Blood Transfusion Reaction Overview

Blood Transfusion Reaction

• Course Objectives: Recap last week's content, identify transfusion reactions & infections, and explain reaction management.

Recap of Blood Transfusion

• Blood products
• Blood product use and storage
• Rights of blood transfusion
• Hospital standard procedures for blood transfusion process
• Monitoring process for transfused patients

Transfusion Reactions

• Category 1 - Mild: Mild reactions, including moderate to severe hypersensitivity and urticarial reactions.
• Category 2 - Moderately Severe: Febrile-NON-Hemolytic reactions caused by antibodies to white cells, platelets, and proteins (like IgA). Possible bacterial contamination (pyrogens) is also a factor.
• Category 3 - Life Threatening: Reactions of acute intravascular hemolysis, bacteria contamination & septic shock, fluid overload, anaphylactic reactions, and transfusion-associated lung injury.

Acute Hemolytic Reactions - Symptoms

• Systemic: Chills, fever
• Vascular: Hypotension, uncontrollable bleeding
• Transfused vein: Heat sensation, pain in the lumbar region
• Heart: Increased heart rate, constricting chest pain
• Urinary: Hemoglobinuria, hyperbilirubinemia

Blood Transfusion Reaction Types

• Allergic: Mild (facial flushing, hives, rash) and severe (increased anxiety, wheezing, decreased blood pressure).
• Febrile: Headache, tachycardia, tachypnea, fever, chills, and anxiety.
• Hemolytic: Decreased blood pressure, increased respiratory rate, hemoglobinuria, chest pain, apprehension, low back pain, fever, tachycardia, and chills.

Delayed Complications of Transfusion (Other)

• Delayed hemolytic reaction
• Post-transfusion purpura
• Graft-vs-Host disease
• Iron overload

Transfusion-Transmitted Infections

• HIV
• HTLV-I & II (human T-lymphotropic virus)
• Viral hepatitis B & C
• Syphilis
• Malaria
• Chagas disease (Trypanosoma cruzi)
• Creutzfeldt-Jakob disease (a neurological disorder)
• Cytomegalovirus
• HPV

Prevention of Reactions

• Observe signs & symptoms
• Take action
• Record
• Report

Management of Mild (Allergic) Reactions

• Stop transfusion, change IV line, and maintain vein access with normal saline
• Inform physician
• Monitor vital signs
• Administer prescribed medication (antihistamine)

Anaphylactic Reaction (Life-Threatening)

• Symptoms: Signs & symptoms, respiratory distress, sudden severe bronchospasm, cardiovascular collapse
• Management: Vasopressors, bronchodilators, corticosteroids, oxygen therapy, IV fluids, antihistamines.

Management of Febrile Reactions

• Stop transfusion, change line, maintain vein access with normal saline
• Inform physician
• Monitor vital signs
• Treat symptoms (e.g., fever)

Management of Hemolytic Reactions

• Stop transfusion; change line; maintain vein with normal saline
• Inform physician
• Monitor vital signs
• Obtain blood sample from site and first urine; send to lab
• Treat shock as needed
• Send tubing, blood, to lab for testing

Management of Circulatory Overload

• Symptoms: Dyspnea, dry cough, pulmonary edema
• Management: Stop or slow transfusion, monitor vital signs, inform physician, place patient in upright position

Management of Bacterial Infection

• Symptoms: Fever, hypertension, dry flushed skin, abdominal pain
• Management: Stop transfusion immediately, maintain vein access with normal saline; obtain blood cultures, return blood bag to lab; monitor vital signs, inform physician immediately, administer antibiotics as prescribed.

Accountability (Legal Requirements)

• Record actions and observations in a timely manner, including the start and end of the transfusion.
• Report any adverse events or transfusion completion.

References cited in presentation:

• Lynn, P. (2015) Taylor's Clinical Nursing Skills 4th Ed. Wolters Kluwer
• Hogan, et al. Reviews and Rationales in Medical/Surgical Nursing
• Fundamentals of Nursing, Taylor, Lillis, Lyn & Le Mone 12th Ed