Investigation - Isolated Hypotensive

Transfusion services should have clear policies describing the required investigation for transfusion complications. An example of an immediate investigation shows steps that could be used to investigate any immediate transfusion reaction.

A hypotensive reaction needs to be differentiated from other types of transfusion reaction that may have hypotension as a symptom. These include but are not limited to bacterial contamination, acute hemolytic, anaphylactic, TRALI and/or allergic reactions.

Fever does not occur with a primary hypotensive reaction. If symptoms do not subside immediately after discontinuing the transfusion, a chest x-ray should be considered to exclude TRALI, and blood cultures to exclude a septic transfusion reaction. Consideration must also be given to whether the hypotensive episode was unrelated to the transfusion or an underlying medical condition. Only after all other reactions and reasons are eliminated should hypotensive transfusion reaction be considered.