Medscape is available in 5 Language Editions – Choose your Edition here.


Transfusion Reactions in Emergency Medicine Medication

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

Medication Summary

In hemolytic transfusion reactions, pharmacologic treatment is aimed at increasing renal blood flow and preserving urinary output. In anaphylaxis, the goals of therapy are to maintain hemodynamic stability and reverse the underlying process.



Class Summary

These agents are used to increase renal blood flow and preserve urinary output in hemolytic transfusion reactions. They also may be used in transfusion-related volume overload.

Furosemide (Lasix)


Increases excretion of water by interfering with chloride-binding cotransport system, which results in inhibition of sodium and chloride reabsorption in ascending loop of Henle and distal renal tubule. Individualize dose to patient. Depending on response, administer at increments of 20-40 mg, no sooner than 6-8 h after previous dose, until desired diuresis occurs.



Class Summary

These agents are used to increase renal blood flow and preserve urinary output in hemolytic transfusion reactions. In severe allergic reactions, epinephrine is used for its inotropic properties and ability to maintain perfusion of vital organs.

Dopamine (Intropin)


Stimulates both adrenergic and dopaminergic receptors. Hemodynamic effect depends on dose. Lower doses stimulate mainly dopaminergic receptors that produce renal and mesenteric vasodilation. Cardiac stimulation and renal vasodilation produced by higher doses.

Epinephrine (Adrenalin, Epinal, Epifrin)


DOC for treating anaphylaxis. Stimulates alpha-, beta1, and beta2-adrenergic receptors, which in turn results in bronchodilatation, increased peripheral vascular resistance, hypertension, increased chronotropic cardiac activity, and positive inotropic effects.



Class Summary

Used to treat minor allergic reactions and anaphylaxis. Diphenhydramine may be used to pretreat patients with prior documentation of minor allergic reactions.

Diphenhydramine (Benadryl, Benylin, Bydramine)


Used for symptomatic relief of allergic symptoms caused by histamine released in response to allergens.

Cimetidine (Tagamet)


H2 antagonist that, when combined with H1 type, may be useful in treating itching and flushing in anaphylaxis, pruritus, urticaria, and contact dermatitis that do not respond to H1 antagonists alone. Use in addition to H1 antihistamines.



Class Summary

These agents have limited benefit in the initial acute treatment of rapidly deteriorating anaphylactic patient. However, they may benefit patients with persistent bronchospasm or hypotension. Onset of action is approximately 4-6 h following its administration.

Methylprednisolone (Solu-Medrol)


Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Useful in treatment of inflammatory and allergic reactions. By reversing increased capillary permeability and suppressing PMN activity, may decrease inflammation.

Contributor Information and Disclosures

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.

  1. Porretti L, Cattaneo A, Coluccio E, Mantione E, Colombo F, Mariani M, et al. Implementation and outcomes of a transfusion-related acute lung injury surveillance programme and study of HLA/HNA alloimmunisation in blood donors. Blood Transfus. 2012 Feb 22. 1-9. [Medline].

  2. The 2011 National Blood Collection and Utilization Survey Report. Report of the US Department of Health and Human Services. Available at 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].

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

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

  7. Tuinman PR, Vlaar AP, Binnenkade JM, Juffermans NP. The effect of aspirin in transfusion-related acute lung injury in critically ill patients*. Anaesthesia. 2012 Feb 11. [Medline].

  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].

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

  10. Callum JL, Rizoli S. Assessment and management of massive bleeding: coagulation assessment, pharmacologic strategies, and transfusion management. Hematology Am Soc Hematol Educ Program. 2012. 2012:522-8. [Medline]. [Full Text].

  11. Nascimento B, Callum J, Tien H, Rubenfeld G, Pinto R, Lin Y, et al. Effect of a fixed-ratio (1:1:1) transfusion protocol versus laboratory-results-guided transfusion in patients with severe trauma: a randomized feasibility trial. CMAJ. 2013 Sep 3. 185 (12):E583-9. [Medline]. [Full Text].

  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].

  13. Miraflor E, Yeung L, Strumwasser A, Liu TH, Victorino GP. Emergency uncrossmatched transfusion effect on blood type alloantibodies. J Trauma Acute Care Surg. 2012 Jan. 72(1):48-53. [Medline].

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

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

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

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

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

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

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

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

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.