Pretransfusion and

transfusion procedures
The clinician is responsible for:

1. Completing patient informed consent for transfusion

2. Prescribing blood components and products

3. Ordering the transfusion of blood products

4. Completing the transfusion request form

5. Collecting blood specimens for compatibility testing

6. Patient ID verification during collection of pre transfusion

specimen
Patient who may require transfusion should read the
information sheet regarding blood transfusion

Patient Information Sheet

Request form
Allows TMD to
contact the
requesting doctor if
Name of Doctor
needed
making the request
with signature
Consultant’s name
Either use the stamp or
write in block letters
Indicate previous blood
group if known and any
Clinical diagnosis should previous transfusion
be relevant indicating reaction
the condition the
patient is suffering from Indicate name and
date of procedure
What makes it
necessary for making If blood or components
a blood request are required, indicate
the type of component
Test required and the number of
units/volume

Special Ensures products are

requirement available when
needed

Name of person
taking the blood
sample together with
date and signature.
Name must be
stamped or CLEARLY
written.
Patient identification band
All patients receiving a transfusion must wear

an identity band.

This is essential for safe transfusion and

phlebotomy practices.
1. Collecting blood for pre-transfusion testing requires critical
attention to identification process

2. Incorrect identification of a patient can cause death due

to an acute hemolytic transfusion reaction

3. Identification procedure must be performed for each

blood taking even if the phlebotomist knows the patient

Blood sample for transfusion

 Patient identification
Positively identify patient using two identifiers:
i. Full name
ii. A numeric secondary identifier: date of birth, IC
number or Hospital register number

Ask the patient to state their full name

Ask for a numeric secondary identifier
Crosscheck with details on identification band , case
notes and request form
 New born identification
The identification band must be attached to the
newborn before blood taking

Be careful not to confuse newborn's

identification with the mother's

For twin babies, the identification and blood sampling

procedure must occur independently for each twin to
avoid mixing up the twin's specimens
Adult: 3ml EDTA

Child >2 year: 3 ml EDTA

Child: 5 months to 2 years: 2 x 0.5ml EDTA

Infant from birth to 4months:

0.5ml EDTA along with mother’s sample with the first

request

If the mother’s sample is not available: 2 x 0.5ml EDTA

infant’s sample

Sample volume required

1. Labels must be affixed to the tubes directly after
collection and in the presence of the patient at
bedside or chair

2. Pre printed labels must be crosschecked with

details on patient’s wristband

3. Tubes must not be pre labeled

Sample tube labeling

Urgent requests should be sent by hand and the
Transfusion laboratory informed by phone

Non urgent samples can be sent by pneumatic tube

Ward must maintain a record of request and sample

sent for each patient

Dispatch Form/Sample
3ml sample in EDTA tube is required for process of
blood group and antibody screen

Test performed

Blood grouping

Blood screen for irregular red cell antibodies

Antibody identification if antibody screen is positive

Pre transfusion testing

Clinically significant red cell antibodies can cause
potentially life-threatening haemolysis

Such antibodies must be identified and patient

provided with units that are negative for that
antigen

Process may be prolonged:in urgent situation need to

alert the incharged physician

Antibody investigations
It is advisable to sent a blood sample at the time of
booking for an elective procedure !!!

This enables the identification of rare groups, red cell

antibodies and the need for antigen typed blood,
and as a cross check for new samples

Elective surgery
Rh negative units are limited and for emergency use
For elective surgery 7 working days notice is required

Rare blood types e.g. Bombay phenotype will require

a longer waiting time and may need checks with
National/International Rare Blood Group Registry

Special Conditions
Blood compatibility form
Patient particulars must match in compatibility label, compatibility form,
patient’s folder and identity band

Unit number and blood group must match on blood bag label,
compatibility label and compatibility form

Checking of labels
Bedside check is vital.

Performed by medical officer and staff nurse who will

commence the transfusion

Officer who signs must take

responsibility for the checking

Identity check
The major risks from transfusion are
associated with unsafe clinical
transfusion practices and
inappropriate blood product
transfusion
 How to transfuse
blood and blood products
 Must be ABO and RhD group specific with the recipient.
Requires compatibility testing except if group is unknown.
TIME FOR TRANSFUSION
Transfusion must be within 30 minutes from
DESCRIPTION receiving the unit.
Volume -300+- 30ml
Hb - >45g/unit MEDICATION
Hct - 35%-45%
Do not add or push any medication
INDICATIONS
- Acute blood loss with
hypovolemia ABO COMPATIBILITY
- Exchange transfusion

TRANSPORTATION
Blood collection box with ice
Recipient Group Compatible Group
packs.
FILTERS Unknown Unmatch O ( low titre
Administered through a A&B)
standard
O O
(170-200µm)blood filter.
COMPATIBLE A A
INTRAVENOUS SOLUTIONS B B
Whole
NaCl Blood
Rh COMPATIBILITY
0.9%
RhDABpositive units to RhD positiveAB
recipients
PUMPS and WARMERS RhD positive to RhD negative recipients if Rh
Acceptable for use if ordered. negative blood stocks are low
 RED CELL

