This document discusses transfusion reactions, which are any adverse events that occur during or after a blood transfusion. Transfusion reactions are classified as either acute (occurring within 24 hours) or delayed (after 24 hours). Acute reactions include hemolytic transfusion reactions, transfusion-associated sepsis, febrile non-hemolytic transfusion reactions, allergic transfusion reactions, transfusion-associated acute lung injury, and transfusion-associated circulatory overload. The document describes the presenting signs and symptoms of each type of reaction and the appropriate response, which is to first stop the transfusion and notify the physician before collecting samples and running tests to identify the cause.

1. TRANSFUSION
REACTIONS
DR. SARAH FARRUKH
MBBS, FCPS (HAEMATOLOGY)
WMO, PUNJAB INSTITUTE OF CARDIOLOGY

2. What is a transfusion reaction?
 Any adverse event which occurs during or after transfusion of whole
blood, blood components and human derived plasma products.

3. CLASSIFICATION
 ACUTE:
Within 24 hours of transfusion
 DELAYED
After 24 hours of transfusion

4. ACUTE TRANSFUSION REACTIONS
 Hemolytic transfusion reaction
 Transfusion associated sepsis
 Febrile non hemolytic transfusion reaction
 Allergic transfusion reaction
 Transfusion associated acute lung injury
 Transfusion associated circulatory overload

5. Presenting signs and symptoms
 PAIN: chest, abdominal, flanks,
back or infusion site.
 BP: Hypotension
 Dark colored urine / red urine
 Vascular collapse (DIC)
POSSIBLE REACTION
 HEMOLYTIC TRANSFUSION
REACTION
 Commonly seen in ABO mismatched
transfusion

6. Presenting signs and symptoms
 Rigors and chills
 BP: Hypotension
 Temperature: 2 degree rise in
temperature
POSSIBLE REACTION
 TRANSFUSION ASSOCIATED SEPSIS
 Commonly seen in Platelet
products as they are stored at
room temperature which favors
bacterial growth.

7. Presenting signs and symptoms
 Chills, nausea, vomiting
 Temperature 1 degree Celsius rise
from baseline
 Blood pressure: increased
 Tachycardia
 Tachypnea/ increased respiratory
rate
POSSIBLE REACTION
 FEBRILE NON HEMOLYTIC
TRANSFUSION REACTION

8. Presenting signs and symptoms
 Wheals, hives, erythema
 Bronchoconstriction, wheeze,
edema, tongue swelling, diarrhea
 Blood pressure: decreased
 Severe cases: arrythmia/ shock
POSSIBLE REACTION
 ALLERGIC TRANSFUSION
REACTION

9. Presenting signs and symptoms
 WITHIN 6 HOURS OF TRANSFUSION
 Blood pressure: Decreased
 Temperature: increased
 Chest Xray: Bilateral pulmonary
infiltrates
POSSIBLE REACTION
 TRANSFUSION ASSOCIATED
ACUTE LUNG INJURY
 Commonly seen in surgical patients
and multiple transfused patients

10. Presenting signs and symptoms
 Severe hypoxemia
 Increased blood pressure
 JUGULAR VEIN DISTENSION
 Increased central venous pressure
POSSIBLE REACTION
 TRANSFUSION ASSOCIATED
CIRCULATROY OVERLOAD

11. WHAT TO DO NEXT?
FIRST AND FOREMOST: STOP THE TRANSFUSION

12. PROCEEDING STEPS
 Maintain IV access open with normal saline.
 Notify the physician
 Perform following checks at the bedside
1. Clerical check
2. Hemolysis check
3. Urine check

15. Samples to be sent to the laboratory
 COMPLETE BLOOD COUNTS
 COAGULATION PROFILE
 ABO GROUPING
 URINE COMPLETE EXAMINATION
 ORIGINAL BLOOD/ COMPONENRT BAG
 RENAL FUNCTION TESTS
 LDH
 COOMBS TEST ( ANTIBODY MEDIATED HEMOLYSIS)
 BLOOD CULTURES (SEPSIS)
 BRAIN NATRIURETIC PEPTIDE ( TACO)
 SERUM HAPTOGLOBIN, BILIRUBIN AND LDH ( if hemolysis is suspected)