transfusion is medical terminology and explaination
1. Bloody Easy Blood Administration
Module 3 – Transfusion Reactions
Content derived from
Bloody Easy Blood Administration Handbook
Version 2, 2015
Prepared by Ana Lima, RN
2. Learning Objectives
• Identify the signs and symptoms of an acute transfusion
reaction
• List the different types of acute transfusion reactions
• Describe the clinical management, reaction investigation
and reporting required when a reaction occurs
• Utilize the Ontario TTISS* transfusion reaction chart
NOTE: Always consult your hospital policy for
information specific to your facility as practice may vary
*TTISS - Transfusion Transmitted Injuries Surveillance System
3. Recognizing Reactions
Acute reactions usually occur during or up to 6 hours
following the end of a transfusion and may present with:
• Fever
• Shaking chills or rigors with or without fever
• Hives or rash, itchiness, swelling
• Dyspnea, shortness of breath, or wheezing
• Hypotension or hypertension
• Red urine, diffuse bleeding or oozing
• Lumbar pain, anxiety, pain at the IV site
• Nausea and vomiting
• Headache
• Irritability (pediatric patients)
4. Recognizing Reactions
• Initially it can be challenging to distinguish a minor
reaction from a serious reaction based solely on the
presenting signs and symptoms.
• Any unexpected or suspicious symptom should be
reported to the TML* for investigation of a possible
transfusion reaction.
• Delayed transfusion reactions do not present with
symptoms until days or weeks following a transfusion
and are not covered in this module.
*TML- Transfusion Medicine Laboratory
5. Signs and Symptoms Possible Transfusion Reaction
Fever, shaking chills, or rigors • Bacterial contamination
• Acute hemolytic transfusion reaction
• Transfusion related acute lung injury (TRALI)
• Febrile non-hemolytic transfusion reaction
Urticaria and other
allergic symptoms
• Anaphylaxis
• Minor allergic reaction
Dyspnea • TRALI
• Transfusion associated circulatory overload (TACO)
• Anaphylaxis
• Bacterial contamination
• Acute hemolytic transfusion reaction
Hypertension • TACO
Hypotension • Bradykinin mediated hypotension
• Bacterial contamination
• Acute hemolytic transfusion reaction
• TRALI
• Anaphylaxis
Hemolysis, hemoglobinuria • Acute hemolytic transfusion reaction
Pain • Acute hemolytic transfusion reaction
o IV site
o lumbar
• TACO
o Chest
Nausea and vomiting • Acute hemolytic transfusion reaction
• Anaphylaxis
• Febrile non hemolytic transfusion reaction
6. Acute Reaction Management
1.Stop the transfusion immediately!
2.Maintain IV access for treatment if necessary but do not
flush the blood tubing
3.Check vial signs
4.Verify that patient ID matches the TML tag/label
5.Verify that the blood unit number matches the TML
tag/label
6.Notify the physician but remain with the patient
7.Notify the TML of the reaction as per hospital policy
8.Treat patient’s symptoms as ordered by the physician
7. Restarting a Transfusion
• If the patient experiences only very minor allergic or febrile
symptoms, restarting the transfusion may be possible.
– Refer to your hospital policy for guidelines
• General guidelines for continuing a transfusion:
– Initially STOP the transfusion and assess the patient
– Consult physician
– Medicate patient as ordered
– Proceed cautiously with more frequent patient assessments
– Remember 4 hour limit
– Report to TML if required but further investigation is not
necessary
8. Reaction Investigation
To investigate a reaction, the following may be required by the TML:
1. Blood bag with attached blood tubing for:
o Possible culture
o Hemolysis check
o Clerical check
2. Previously infused blood bags if available
3. Transfusion reaction reporting document with:
o Symptoms
o Pre and post vital signs
o Time of onset
o Blood unit number or lot number
4. Post transfusion blood sample with required paperwork for:
o Repeat group/type and screen and repeat crossmatch for comparison with
pre transfusion testing results
o Direct antiglobulin test (DAT)
o Hemolysis check
9. Reaction Investigation
Depending on patient signs and symptoms, additional
testing my be required:
• Next voided urine for hemoglobin testing
– Monitor urine output if hemolysis suspected
• Chest x-ray if patient has new respiratory symptoms
• Blood cultures from the patient:
– Drawn from a different vein
– Antibiotics should be started immediately if bacterial sepsis suspected
– Report immediately to the TML as the blood supplier/manufacturer must
be alerted
• Other blood samples may be required to investigate:
– Anaphylactic reactions
– TRALI
– Acute hemolytic transfusion reaction
10. Reaction Investigation
• The TML must report serious reactions to blood
components/products to the manufacturer or the
Canada Vigilance Program.
Other components/products may be implicated
and need to be recalled.
• The TML may also report reactions to Ontario
TTISS, which collects transfusion reaction data
in order to monitor and improve transfusion
safety for all patients.
11. Ontario TTISS
Transfusion Reaction Chart
The Ontario TTISS Educational Committee has developed a
Reaction Chart that is available for all hospitals to use.
• Editable versions of the chart can be obtained from the
ORBCoN website – www.transfusionontario.org under
TTISS Resources
• As well it is included in the ORBCoN handbook
– Bloody Easy Blood Administration
• The chart categorizes reactions by signs and symptoms
and recommends investigations as well as suggested
treatment and actions.
12.
