Investigation of Transfusion Complications

Overview

Recognizing the signs and symptoms of a transfusion reaction and acting promptly and appropriately are key to reducing serious sequelae to the patient receiving transfusion and may also prevent a similar reaction in other patients by identifying when other components should be withdrawn from circulation.

Although policies and procedures will vary between facilities and regional transfusion services, certain protocols are commonly recommended.

Investigation of delayed reactions are much more difficult to detect and identification is dependant upon the treating physician making the connection to the transfusion which may have occurred weeks, months or years previously.

Below is an example of a protocol suitable for investigating an adverse event such as an immediate/acute hemolytic transfusion reaction. Individuals should always adhere to the policies developed in their institutions.

Immediate Actions

In the presence of any immediate adverse event that is suspected to be a transfusion reaction, the following is an example of initial steps that should be taken in accordance with an institution's policies and procedures:

• Stop the transfusion immediately. The severity of the transfusion reaction is directly related to the volume of blood transfused.
• Keep the intravenous line open with normal saline.
• Monitor the patient's vital signs.
• Examine the compatibility label on the blood container and other records to determine if there has been an error in identifying the patient or the blood, and document results. If misidentification has occurred, another patient may also be at risk.
• Notify the transfusion service and the physician ordering the transfusion for directions for patient care.
• Return the blood product container(s) to the transfusion service, along with attached transfusion set and attached intravenous solution, if any.
• Draw a new, properly labelled blood specimen from the patient (taking care to avoid hemolysis) and send it immediately to the transfusion service along with a completed request form.
• Collect first voided urine and send it to the appropriate laboratory.
• Continue to observe and monitor the patient's vital signs.
• Follow physician's orders for treatment.

NOTE: If the only signs and symptoms are urticaria and/or pruritis and the identification of the patient and donor do not reveal any discrepancies, a laboratory investigation is not usually indicated. The transfusion can usually be restarted after antihistamine is administered provided the patient is monitored and if in accord with an institution's policies and protocols.