Transfusion reaction

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Author: Mikael Häggström [note 1]

Immediate management

  • Check if transfusion is ongoing, and if so, stop it until resolution.

Workup

Even for unspecific symptoms, it is essentially never wrong to take blood samples for direct antiglobulin test (DAT) and hemolysis, as well as a urine sample for hemolysis.

Generally request temperature and blood pressure if not already available, and compare with measurements before the transfusion.

The most probable reaction can often be appreciated with the following algorithm:

Transfusion reaction algorithm.jpg

Look up the most probable reaction in the hemovigilance protocol of NHSN, and check whether the patient fulfills its criteria:

If the condition fulfills the criteria, classify it as such. Otherwise, you may look in the left column of each reaction type in that protocol to see if the patient fulfills any of them. In case blood cultures are pending, you may generally still classify the current condition as if it was negative, and change the classification if cultures points towards a transfusion-transmitted infection. Non-severe symptoms that don't fill any criteria can generally be classified as "non-specific symptoms". In such cases where there are other conditions of the patient that likely have caused the symptoms, consider "no evidence of transfusion reaction".

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

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