Our State Department of Health requires that we specify the level of increase or decrease in blood pressure from the pre-transfusion value that will trigger a transfusion reaction investigation, in our blood administration policy. We currently do not specify a number for the change in bp. When this occurs, it is evaluated by the physician and pathologist and other contributing factors are considered before a reaction work-up is initiated. Please advise as to the criteria that may be used in your facility.

We do not specify actual numbers in my facility either. Transfusion reactions and the signs of them are pretty much up to the physician to decide on (not that I necessarily always think that is a good thing!!).

We actually indicate a decrease of >15 mmHG in systolic &/or diastolic pressure. If this occurs within 90 minutes of the transfusion we are to culture the unit for possible bacterial contamination. This came from the corporate transfusion medical director. Not sure where she got it from.

Ours state the a change >= 30 may be indicative of a symptom of a transfusion reaction

Our old policy was that a 20% or more drop in the systolic (or a 10% drop, if the baseline was 100 or less) indicated the need for a transfusion reaction workup. Our new policy is that the physician has the sole responsibility for determing the need for a transfusion reaction workup. If I feel a transfusion needs to be worked up, I'll ask the pathologist to exert influence on the physician. This has cut down the number of transfusion reaction workups.

Our old policy was that a 20% or more drop in the systolic (or a 10% drop, if the baseline was 100 or less) indicated the need for a transfusion reaction workup. Our new policy is that the physician has the sole responsibility for determing the need for a transfusion reaction workup. If I feel a transfusion needs to be worked up, I'll ask the pathologist to exert influence on the physician. This has cut down the number of transfusion reaction workups.

Does this policy apply to any and all symptoms and signs of a possible transfusion reaction or just the BP?

It has been my unfortunate experience to be involved in a decision by a physician to not work up a transfusion reaction which ended up as a severe hemolytic reaction. Unfortunately the patient went into cardiac arrest during reaction and expired. Although it was not the direct casue of fatality it was a contributing factor. There have been several other cases similiar to this. This is why the JCAHO, CAP and AABB require that both the physician and Blood bank are notified immediately of a possible transfusion reaction.

Our policy doesn't state exact numbers but we say any change in BP or symptoms would constitute a possible reaction. Whether they all follow this is doubtful. We do state that a change in BP of 30mmHG as a trigger to culture the unit once the reaction is called. We are educating our nurses to call any symptom a possible transfusion reaction and not give the physician a choice. We have them call us first and then the physician unless of course the patient needs immediate attention from the physician!!