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jojo808

Transfusion Reaction Criteria

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Hi all,

I am trying to overhaul our policy for transfusion reactions as recommended by our last CAP inspector. We were basically culturing all reactions except urticaria and the inspector said we were wasting time and energy and I agree but I need more assurance for the definite criteria so I want to know what are your criteria for culture and gram stain for blood products that are in question. I've looked online and found some use only temperature increase while others use temp increase with or without other symptoms What my research has found is the following: Most call febrile reactions bet 38-40C, or an increase in temp bet 1-2C from the baseline (pre-transfusion). The ones that use other symptoms use tachycardia and/or hypotension.

Just want a poll for several things:

1. At what temp do you call it a Febrile reaction?

2. Do you also use temp increase from the baseline? If so what is?

3. Do you use other criteria with Temp increase for culture? If so what are they?

4. If you do have one, what is your definition for tachycardia (eg =>100 bpm?)

5. Same with Hypotension, any numerical definition?

I know there are threads on this but I don't want to sort through it all. Please, I would love as much input as possible. Add any advice or other pertinent information is greatly appreciated. Thank you all in advance. 

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7 hours ago, jojo808 said:

Hi all,

I am trying to overhaul our policy for transfusion reactions as recommended by our last CAP inspector. We were basically culturing all reactions except urticaria and the inspector said we were wasting time and energy and I agree but I need more assurance for the definite criteria so I want to know what are your criteria for culture and gram stain for blood products that are in question. I've looked online and found some use only temperature increase while others use temp increase with or without other symptoms What my research has found is the following: Most call febrile reactions bet 38-40C, or an increase in temp bet 1-2C from the baseline (pre-transfusion). The ones that use other symptoms use tachycardia and/or hypotension.

Just want a poll for several things:

1. At what temp do you call it a Febrile reaction?

2. Do you also use temp increase from the baseline? If so what is?

3. Do you use other criteria with Temp increase for culture? If so what are they?

4. If you do have one, what is your definition for tachycardia (eg =>100 bpm?)

5. Same with Hypotension, any numerical definition?

I know there are threads on this but I don't want to sort through it all. Please, I would love as much input as possible. Add any advice or other pertinent information is greatly appreciated. Thank you all in advance. 

1.  Febrile 1-2 C.

2.  Measured from the baseline, which is just before the transfusion starts.

3.  Cultures are done only when directed by a pathologist or other physician.

4. and 5.  These are nursing calls.

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Here, a temp >1 degree Celsius over baseline AND any other symptom gets an automatic culture.  Plus I suppose we would honour any direct request for a culture (not that I've seen that happen). 

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1. At what temp do you call it a Febrile reaction? >/= 38C

2. Do you also use temp increase from the baseline? If so what is? No

3. Do you use other criteria with Temp increase for culture? If so what are they? Have symptoms related to sepsis (CDC defin); however it is our MD call to culture.

4. If you do have one, what is your definition for tachycardia (eg =>100 bpm?) do not define

5. Same with Hypotension, any numerical definition? do not define

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The norm for febrile reactions is 1C or 2F based on the pre-transfusion vital signs. Please keep in mind that some of the suggestions provided need to be evaluated by your medical director as he/she will determine what other tests (if any) need to be added to the work-up. Having said that, we do not culture every single transfusion reaction. I have worked at different blood banks throughout the years and this is what I have found. Some facilities based the use of an automatic blood culture on temperature increments from pre-transfusion vital signs of 1 C or 2F. Other implemented the same parameter but added chills to the mix, so if the patient presented with at least these two symptoms a culture was done. Other sites included the temperature ranges listed plus a drop in blood pressure of 30mmHg whether systolic or diastolic. If the temperature difference was 0.5C or 1F a culture was not generated. I have not seen any requirements based on pulse, however, pulse can be evaluated alongside other symptoms to determine a bigger or more complex reaction. I would not culture every single transfusion reaction regardless of blood component. I would, however, sit down with your medical director and nursing to establish different protocols as to when to order a transfusion reaction and what tests need to be run to fulfill regulatory suggestions and requirements. Transfusion reactions tend to be under-reported so transparency and transfusion administration education from healthcare providers is key to address these issues.  I might have not provided specific answers but this is one of those processes that require your site to feel comfortable with work-ups and tests ordered. Patient safety and stewardship of resources is key to any process.

I hope this helps.

Thanks

Frank

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I recommend to all that you poke around on the NHSN site.  I'm in Massachusetts, we are required to report all of our transfusion statistics, including adding each transfusion reaction separately.  It's a fair amount of work, but required by our DPH.  We use their descriptions for our transfusion reaction categories.

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Pathologist makes all the calls we just give them the information; pre/post vitals, reason the rx is being called, clerical checks and pre/post ABORH and DAT

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