Suspected Transfusion Reactions

[jtk]

When a suspected transfusion reaction (fever of 2 F above baseline) occurs, the nurse stops the transfusion and contacts the Blood Bank and the patients physician, who may give orders to continue with the transfusion. While the pathologist is contacting and consulting with the physician, the nurse feels that she must follow doctors orders and continue with the transfusion. Does this occur in other institutions and if so, how is it handled?

Also, what is your protocol when the patients physician is adamant that the transfusion continue and that a suspected reaction work-up not be performed? Does the pathologist intervene and initiate the reaction work-up and discontinue the transfusion? We are caught between the physicians and our State Dept. of Health on this issue and would appreciate other opinions.

[Malcolm Needs ☆]

In such a situation, we would tell our Consultant Haematologist as a matter of urgency.

He/she should have the power to make the physician see sense.

[L106]

At our instituation, if the physician orders a Transfusion Reaction Investigation, the transfusion STOPS. No further transfusions can be administered until Blood Bank has completed the preliminary Reaction Investigation.

[AMcCord]

We have asked the pathologist to call the nurse and order her to stop the transfusion. This is a rare occurence thankfully.

[LaraT23]

HMM. That would be hemolytic or not. A FNHTR would most likely be treated with tylenol and an allergic reaction is treated with benadryl. Our nurses have guidelines that tell them, stop the transfusion with these S/S but not with these, etc. Any temp spike of more than a degree with no history of prior fever is medicated. If the fever is also accompanied by drops in pressure or any extreme dicomfort in the patient the transfusion is stopped. We have not had to argue that point with any of our physicians thankfully.

[Bill]

At our facility, if the nurse notes the signs/symptoms, this starts a suspected transfusion reaction investigation during which no more blood may be infused until the pathologist has reviewed preliminary findings and OK's further transfusions.

Edited October 27, 2009 by Bill
spelling

[Mary**]

Our your pathologists on site 24/7?

[KKidd]

HMM. That would be hemolytic or not. A FNHTR would most likely be treated with tylenol and an allergic reaction is treated with benadryl. Our nurses have guidelines that tell them, stop the transfusion with these S/S but not with these, etc. Any temp spike of more than a degree with no history of prior fever is medicated. If the fever is also accompanied by drops in pressure or any extreme dicomfort in the patient the transfusion is stopped. We have not had to argue that point with any of our physicians thankfully.

WHat is your time frame for a history of prior fever?

[Abdulhameed Al-Attas]

Whilst fever or rigors are not uncommon in response to a transfusion and may represent a non-haemolytic febrile reaction, they may also be the first sign of a severe adverse reaction.

The transfusion can only be continued if the only feature is a rise in temperature of <1.5oC from baseline or urticaria, recheck that the correct blood is being transfused, give paracetamol and anti-histamine, reset the transfusion at a slower rate and observe more frequently.

[angie]

Whilst fever or rigors are not uncommon in response to a transfusion and may represent a non-haemolytic febrile reaction, they may also be the first sign of a severe adverse reaction.

The transfusion can only be continued if the only feature is a rise in temperature of <1.5oC from baseline or urticaria, recheck that the correct blood is being transfused, give paracetamol and anti-histamine, reset the transfusion at a slower rate and observe more frequently.

This is the procedure followed in our hospital too.

[irshadaad]

in our situation in king fahad armed forces hospital no Dr.takes risk of getting responsible for any thing the protocall is to stop transfusion immediatly the moment any kind of reaction is evident during transfusion of any componant and blood bank is informed the phisician asses the condition for rbc transfusion we go ahead with transfusion reaction work up but for FFP and PLT. we let phsician to decide if they want reaction work up cose we dont x-match FFP CRYO and PLT serologically...

[irshadaad]

I think its better to stop further transfusion of any blood componant till blood bank cmpletes its assesment of the case ,iresspective of what the phisician considers the situation

[Malcolm Needs ☆]

in our situation in king fahad armed forces hospital no Dr.takes risk of getting responsible for any thing the protocall is to stop transfusion immediatly the moment any kind of reaction is evident during transfusion of any componant and blood bank is informed the phisician asses the condition for rbc transfusion we go ahead with transfusion reaction work up but for FFP and PLT. we let phsician to decide if they want reaction work up cose we dont x-match FFP CRYO and PLT serologically...

True, you don't cross-match FFP, cryoprecipitate or platelets serologically, but if the reaction turns out to be severe, then I think there is justification, if not a necessity, to look for HLA/HPA antibodies in the patient and, possibly, HLA/HPA/granulocyte antigens in the donors (TRALI).

:confused: