Transfusion Reactions in Emergency Medicine Follow-up
- Author: Eric M Kardon, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP more...
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
- Intravascular hemolysis may result in the following:
- Acute renal failure
- Disseminated intravascular coagulation (DIC)
- Cardiovascular collapse
- Death
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.
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].
Fiebig EW, Busch MP. Emerging infections in transfusion medicine. Clin Lab Med. Sep 2004;24(3):797-823, viii. [Medline].
Triulzi DJ. Transfusion-related acute lung injury: current concepts for the clinician. Anesth Analg. Mar 2009;108(3):770-6. [Medline].
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].
Dellinger EP, Anaya DA. Infectious and immunologic consequences of blood transfusion. Crit Care. 2004;8 Suppl 2:S18-23. [Medline].
Dodd RY, Leiby DA. Emerging infectious threats to the blood supply. Annu Rev Med. 2004;55:191-207. [Medline].
Goodnough LT. Risks of blood transfusion. Anesthesiol Clin North America. Jun 2005;23(2):241-52, v. [Medline].
Looney MR, Gropper MA, Matthay MA. Transfusion-related acute lung injury: a review. Chest. Jul 2004;126(1):249-58. [Medline].
Spahn DR, Rossaint R. Coagulopathy and blood component transfusion in trauma. Br J Anaesth. Aug 2005;95(2):130-9. [Medline].
[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].
Stainsby D, Russell J, Cohen H, Lilleyman J. Reducing adverse events in blood transfusion. Br J Haematol. Oct 2005;131(1):8-12. [Medline].
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].