DESCRIPTION ADMINISTRATION
volume- 150-200ml Must be ABO and RhD group specific.(1st option)
Hb - > 45g/dl Compatible ABO and RhD group (2nd option)
Hct – 50%-70% Requires compatibility testing
DOSE TIME TRANSFUSED
4ml/kg in adults raises the Hb Transfuse within 30 minutes once received from blood bank.
concentration by 1g/dl or Hct by Transfusion must be completed within 4 hours.
3%
A dose of 10-15ml/kg in neonates
Patient ABO
MEDICATION Donor Group Donor Group
increases the Hb by 3g/dl and Hct st
by 60%. Group 1 Option 2nd Option
Do not add any medication with red cell components .
INDICATIONS A COMPATIBILITYA
ABO O
Replacement of red cells in B B O
anemic patients. AB AB A,B,O
TRANSPORTATION O O -
Blood collection box with

Red Blood
ice packs. Patient Rh Donor Rh Donor Rh
FILTEr 1st Option 2nd Option
InfuseCells
using a standard blood set
with filter.(170-200µm). Positive
Rh Positive
COMPATIBILITY Negative
Negative Negative Positive
PUMPS and WARMERS ( elderly males and females
Acceptable for use upon non child bearing age)
physician’s order.
 Platelet ABO Selection Chart

Platelets
Patient ABO Donor ABO Specific Donor non-ABO Specific
Group ( 1st option) ( 2nd option)Selection order
INDICATION
A A AB,B,O(low titre anti-
Treatment and Prevention of A&B)
bleeding.
B B AB,A,O
DOSE
AB AB A,B,O
4-6 random platelets (one adult O O B,A,AB
dose)should raise the platelet count *1 adult dose is equivalent to 4-6 Random platelets
by 20-40x109/L TIME OF INFUSION
TRANSPORTATION Should be transfused as soon as possible within a period 30 minutes.
Collected in blood boxes not chilled
ADMINISTRATION.
FILTERS
A standard blood administration set. Requires ABO identification of the recipient.
PUMPS ABO specific transfusion is preferred but not required.
Infusion devise not recommended, Always use a fresh new set.
Flush with normal saline if continue to use for red cell or FFP.

Rh COMPATIBILITY
If RhD positive platelets are given to RhD negative patients, Rh Immuno Globulin (Anti-D) should be given.
One vial (250i.u) of anti globulin will cover 4-5 adult doses of platelets within 6 weeks.

Type Volume Platelet count

Random Platelet 50ml-60ml 55x109 platelets
Pooled Platelet(4-6 Random) 200ml-400ml 240x109 platelets
Platelet Apheresis (Single Donor Platelet) 180ml-300ml 150-500x109 platelets

All apheresis platelets and pooled platelets are leucodepleted and irradiated
Plasma (FFP)
INDICATION
Replacement of coagulation factor DESCRIPTION
deficiency. Volume- 200ml-300ml
Disseminated Intravascular Contains factor VIII level >70% of normal fresh plasma level
Coagulation (DIC) ADMINISTRATION
DOSE Must normally be ABO compatible.
10-15ml/kg ABO identification of recipient is required
No compatibility testing required.
MEDICATION Infuse using a standard blood administration set.
No medication should be added. Transfusion should be completed within 30 minutes to one
PUMPS hour.
Acceptable for use. Return the units to blood bank if not used within 30 minutes.
TRANSPORTATION
Blood collection boxes without ice packs.
Patient Donor Group Donor
Group
Rh
ABO
ABO group (1st option) (2nd option)
Plasma may be transfused without regard
COMPATIBILITY
A A AB to Rh type.
B B AB
AB AB -
O O A,B,AB
 COMPATIBILITY
Cryoprecipitate If possible use ABO compatible products.
May be transfused without regard to Rh type.

DESCRIPTION
Volume – 10ml-20ml
Contains- Factor VIII-80-
100iu/pack
Fibrinogen 150-
300mg/pack
INDICATIONS
Accquired Coaglulopathies
Disseminted Intravascular
Coaglulopathies (DIC)
DOSE
One unit/7-10kg body wt
One adult dose will increase the
fibrinogen levels by about 1g/dl.
TRANSPORTATION
Blood collection boxes without
ice packs
ADMINISTRATION
No compatibility testing required
After thawing infuse as soon as possible
Transfuse using a standard blood administration set
Must be transfused within 30 minutes to one hour
Must be completed within 4 hours of thawing .
Plasma Products for one DIC cycle
1. 6 Cryoprecipitate
2. 4 Platelets
3. 2 FFP
Preparation of plasma for use
FFP, Cryoprecipitate and Cryosupernatant are thawed for 20-30
minutes at 37oC in a water bath.
Once thawed plasma cannot be refrozen again.
General Transfusion Practices

