Adverse transfusion reactions

Things to consider in the event of an adverse transfusion reaction

• Transfusion Reaction Policy: you should follow the hospital transfusion policy for management of transfusion reactions.
• You should monitor all patients receiving a blood transfusion for adverse reactions.
• Observations of blood pressure, pulse, temperature and respiratory rate should be measured at baseline and at 15 minutes after the start of the transfusion. Observations should continue based on local transfusion policy advice.
• If your patient becomes unwell during or after the transfusion you should stop the transfusion, assess the patient and seek medical advice immediately.
• The blood bank and/or local haematology team can be contacted for advice on management and investigations: you should refer to the hospital transfusion policy for contact details.
• Transfusion Reaction Form: you should use the local hospital forms for the management of transfusion reactions.
• Use the local transfusion reaction form to document the details of the reaction. A summary of events should be included in the patient’s hospital record.
• You should report the transfusion reaction to the local blood bank and transfusion practitioner.

You can see a flowchart on dealing with acute reactions on the Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee (JPAC) website.

Transfusion reaction investigations

Allergic or febrile transfusion reactions don't require lab investigations if they are mild and resolve quickly.

When laboratory investigations are carried out the results of can be used to manage the patient and guide any future blood transfusions.

• You should not discard blood component bags in the event of moderate or severe transfusion reactions.
• You should return any blood bags (with the giving set attached) implicated in the transfusion to the blood bank with a full explanation of the reaction.
• The blood bank and the haematology team will let you know what samples to take depending on the clinical situation and the nature of the suspected reaction.

Acute transfusion reactions – during or within 24 hours of the transfusion

ABO incompatibility (red cells) – acute haemolytic transfusion reaction (HTR)

Acute HTR typically occurs during or within 24 hours of the transfusion and is predominantly associated with intravascular haemolysis.

This type of reaction can be seen following ABO incompatible transfusion.

• Send samples repeat group and antibody screen

Find out more about red cell reference tests.

Severe allergy/anaphylaxis

• Mast cell tryptase at baseline, 4 hours and 24 hours to establish anaphylaxis
• Pre-transfusion IgA level and if low/absent, anti-IgA antibodies

If you require a copy of the managing transfusions for patients found to be IgA deficient policy, please contact nss.snbtsnatsops@nhs.scot

Suspected bacterial contamination

• Blood cultures on the patient
• Return the implicated blood bag(s) (with giving set still attached)

Find out more about Scotland's National Microbiology Reference Unit (NMRU).

Transfusion-associated circulatory overload (TACO)

• No specific laboratory tests but establish fluid balance and examine a CXR in the first instance.

Transfusion-related acute lung injury (TRALI)

• Check if the blood component donor(s) was female or male.
• Exclude TACO and, if TRALI supported by clinical findings, we will test the female donors for HLA/HNA antibodies.
• Patient will be tested for HLA/HNA type if antibodies are identified in the donor.

Find out more about testing for TRALI.

Delayed transfusion reactions – more than 24 hours after the transfusion

Red cell antibody incompatibility – delayed haemolytic transfusion reaction (HTR)

Delayed HTR typically occurs within 5 to 7 days of the transfusion and is predominantly associated with extravascular haemolysis.

Antibodies commonly involved in this type of reaction are Rh, Jk, Fy and K related.

• Send samples to the blood bank for repeat group and antibody screen and direct antiglobulin test,
• Blood count, blood film, liver function tests and LDH are also required.

Find out more about red cell reference tests.

Post transfusion purpura

• Send samples for HPA antibodies and HPA genotype

Find out more about our Edinburgh Histocompatibility and Immunogenetics lab services.

Suspected viral transfusion transmitted infection

• Any suspected viral infection should be reported through the clinical service team.
• A full clinical history plus a transfusion history (with donation numbers for each unit) will be required.
• You are reminded that all communications about patients should be compliant with information governance regulations - do not email patient identifiable data.

Find out more about Scotland's National Microbiology Reference Unit (NMRU).