Transfusion Reactions in Emergency Medicine Follow-up

Updated: Dec 24, 2020
  • Author: Ross A Wanner, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Follow-up

Further Inpatient Care

Inpatient treatment is largely supportive. Any combination of the following may be necessary in the management of these patients:

  • Intravenous fluids to maintain appropriate urine output
  • Diuretics for fluid overload
  • Airway management with noninvasive positive pressure ventilation (NIPPV) or endotracheal intubation
  • Hemodynamic support with inotropes and vasopressors
  • Continuous cardiac monitoring
  • Short-term dialysis or continuous renal replacement therapy, in severe cases of acute kidney injury
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Deterrence/Prevention

Acute hemolytic transfusion reactions (AHTR) can be prevented by appropriate cross-matching of blood products and ensuring processes to minimize clerical error, including correct patient transfusion and double-checking that the patient’s blood type matches that on the product to be transfused.

Transfusion-related acute lung injury (TRALI) reactions have no specific mitigation strategies, but more detailed donor selection and screening for HLA antibodies has substantially decreased the incidence of these reactions. New methods include filtration of reactive antibodies, antigens, and other products implicated in TRALI pathogenesis.

Transfusion-associated circulatory overload (TACO) has no definite prevention strategy, but it has been postulated that diuretics either before or with transfusion may help decrease symptoms.

Anaphylaxis can be prevented by using IgA-depleted blood products or washed blood products to remove the reactive antigens. There is no evidence to support the routine use of antihistamines or glucocorticoids as pretreatment.

Graft-versus-host disease (GVHD) reactions can be prevented by transfusing blood products that have been irradiated or treated with reagents that disrupt the ability for lymphocytes to proliferate.

Febrile nonhemolytic reactions (FNHR) can be prevented by administering leukocyte-reduced blood products.

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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. Patients should also be counseled on these risks and provide consent for transfusion when appropriate. For patient education information, see Blood Transfusion: What to Know If You Get One.

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Acknowledgements

We thank the previous authors, Dr. S Gerald Sandler and Dr. Viviana V. Johnson, for their contributions and framework for the current updated article.

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