learned about Ring and messmer scale which is used for severity
of Allergic reactions.

22. Refference
1.https://jmsh.ac.in/articles/a-study-of-transfusion-related-adverse-
events-at-a-tertiary-care-center-in-central-india-a-retrospective-
evaluation?
2.Pai S. Surveillance of Transfusion Related Adverse Reactions in a
Tertiary Care Centre in Bangalore: A 4-Year Hemovigilance Initiative.
Indian J Hematol Blood Transfus. 2020;36(4):733-739.
doi:10.1007/s12288-020-01312-w
3.https://www.researchgate.net/figure/Ring-and-Messmer-grading-
scale-for-allergic-reactions-25_tbl1_371121943
4.https://www.mayoclinic.org/drugs-supplements/prednisolone-oral-
route/description/drg-20075189
5.https://nib.gov.in/haemovigilance.aspx 22