Transfusion Reactions in Emergency Medicine Workup

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

Laboratory Studies

For acute hemolytic transfusion reactions (AHTR), the following studies are indicated:

  • Complete blood cell count (CBC)
  • Metabolic panel
  • Liver function tests, including total and direct bilirubin
  • Haptoglobin
  • Reticulocytes
  • Lactate dehydrogenase (LDH)
  • Coombs test
  • Electrocardiogram (ECG)

Although transfusion-related acute lung injury (TRALI) is a clinical diagnosis, the following are adjuncts that can support the diagnosis:

  • Full vitals, including pulse oximetry
  • Arterial or venous blood gas
  • Chest x-ray
  • ECG

Transfusion-associated circulatory overload (TACO) is also a clinical diagnosis, but the following are adjuncts that can support the diagnosis:

  • Full signs, including blood pressure and heart rate
  • Chest x-ray
  • Evidence of fluid overload on physical exam
  • Acute respiratory distress

Anaphylaxis is a clinical diagnosis with involvement of two or more of the following systems after exposure:

  • Skin/mucosa,
  • Cardiovascular
  • Respiratory
  • Gastrointestinal

For graft-versus-host disease (GVHD), the following studies are indicated:

  • CBC (to assess for cytopenias)
  • Complete metabolic panel
  • Liver function tests
  • Coagulation studies
  • Stool studies in setting of profuse diarrhea