Guideline on the investigation and management of acute transfusion reactions Prepared by the BCSH Blood Transfusion Task Force

Abstract

SummaryAlthough acute non-haemolytic febrile or allergic reactions (ATRs) are a common complication of transfusion and often result in little or no morbidity, prompt recognition and management are essential. The serious hazards of transfusion haemovigilance organisation (SHOT) receives 30-40 reports of anaphylactic reactions each year. Other serious complications of transfusion, such as acute haemolysis, bacterial contamination, transfusion-related acute lung injury (TRALI) or transfusion-associated circulatory overload (TACO) may present with similar clinical features to ATR.This guideline describes the approach to a patient developing adverse symptoms and signs related to transfusion, including initial recognition, establishing a likely cause, treatment, investigations, planning future transfusion and reporting within the hospital and to haemovigilance organisations.Key recommendations are that adrenaline should be used as first line treatment of anaphylaxis, and that transfusions should only be carried out where patients can be directly observed and where staff are trained in manging complications of transfusion, particularly anaphylaxis. Management of ATRs is not dependent on classification but should be guided by symptoms and signs. Patients who have experienced an anaphylactic reaction should be discussed with an allergist or immunologist, in keeping with UK resuscitation council guidelines.

A randomised controlled trial and economic evaluation of intraoperative cell salvage during caesarean section in women at risk of haemorrhage: the SALVO (cell SALVage in Obstetrics) trial

“…The following approach was taken to calculate the mean cost per patient in each arm of the model (Table 25): is to discontinue transfusion. 81 Therefore, no additional costs were incurred and the occurrence of AEs is not included in this analysis.…”

An acute transfusion reaction

“…A blood bank search was performed so that any other components from the implicated donation could be withdrawn if necessary. 2 Blood tests results are summarised in Table 1 . Repeat compatibility testing confirmed no serological incompatibility between the patient and implicated donor red cells.…”

Respiracijske transfuzijske reakcije

“…Potrebno je nadzorovati vitalne parametre (telesna temperatura, srčna frekvenca, krvni tlak, oksigenacija), opravimo pa tudi rentgensko slikanje prsnega koša in odvzamemo kri (elektroliti, retenti, hemogram, vnetni parametri, diferencialna krvna slika, natriuretični peptid B oz. NT pro-BNP in po potrebi plinska analiza arterijske krvi) (31). TRALI in TACO je težko ločiti med seboj, saj je klinična slika zelo podobna, pri TRALI gre namreč za nekardiogeni, pri TACO pa kardiogeni pljučni edem (32).…”

“…Vsi bolniki z znižano oksigenacijo krvi, izmerjeno bodisi s pulznim oksi- (31). Bolnike, pri katerih gre za TACO, zdravimo po načelih zdravljenja kardiogenega pljučnega edema.…”

“…Zdravljenje respiracijskih transfuzijskih reakcij je poleg ustavitve transfuzije predvsem podporno, v pomoč pa so nam lahko nekateri izdelani algoritmi in smernice (31,38).…”