This document discusses the laboratory investigation of transfusion reactions. It begins by defining transfusion and transfusion reactions. It then outlines the initial measures taken before investigation, including maintaining IV saline and notifying physicians. The main laboratory investigations include clerical checks to identify errors, visual checks of plasma for hemolysis, and serology checks including ABO testing and direct antiglobulin testing on pre-and post-transfusion samples. If these preliminary tests have positive results, additional tests like grouping, antibody screening and crossmatching are repeated from before transfusion.

1. LABORATORY
INVESTIGATION OF
TRANSFUSION REACTION
PRESENTED BY,
S.SHRUTHI VASAN
III BSc.CLT
Dr.NGPARTS & SCIENCE COLLEGE

2. TRANSFUSION:
 The process of transferring donated blood, blood
products, or other fluids into the circulatory system
of a person or animal.

3. TRANSFUSION REACTION:
 Reaction of the body to a transfusion of blood that
is not compatible with its own blood.
 It is an adverse reaction that can range from fever
and hives, to renal failure, shock and death.

4. NEED FOR BLOOD TRANSFUSION:
 Blood transfusion is needed when if the person is
too much of blood loss, such as the following:
 Injury or major surgery
 An illness that causes bleeding such as a Bleeding
ulcer.
 An illness that destroys blood cells, such as Haemolytic
Anemia or Thrombocytopenia.
 If there is an illness in which bone marrow doesn’t make
enough blood, such as Aplastic anemia, you may
needed transfusion.

5. INITIAL MEASURE BEFORE THE INVESTIGATION
TEST:
 An intravenous line with normal saline should be maintained.
 The patient should be assessed and supported as necessary
while the patient’s physician and the transfusion service are
notified.
 A responsible physician will need to evaluated the patient and
determine appropriate clinical care.
 The unit and all tubing should be returned to the blood bank
along, along with post-infusion blood and urine sample as
clinically indicated.
 The reaction should be documented in the patient’s chart.

6. SAMPLE CRITERIA:
MINIMUM SAMPLE REQUIREMENT:
 Verify the patient’s identify using at least two unique
identifiers.
 Date and time of sample collection.
 Ensure all section in the form are completed in a legible
and detailed manner.
 Completed all the information in the ‘specimen
collection’ information.
 Ensure both the nursing and facility of blood bank
clerical checks have been completed and this
documented on the form. This will prevent delays in
testing.

7. SAMPLE REJECTION:
 Specimen receives unlabeled/improperly labeled or
overloaded with more than one name.
 Key identifiers information is missing, incorrect or
discrepant on the sample and / or requisition.
 Specimen not received the laboratory within 8 hours of
collection.
 Unacceptable tube received.
 Specimens which are haemolysed.
 Insufficient of sample.

8. LABORATORY INVESTIGATION:
 After initial measures, there are three basic
preliminary test are done. They are:
 Clerical check
 Visual check
 Serology check

9. PURPOSE:
 To determine the likelihood the occurrence of haemolytic
transfusion reaction.
 It is a serious complications that can occur after a blood
transfusion. The reaction occurs when the red blood cells that
were give during the transfusion are destroyed by the persons
immune system.
 If there is evidence of haemolysis or if the clinical situation
something severe and unusual, the addition test such as
TRALI and TACO must be performed.
 TRALI – Transfusion Belated Acute Lung Injury. it is an acute lung
injury that is temporally related to a blood transfusion, specially it
occurs within the first six hours following a transfusion.
 TACO – Transfusion Associated Circulatory Overloaded. It occurs
due to the rapid transfusion of a large volume of blood

10. Transfusion reaction
Lab investigation
Preliminary test
Clerical check visual check serology

11. CLERICAL CHECK:
 To identify the possibilities of ABO blood compatibility.
 Compare the component bag, label, paper work with
patient sample and look for errors.
 If an error is found, the physician must be notified.
 Most common errors:
 Misidentifications of patient when pre transfusion sample
drawn.
 Mix up of sample in the lab.
 Not enough incubation time.

12. VISUAL CHECK:
 Plasma or serum reaction and compare with pre-transfusion.
 This step is done to examine the presence.
 This destruction of red cells and releasing haemoglobin will
resulting a pink to red.
 The pink colour or red colour serum indicates into haemolysis.
 Thus the ABO testing must be repeated of post transfusion
specimen.
 An urine examination of a post reaction helps in diagnosis of
acute haemolysis.
 The free haemoglobin in the urine indicates the intravascular.

13. SEROLOGY CHECK:
 On post transfusion sample redo the ABO test and
perform the direct antiglobulin test (DAT).
 The sample post transfusion must be preserved in
a EDTA preservation.
 If the DAT is positive on the post transfusion sample
then one should be performed on the pre
transfusion sample.
 If the result for the pre transfusion DAT is negative
but the result for post transfusion is positive.

14.  If any of these three test above have positive and
suspicious results, REDO test done before blood
transfusion which are:
 ABO &Rhesus grouping.
 Antibody screening.
 Repeat crossmatch.