eMedicine Specialties > Emergency Medicine > Hematology & Oncology

Transfusion Reactions: Follow-up

Author: Eric M Kardon, MD, FACEP, Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center
Contributor Information and Disclosures

Updated: Dec 10, 2009

Follow-up

Further Inpatient Care

  • Continue IV fluids to maintain urine output.
  • Monitor urine output.
  • Continuous cardiac and blood pressure monitoring for early detection of any hemodynamic instability
  • Transfusion-related acute lung injury
    • Intubated patients usually improve quickly with supportive care.
    • Once patients recover from transfusion-related acute lung injury, they can safely receive blood products as needed.

Deterrence/Prevention

  • All healthcare personnel should be familiar with the hospital's policy of checks and cross-checks to ensure that donor blood being transfused is administered to the intended patient. This best prevents hemolytic reactions.
  • Administer leukocyte-poor packed RBCs in patients who have had 2 previous febrile nonhemolytic reactions and in patients who frequently receive blood products.
  • If the patient has history of previous anaphylactic reactions to transfused blood, transfuse blood from IgA-deficient donors, or if this is not available, frozen deglycerolized packed RBCs.
  • Administer CMV-negative blood in patients who are immunocompromised.
  • To reduce the risk of GVH disease, irradiated blood should be given to immunocompromised patients, those receiving bone marrow transplants, and those receiving blood products from a blood relative donor.
  • Nonhemolytic febrile reactions recur in 15-20% of patients receiving future transfusions.

Complications

Patient Education

  • Patients and family members of patients having any reaction to blood products must be educated about the reaction. They should be instructed to inform healthcare workers about this in order to prevent any future transfusion reactions.

Miscellaneous

Medicolegal Pitfalls

  • Failure to carefully examine and compare patient's name and identification numbers to label on unit of blood to ensure administration to the intended recipient.
  • Failure to diagnose acute intravascular hemolysis in patients who are obtunded, unconscious, or anesthetized
  • Failure to suspect acute intravascular hemolysis if patient develops hypotension, dark urine, or oozing from IV or other puncture sites
  • Failure to obtain informed consent, when possible, from the patient or their family or power of attorney
  • Failure to inform patient of risk of transmission of infectious diseases
  • Monitor coagulation parameters, potassium, and ionized calcium in patients receiving massive transfusion.
 


More on Transfusion Reactions

Overview: Transfusion Reactions
Differential Diagnoses & Workup: Transfusion Reactions
Treatment & Medication: Transfusion Reactions
Follow-up: Transfusion Reactions
References
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References

  1. Stramer SL, Hollinger FB, Katz LM, Kleinman S, Metzel PS, Gregory KR, et al. Emerging infectious disease agents and their potential threat to transfusion safety. Transfusion. Aug 2009;49 Suppl 2:1S-29S. [Medline].

  2. Fiebig EW, Busch MP. Emerging infections in transfusion medicine. Clin Lab Med. Sep 2004;24(3):797-823, viii. [Medline].

  3. Triulzi DJ. Transfusion-related acute lung injury: current concepts for the clinician. Anesth Analg. Mar 2009;108(3):770-6. [Medline].

  4. Cherry T, Steciuk M, Reddy VV, Marques MB. Transfusion-related acute lung injury: past, present, and future. Am J Clin Pathol. Feb 2008;129(2):287-97. [Medline].

  5. Dellinger EP, Anaya DA. Infectious and immunologic consequences of blood transfusion. Crit Care. 2004;8 Suppl 2:S18-23. [Medline].

  6. Dodd RY, Leiby DA. Emerging infectious threats to the blood supply. Annu Rev Med. 2004;55:191-207. [Medline].

  7. Goodnough LT. Risks of blood transfusion. Anesthesiol Clin North America. Jun 2005;23(2):241-52, v. [Medline].

  8. Looney MR, Gropper MA, Matthay MA. Transfusion-related acute lung injury: a review. Chest. Jul 2004;126(1):249-58. [Medline].

  9. Spahn DR, Rossaint R. Coagulopathy and blood component transfusion in trauma. Br J Anaesth. Aug 2005;95(2):130-9. [Medline].

  10. [Guideline] Stainsby D, MacLennan S, Thomas D, Isaac J, Hamilton PJ. Guidelines on the management of massive blood loss. Br J Haematol. Dec 2006;135(5):634-41. [Medline].

  11. Stainsby D, Russell J, Cohen H, Lilleyman J. Reducing adverse events in blood transfusion. Br J Haematol. Oct 2005;131(1):8-12. [Medline].

  12. Williams AE, Thomson RA, Schreiber GB, et al. Estimates of infectious disease risk factors in US blood donors. Retrovirus Epidemiology Donor Study. JAMA. Mar 26 1997;277(12):967-72. [Medline].

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Further Reading

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Keywords

transfusion reaction, hemolytic transfusion reactions, nonhemolytic febrile reactions, anaphylactic reactions, graft-versus-host disease, GVH disease, massive transfusion complications, transfusion-related hepatitis C, chronic hepatitis, cirrhosis, blood replacement, symptomatic anemia, acute blood loss, blood transfusion, transfusion-related acute lung injury

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Contributor Information and Disclosures

Author

Eric M Kardon, MD, FACEP, Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center
Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Theodore J Gaeta, DO, MPH, FACEP, Clinical Associate Professor, Department of Emergency Medicine, Joan and Sanford Weill Medical College at Cornell University; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine
Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: Alliance for Clinical Education, American College of Emergency Physicians, Clerkship Directors in Emergency Medicine, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jeffrey L Arnold, MD, FACEP, Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center
Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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