transfusion reaction, any adverse event following a blood transfusion, attributed to the transfusion. The most common reactions are allergic, manifested by hives and urticaria, and febrile nonhemolytic, shown by chills and fever. More serious reactions are hemolytic, due to an antibody in the recipient to an antigen on the donor’s red cells, anaphylactic, bacterial contamination of the donor unit, transfusion-related acute lung injury (TRALI), and transfusion-associated circulatory overload (TACO). Delayed reactions may include delayed hemolytic, disease transmission, alloimmunization to red cell or HLA antigens, and transfusion-associated graft-versus-host disease. Post-transfusion purpura may occur 5-12 days after a transfusion. See also hemolysis. ▪ OBSERVATIONS: Fever is the most common transfusion reaction; urticaria is a relatively common allergic response. Asthma, vascular collapse, and renal failure occur less commonly. A hemolytic reaction from red blood cell incompatibility is serious and must be diagnosed and treated promptly. Symptoms develop shortly after beginning the transfusion, before 50 mL has been given, and include a throbbing headache, sudden deep severe lumbar pain, precordial pain, dyspnea, and restlessness. Objective signs include ruddy facial flushing followed by cyanosis and distended neck veins; rapid, thready pulse; diaphoresis; and cold, clammy skin. Profound shock may occur within 1 hour. ▪ INTERVENTIONS: When a hemolytic reaction is suspected, the transfusion is promptly terminated and the infusion line kept open with a normal solution of IV fluid. The remaining bank blood is saved for a repeat type and crossmatch against a fresh sample of blood from the recipient. Direct and indirect antiglobulin tests are usually ordered to detect hemolytic antibodies, and a sample of urine is examined for free hemoglobin. Immediate treatment may include IV mannitol and a solution of 5% dextrose in water to maintain urine flow of more than 100 mL per hour. In the presence of oliguria, the possibility of acute renal failure is evaluated and the patient managed accordingly. Hypovolemia is corrected with saline or plasma expanders, but the administration of more whole blood is avoided, if possible. ▪ PATIENT CARE CONSIDERATIONS: The need for exceptional care to ensure that typed and crossmatched blood conforms to compatibility standards is emphasized. The identifying information on the blood container is always checked against the transfusion records and the patient’s identification on the band. Questioning the patient about previous transfusions may elicit warning indications of possible adverse reactions. After the transfusion is started, the patient is watched for objective signs of a transfusion reaction and is questioned for subjective symptoms. Routine temperature checks are done to detect febrile reactions that can be controlled by antipyretic drugs.
