Transfusion Reactions in Emergency Medicine Treatment & Management

  • Author: Eric M Kardon, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Dec 10, 2009
 

Emergency Department Care

All patients receiving blood products should be placed on continuous cardiac monitoring and pulse oximetry.

  • Hemolytic transfusion reaction
    • Stop transfusion as soon as a reaction is suspected.
    • Replace the donor blood with normal saline.
    • Examine the blood to determine if the patient was the intended recipient and then send the unit back to the blood bank.
    • Furosemide may be administered to increase renal blood flow.
    • Low-dose dopamine may be considered to improve renal blood flow.
    • Make efforts to maintain urine output at 30-100 mL/h.
  • Extravascular hemolytic reactions do not require any specific treatment. However, if clinically ruling out intravascular hemolysis is difficult, follow the same treatment.
  • Nonhemolytic transfusion reaction
    • Aggressive treatment of simple febrile reactions is not necessary. However, because the nonspecific symptoms are similar to those of a hemolytic transfusion reaction, differentiating this entity from a hemolytic reaction is necessary.
    • The transfusion should be terminated.
    • Evaluate the patient for evidence of hemolysis.
    • The patient's fever can be treated with acetaminophen.
  • Anaphylactic reaction
    • Stop the transfusion immediately.
    • Support the airway and circulation as necessary.
    • Administer epinephrine, diphenhydramine, and corticosteroids.
    • Maintain intravascular volume.
  • Minor allergic reaction
    • Administer antihistamines.
    • Although the necessity of stopping the transfusion is unclear, in more severe cases and in uncertain cases, the transfusion should be stopped.
  • Transfusion-related acute lung injury[3]
    • Monitor oxygen saturation.
    • Provide supplemental oxygen to maintain oxygen saturation greater than 92%.
    • Hypoxemia severe enough to require endotracheal intubation and positive-pressure ventilation occurs in 70-75% of patients.
    • No evidence supports the routine use of corticosteroids.[4]
    • The blood bank should be notified.
  • GVH disease
    • No effective therapies currently exist.
    • Emphasis needs to be placed on prevention.
  • Massive transfusion
    • To decrease the risk of hypothermia in patients receiving massive transfusion, administer the blood through a blood warmer. Do not place blood in a microwave oven to warm, as this causes hemolysis.
    • Do not administer platelets and fresh frozen plasma routinely or by using a formula based on the number of units of packed cells transfused. Only administer with evidence of abnormal bleeding associated with thrombocytopenia or an elevated PT or aPTT.
    • Treat symptomatic hypocalcemia with calcium chloride or calcium gluconate.
Proceed to Medication
 
 
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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

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.

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].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.