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Transfusion Reactions in Emergency Medicine Follow-up

  • Author: Eric M Kardon, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
 
Updated: Feb 29, 2016
 

Further Inpatient Care

See the list below:

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

See the list below:

  • 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[13]
  • Administer leukocyte-poor packed RBCs in patients who have had two 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 that is not available, frozen deglycerolized packed RBCs
  • Administer cytomegalovirus (CMV)-negative blood to patients who are immunocompromised
  • To reduce the risk of graft versus host 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
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Complications

Intravascular hemolysis may result in the following:

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Patient Education

Patients and family members of patients who have 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.

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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, American Medical Informatics Association, Medical Association of Georgia

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Theodore J Gaeta, DO, MPH, FACEP Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; 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: American College of Emergency Physicians, New York Academy of Medicine, Society for Academic Emergency Medicine, Council of Emergency Medicine Residency Directors, Clerkship Directors in Emergency Medicine, Alliance for Clinical Education

Disclosure: Nothing to disclose.

References
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  2. The 2011 National Blood Collection and Utilization Survey Report. Report of the US Department of Health and Human Services. Available at http://www.hhs.gov/ash/bloodsafety/2011-nbcus.pdf. Accessed: October 14, 2014.

  3. Rohde JM, Dimcheff DE, Blumberg N, Saint S, Langa KM, Kuhn L, et al. Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA. 2014 Apr 2. 311(13):1317-26. [Medline].

  4. 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. 2009 Aug. 49 Suppl 2:1S-29S. [Medline].

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  8. Tung JP, Fraser JF, Nataatmadja M, Colebourne KI, Barnett AG, Glenister KM, et al. Age of blood and recipient factors determine the severity of transfusion-related acute lung injury (TRALI). Crit Care. 2012 Feb 1. 16(1):R19. [Medline].

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  12. Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015 Feb 3. 313 (5):471-82. [Medline]. [Full Text].

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