Blood and Tissue Resources

Symptoms/Signs

Possible Etiology

Actions

• Local erythema

• Hives

• Itching

• Flushing

These symptoms/signs are related to a mild allergic reaction to plasma proteins

• Stop infusion

• Maintain IV line with normal saline at a "keep vein open” rate

• Notify physician or other provider

• Reconfirm patient and unit identification to verify that the correct unit is being given to the intended recipient

• Administer diphenhydramine (Benadryl), if ordered

• Notify the Blood Bank; no specimen need be sent

• If symptoms resolve, the physician or other provider may decide to restart the transfusion after treatment

• Monitor closely for any further signs or symptoms

• Document the reaction in the patient’s chart as per institution policy

• Chills

• Fever - 1°C/2°F or more increase in temperature up to 4 hours after the transfusion

• Flushing

• Restlessness

• Chest pain or pressure

• Lower back pain

• Dyspnea

• Tachycardia

• Nausea/vomiting

• Diarrhea

• Hypotension

• Shock

• Wheezing

• Throat tightness

• Rigors

• Wine- or cola-colored urine

• Pain at the infusion site

• Unexplained bleeding from mucous membranes or infusion site

These symptoms/signs may be due to a febrile, nonhemolytic reaction related to infused white blood cells or cytokines, or may be the initial presentation of a more serious acute hemolytic reaction or sepsis

These symptoms/signs may be related to fluid overload, acute hemolysis , sepsis , anaphylaxis , or transfusion-related acute lung injury (TRALI)

• Stop infusion

• Maintain IV line with normal saline at a “keep vein open” rate

• Notify physician or other provider

• Reconfirm patient and unit identification to verify that the correct unit is being given to the intended recipient

• Notify the Blood Bank; collect a type and screen specimen and a first post-transfusion urine specimen. Send these along with the remaining blood unit and administration set, with attached solutions, to the laboratory unless otherwise instructed

• Do not initiate another transfusion without Blood Bank consultation

• Document the reaction in the patient’s chart as per institution policy

Clinical Presentation

Possible Etiology

• Fever

• Rash

• Elevated liver function tests

• Watery diarrhea

• Symptoms/signs may occur from several days to a month after transfusion

• Rapid progression to death with virtually 100% mortality

These symptoms/signs may be caused by graft-vs-host disease , which can arise if HLA-incompatible donor T-lymphocytes attack recipient tissues.

• Fall in hemoglobin and hematocrit

• Fever

• Jaundice

• ↑ Lactate dehydrogenase (LDH)

• Typically occurs 3-7 days after transfusion, but may occur 14 days or more after transfusion

• Often, patient is asymptomatic

• Direct antiglobulin test (DAT) may be positive and an antibody not detected prior to the transfusion may be identified

These symptoms/signs may be caused by a delayed hemolytic reaction , which is due to an antibody, developed as a result of pregnancy or a transfusion in the past, when the antibody is of low enough titer so as to be undetectable at the time of a recent transfusion, but has intensified as a result of the transfusion (an anamnestic response).

• Thrombocytopenia, often severe, occurring with an abrupt onset, generally 1-2 weeks after a transfusion

• Melena

• Hematuria

• Vaginal bleeding

• Occurs most commonly in multiparous women

• Usually self-limited, but severe bleeding may occur and can be fatal ( e.g., intracranial bleeding)

These symptoms/signs may be caused by posttransfusion purpura , in which antibodies stimulated by a recent transfusion (usually of red blood cells or platelets) destroy platelets in a patient who has made an antibody against a foreign platelet antigen as a result of pregnancy or a previous transfusion.