Transfusion Reaction Workups

[bevydawn]

I would like to get some feedback as to what kind of workup other facilities require when a transfusion reaction is suspected. Currently we do a full workup on all possible reactions but I would like to go to doing only the clerical check and pre- and post-DATs unless something in those shows a reason to do the full workup.

Can anyone tell me what procedures and guidelines you follow??

[David Saikin]

We do a clerical check, compare pre and post specimens for evidence of hemolysis, urine dipstick for blood with microscopic if positive, and pre and post DAT.

[Jane]

We were doing the clerical check, post DAT (unless post was positive, then we added the pre), check for hemolysis. Because of a CAP standard in the Dec 2004 checklist (TRM.41850) we are adding the post ABO/Rh as well. I have pasted the revised standard below.

**REVISED** 12/29/2004

TRM.41850 Phase II N/A YES NO

Does the immediate investigation of a transfusion reaction include all of the following?

1. Examination of patient identification, blood unit labels and all pre-reaction records for possible errors in patient or blood identification at the bedside and in the laboratory

2. Visual examination of post-reaction and pre-reaction (if available) serum or plasma for evidence of hemolysis

3. ABO/Rh and direct antiglobulin test on post-reaction patient (recipient) blood sample

Hope this helps!

Jane

[Rita]

We also routinely do a clerical check, a comparison of pre and post plasma for hemolysis and icterus, a post DAT and ABO/Rh. We do additional testing if any of these are positive, or if it is classified as a severe reaction.