Management of Blood Transfusion Reactions

Initial Management

The American Society of Anesthesiologists recommends immediately stopping the transfusion if signs of a reaction are observed, such as tachycardia, rash, breathlessness, hypotension, or fever, and maintaining intravenous access with normal saline for medication administration and fluid resuscitation 1, 2
The initial management of a blood transfusion reaction includes contacting the transfusion laboratory immediately and sending the blood unit with administration set for investigation, as well as monitoring vital signs closely, including heart rate, blood pressure, temperature, and respiratory rate 1, 2, 3
Monitoring for signs of hemolytic reactions, including hypotension, tachycardia, hemoglobinuria, and microvascular bleeding, and assessing urine output and color to monitor for hemolytic reactions is crucial 3
Peak airway pressure should be monitored to detect potential transfusion-related acute lung injury (TRALI) 3

For mild allergic reactions, antihistamines may be administered for urticaria or mild allergic symptoms 1
In cases of severe reactions, such as anaphylaxis, intramuscular or intravenous adrenaline may be administered if the reaction is life-threatening 1
For transfusion-related acute lung injury (TRALI), critical care supportive measures focusing on respiratory support should be provided, with no specific therapy other than stopping transfusion and instituting critical care measures 3, 5
Most patients with TRALI recover within 96 hours, although it is among the top three most common causes of transfusion-related deaths 3

The Anesthesia society recommends considering washed blood products for future transfusions if allergic reactions occurred, and using slower transfusion rates if TACO is suspected 4
Implementing weight-based dosing of blood products to prevent volume overload is also recommended 4

The American Society of Anesthesiologists notes that general anesthesia may mask the symptoms of both hemolytic and nonhemolytic transfusion reactions, and signs of hemolytic reactions may be erroneously attributed to other causes in anesthetized patients 3
Diagnosis of a transfusion reaction during ongoing hemorrhage may be difficult, and if concerns arise, documentation for administration errors should be double-checked 1, 2