13. Acute Reactions - Risk and Description
Acute Transfusion
Reaction
Risk of
Event
Description
Minor Allergic Reaction 1 in 100 Mild allergic reaction to an allergen in the
blood component/product.
Anaphylaxis 1 in 40,000 Potentially fatal reaction caused by an
allergen that the patient has been
sensitized to.
Febrile Non-Hemolytic 1 in 300 Mild usually self-limiting reaction
associated with donor white blood cells or
cytokines in the blood component/product.
Usually presents with fever and/or rigors
(shaking).
14. Acute Reactions - Risk and Description
Acute Transfusion
Reaction
Risk of Event Description
Bacterial Sepsis
(platelet pool)
1 in 10,000 will
become symptomatic
1 in 60,000 will be fatal
Potentially fatal reaction caused by
bacteria inadvertently introduced into
the blood component/product or
originating from the donor.
More common in platelets due to
room temperature storage.
Bacterial Sepsis
(red blood cells)
1 in 250,000 will
become symptomatic
1 in 500,000 will be fatal
15. Acute Reactions - Risk and Description
Acute Transfusion
Reaction
Risk of
Event
Description
Acute Hemolytic
Transfusion Reaction
1 in 40,000 Potentially fatal reaction caused by blood group
incompatibility. Can also be caused by chemical
hemolysis (e.g. incompatible solutions) or
mechanical hemolysis (e.g. improper storage). Can
result in renal failure, shock and coagulopathy.
Transfusion Related
Acute Lung Injury
(TRALI)
1 in 12,000 Acute hypoxemia with evidence of new bilateral lung
infiltrates on X-Ray and no evidence of circulatory
overload. Patients often require ventilatory support.
Usually occurs within 1-2 hours of start of
transfusion and rarely after 6 hours. Usually resolves
within 24-72 hours with death occurring in 5-10%.
Cause not fully understood. Postulated to be related
to donor or recipient antibodies acquired through
pregnancy or transfusion.
16. Acute Reactions - Risk and Description
Acute Transfusion
Reaction
Risk of
Event
Description
Transfusion Associated
Circulatory Overload
(TACO)
1 in 100 Circulatory overload from excessively rapid
transfusion and/or in patients at greater risk for
overload (e.g. very young, elderly, impaired cardiac
function). Preventative measures include slower
transfusion rates and pre-emptive diuretics for
patients at risk.
Hypotensive Reaction Very Rare Bradykinin mediated hypotension. Characterized by
profound drop in blood pressure usually seen in
patients on ACE Inhibitors unable to degrade
bradykinin in blood component/product.
18. 1. Signs and symptoms that may be associated with a
transfusion reaction include:
a. Rash
b. Fever
c. Lumbar/Lower back pain
d. Dyspnea
e. All of the above
19. 2. Serious reactions such as an Acute Hemolytic Transfusion
Reaction usually present more than 6 hours after the
completion of the transfusion.
a. True
b. False
20. 3. You assess Luke White after the first 15 minutes of his
transfusion and notice a red rash appearing on his chest
and upper arms. What should you do first?
a. Stop the transfusion and complete a patient
assessment
b. Increase the rate of infusion so the transfusion will
finish before the symptoms worsen
c. Slow the transfusion and reassess Luke in another
15 minutes
d. Check Luke’s vital signs
21. 4. Luke White’s platelet transfusion has just finished. Suddenly
he says he can’t breathe and collapses in his chair.
What type of transfusion reaction can present with dyspnea?
a. Transfusion related acute lung injury (TRALI)
b. Hypotensive reaction
c. Minor allergic
d. Febrile non-hemolytic
22. 5. If the patient’s only symptoms are hypertension and mild
dyspnea, the transfusion may be continued cautiously.
a. True
b. False
23. 6. Which of the following is an Acute Transfusion Reaction?
a. Post transfusion Purpura
b. Delayed Hemolytic Transfusion Reaction
c. Hepatitis B infection
d. Acute Lymphocytic Leukemia
e. Transfusion Associated Circulatory Overload
24. 7. In the case of a suspected serious transfusion reaction
what should be sent to the TML?
a. Post transfusion blood sample from the patient
b. Blood bag with attached tubing
c. Transfusion reaction reporting document
d. All of the above
e. a and c only
25. 8. Which of the following is the most common Acute
Transfusion Reaction?
a. Acute Hemolytic Transfusion Reaction
b. Febrile Non-Hemolytic Transfusion Reaction
c. Anaphylaxis
d. Bacterial Sepsis
26. 9. Which of the following can cause hemolysis of transfused
blood?
a. Using an IV access ‘Y’d with an incompatible solution
b. Using an IV access that is too small when transfusing
rapidly
c. Using an IV access ‘Y’d with a medication
d. Transfusing incompatible blood
e. All of the above
f. a, b and c only
27. 10. A patient with leukemia is receiving a platelet transfusion 2 weeks after
completing chemotherapy. 20 minutes after the transfusion starts the
patient experiences rigors and is febrile (39.80 C from 37.70 C pre-
transfusion). Which of the following is recommended?
a. Administer an antipyretic and continue the
transfusion with more frequent assessments.
b. Stop the transfusion and contact the TML. Blood
cultures should be drawn from the patient.
c. Stop the transfusion and do not restart. No
investigation is required as this is a Febrile Non-
Hemolytic Reaction.
d. No treatment is required as this is related to the
patient’s underlying medical condition. The platelet
transfusion is not the cause.
