Transfusion Reactions & Administration

Range of Transfusion Reactions

Transfusion reactions can range from common minor reactions to life-threatening emergencies or death.

Infection Transmission Timeline

Problems caused by the transmission of infection from blood products are typically seen years after the transfusion.

Timing of Incompatible Blood Reactions

Reactions involving incompatible blood units tend to occur early in the transfusion process.

Initial Nursing Priorities

Early recognition of symptoms and prompt reporting to the blood bank are essential.

Common Symptoms of Transfusion Reactions

Chills, rigors, fever, dyspnea, lightheadedness, urticaria, itching, and flank pain.

Action for Non-Localized Itching Symptoms

Stop the transfusion immediately, keep the line open with normal saline, notify the physician, and obtain further directions.

Emergency Equipment Requirement

Emergency equipment must be available due to the seriousness of complications associated with blood products.

Reaction Line Definition

A pre-primed IV line of normal saline kept available to switch to if a transfusion reaction develops.

Steps When a Reaction Develops

Stop the blood product, disconnect the blood product line, attach the patient's IV to the reaction line, and infuse normal saline.

Emergency Oxygen Equipment

Oxygen via nasal cannula or mask must be available.

Emergency Medications Required

Epinephrine, diphenhydramine, and hydrocortisone.

Timeframe for Acute/Immediate Reactions

Acute or immediate reactions occur within the first 5 to 15 minutes of the transfusion.

Reason for Bedside Monitoring

The nurse remains at the bedside during the initial 5 to 15 minutes because acute reactions occur early.

Examples of Acute Reactions

Acute hemolytic transfusion reactions, febrile reactions, and allergic reactions.

Acute Hemolytic Reaction Onset

Onset is abrupt.

Early Symptoms of Acute Hemolytic Reaction

Discomfort, anxiety, dyspnea, fever, chills, facial flushing, and severe lumbar pain.

Signs of Shock in Acute Hemolytic Reaction

Rapid pulse, cold and clammy skin, low blood pressure, nausea, and vomiting.

Major Complications of Acute Hemolytic Reaction

Can lead to disseminated intravascular coagulation (DIC) and death.

Primary Cause of Acute Hemolytic Reaction

Occurs when the wrong blood is given to the wrong patient.

Immediate Management Goal for Hemolytic Reaction

Stop the transfusion and achieve/maintain adequate blood pressure using supportive treatment and normal saline.

Use of Lasix in Hemolytic Reactions

Given to help ensure renal blood flow.

Urine Output Goal with Lasix

Promote a urine output of 100 mL/hour for the next 24 hours in conjunction with physician orders.

Signs and Symptoms of Febrile Reactions

Fever and chills.

Definition of Fever in Transfusion Reactions

An increase from the baseline temperature of at least 1°C.

Cause of Febrile Reactions

A reaction to antibodies in the blood.

Treatment of Febrile Reactions

Stop the blood, notify the physician, and treat with an antipyretic medication such as Tylenol.

Prevention of Febrile Reactions

Consider using a leukocyte filter in conjunction with the blood bank team and physician.

Cause of Allergic Reactions

Antibody formation.

Signs and Symptoms of Allergic Reactions

Hives, itching, and respiratory distress.

Treatment of Allergic Reactions

Stop the transfusion, notify the physician, and prepare to give antihistamines.

General Rule for Abnormal Presentation

Stop the transfusion whenever a patient develops concerning or abnormal symptoms.

TRALI Incidence

Approximately 1 in 500,000.

TRALI Onset Timeframe

Usually occurs within hours of the transfusion.

Signs and Symptoms of TRALI

Respiratory distress, hypoxia, pulmonary edema, crackles in the lungs, hypotension, and fever.

Treatment for TRALI

Oxygen support, mechanical ventilation, and potential transfer to an ICU setting.

Post-Transfusion Monitoring Duration

Patients continue to be monitored for hours after the transfusion.

Cause of Circulatory Overload (TACO)

The high osmotic load of blood products draws volume into the intravascular space over hours.

Patients at Risk for Circulatory Overload

Patients with cardiac insufficiency or renal insufficiency.

Pre-Transfusion Assessment for TACO Risk

Kidney function is assessed prior to transfusion.

Risk Factor for Circulatory Overload

Tends to be more prevalent when blood units are transfused too quickly.

Signs of Circulatory Overload

Dyspnea and crackles indicating heart failure.

Treatment for Circulatory Overload

Stop the transfusion and consider the use of Lasix in conjunction with the physician.

Purpose of Citrate in Blood Bags

Citrate is used as an anticoagulant to keep blood in the bag from clotting.

Risk of Rapid Blood Administration (Citrate)

Can lead to hypocalcemia and hypomagnesemia.

Prognosis of Transfusion-Associated GVHD

This reaction is fatal.

Mechanism of TA-GVHD

Lymphocytes from the transfused blood component attack the recipient's tissues.

Tissues Attacked in TA-GVHD

Skin, bone marrow, and the GI tract.

Recognition Challenge in TA-GVHD

Recognition is often delayed because symptoms like GI distress and diarrhea are very nonspecific.

Delayed Hemolytic Reaction Presentation

Patients may present asymptomatically, or with a slight fever.

Delayed Hemolytic Reaction Timeframe

May occur up to four weeks after transfusion.

Target Population for Delayed Hemolytic Reactions

Patients who have been sensitized to an RBC antigen through previous blood product exposure.

Pathogens Involved in Infection Transmission

Viruses and bacteria present in blood products.

Blood Bank Prevention Measures

Leukocyte reduction, saline washing, and radiation treatment to kill viruses and bacteria.

Historical Infection Mentioned

Hepatitis from blood transfusions has occurred.

Blood Product Administration Knowledge

Know why the patient is receiving the product, guidelines, line expiration, and unit time frames.

Medication Knowledge for Transfusions

Know pre- and post-medications and why each is being given (e.g., Lasix).

Patient Education Purpose

To help patients recognize key signs and symptoms of a transfusion reaction.

Pre-Transfusion Vital Signs

Obtain a baseline set of vital signs and assess the patient before the transfusion starts.

Transfusion Rate Adjustment

After the initial 15 minutes, switch to the rate needed to complete the transfusion within two hours.

The SSS Approach

Assess the patient before, during, and after the transfusion, and document.

Essential Documentation Elements

Ensure the right product goes to the right patient, chart the product, and return info to the blood bank.

Documentation Requirements During a Reaction

Document the reaction, actions taken, that the transfusion was stopped, and that the physician was notified.

Universal First Two Steps for Reactions

Stop the infusion and notify the physician.