Transfusion Reaction Work Up

• TACO, TRALI, and HTRs are the three most commonly reported causes of transfusion related mortality
• hemovigilance: the systematic surveillance for the complications of transfusion, analysis of these data, and improvements in transfusion practices
• it is believed that major non-infectious complications are underrecognized and underreported
• signs and symptoms of a transfusion reaction include a fever (>1 degree C rise); chills; respiratory distress; hyper/hypotension; abdominal, chest, flank, or back pain; pain at the infusion site; skin manifestations, including rash, flushing, urticaria, pruritis, edema; jaundice/hemoglobinuria; nausea/vomiting; abnormal bleeding; oliguria/anuria
• patient focused steps for transfusion rxn

  • stop transfusion
  • document the clerical recheck between pt and components
  • consult clinical team for plan of care
  • ID appropriate diagnostic tests to work up the case
  • contact transfusion service for steps for investigation
  • obtain instructions about return of any remaining component and tubing
  • transfusion service decides if blood bank is notified (if component is at fault)
  • FDA notified if the transfusion rxn is fatal
  • co-components should be immediately quarantined pending investigation results
• Lab investigation

  • clerical check of the component bag, label, paperwork, and sample
  • repeat ABO testing on post-transfusion sample
  • visual check of the pre- and post- transfusion sample, looking for evidence of hemolysis
  • should look at urine for present of hgb, you are not looking for intact RBCs, just for Hgb
• lab investigation

  • run post-transfusion DAT - if positive, need to check the pre-transfusion specimen
  • the findings are reported to the blood bank supervisor or the medical director; they may want more testing
  • when a patient is cared for by different transfusion services, medical warning bracelets or wallet ID's may benefit with red cell alloantibodies
• HTR - additional tests

  • repeat ABO and Rh on both the pre- and post-transfusion specimens (from recipient), as well as the donor unit or segment
• HTR - additional tests

  • do antibody detection on both the pre- and post-transfusion specimens, to see if antibodies were missed; if an antibody is found in the pre-transfusion specimen, check the donor for the antigen
• HTR- additional tests

  • the crossmatch should be repeated with pre- and post-transfusion specimens through the IAT phase
• HTR

  • check the patient haptoglobin, LDH, and unconjugated bilirubin
  • in medicine, LDH is oten used as a marker of tissue breakdown as LDH is abundant in RBCs and can function as a marker for hemolysis
• HTR

  • look at the physical properties of the bag, to rule out traumatic or mechanical hemolysis
• HTR

  • microbiology studies are done to assess possible contamination
  • if septic transfusion reaction is suspected, immediately report the blood collector so that ALL co-components form teh same donation can be interrupted to avoid possible exposure to other patients