• When to transfuse.
• Rate to transfuse.
• Devices used for transfusion.
• Time limit for transfusion.
General Practices in TransfusionADMINISTRATION SETS
OPTIMAL TIME FOR TRANSFUSION
Elective transfusions and transfusion for
transfusion-dependent anemia should normally
be carried out during the day.
INFUSION RATES
Initial flow rate 1ml/min and if there is no
reaction at 15 min increase the rate to
4ml/min.
Except in the massive transfusion setting,
transfusion rates for blood should not exceed
2-4 ml/kg/hr.
Platelets and plasma flow rate is 10ml/min.
DEVISES USED FOR TRANSFUSION
CANNULA
There is no minimum or maximum size
cannula for transfusion.
The size of the cannula chosen should depend
on the size of the vein and the speed at
which the blood is to be transfused.
- All blood and blood components must be
transfused trough a standard sterile blood
administration set containing an integrated
filter.(170µm- 200µm).
- To minimize clogging of the filter, a
maximum of 4 units of red cells should be
transfused trough a giving set.
- In an emergency bleeding situation 8-10
units of red cells may be transfused before
the giving set is changed.
- Each administration set should be used
within 8 hours to prevent the risk of
bacterial contamination.
- Platelets must not be transfused through a
giving set which has been used to transfuse
red cells.Cellular debris in the filter will trap
the platelets
General Transfusion Practices
BLOOD WARMERS
A specially designed commercial device with
a visible thermometer and audible warning is
to be used.
Red blood cells expose to temperatures above
400C may cause red cell haemolysis.
Blood that has been warmed cannot be
returned back to TMD.
Clinical indications
- Large volumes transfused rapidly.
e.g at flow rates > 50ml/kg/hr in adults
> 15ml/kg/hr in children
- Neonates requiring exchange
transfusions.
- Transfusion for patients with clinically
cold reactive antibodies.(Cold
agglutinins reacting at 370C in vitro.)
ELECTRONIC PUMPS
Electronics infusions pumps may be used for
the administration of red cells/plasma if they
have been verified as safe to use for this
purpose according to the manufacturer’s
instructions.
COMPATIBLE INTRAVENOUS
SOLUTIONS
Administration sets may be primed with
0.9% Normal Saline or the component being
transfused.
Do not use Dextrose solutions (may induce
haemolysis ).
Do not use Lactated Ringers (may induce clot
formation in the blood pack/or administration
set as it contains calcium).
Medications must not be added to
any blood components or transfusion line.
General Transfusion PracticesPLATELETS
TIME LIMIT FOR TRANSFUSION
RED CELLS
Transfusion should begin as soon as possible
following removal of the unit from the
refrigerator.
When a short delay occurs red cells may be
held at room temperature for less than 30
minutes prior to transfusion.
If transfusion cannot be started within 30
minutes the unit should be returned without a
delay to the blood bank.
If a unit has been out of controlled storage for
>30 minutes the unit cannot be accepted
back into the blood bank stock.
Transfuse immediately as soon as the platelets
are received from the TMD.
If not used immediately platelet must be
returned to blood bank within one hour of issue.
FFP
Must be transfused immediately after thawing.
Return to blood bank within 30 minutes if not
transfused.
Thawed FFP can be stored at 2-6oC for 24 hours
until use.
CRYOPRECIPITATE
Must be transfused immediately after thawing.
If the unit is not used it must be returned to
the blood bank immediately where it can be
stored at room temperature for up to 4 hours
until used.
Transfusion
reaction
Blood products
Transfusion Risk
Individual patient characteristics
Blood product
Equipments
Concomitant medications and
intravenous fluids
Procedures
Risk factors
Multiple transfusion / multiparous
Emergency uncrossmatched blood
Immunocompromised
Cardiovascular disease
Types and volume
Leucodepleted products
Storage & time of delivery
Leucocyte-filter
Infusion pump -> mechanical damage
Blood warmer
IV medications or other fluids through
the same tubing -> interfere with
anticoagulant effect of citrate except 0.9%
normal saline.
Indications
Clear documentation
Well-trained staff
 Acute Non-immunologic
Acute Immunologic Transfusion associated sepsis
Acute Haemolysis Reaction Hypotension associated ACE inhibition
FNHTR TACO
Non-immune haemolysis
AAR
Air embolus
Anaphylactic reaction Hypocalcaemia
TRALI Hypothermia
Classificatio
n
Delayed Immunologic
Alloimmunization Delayed Non-
Delayed hemolytic reactions immunologic
GVHD Iron Overload
Post-transfusion purpura
Types of Non-
Immunological Incidence Incidence
Reaction Immunological
Acute haemolytic Variable (1:12 000 –
transfusion reaction 1:177000 : ABO Hypothermia Variable
incompatibilty)
Allergy reactions 1-3% plasma Metabolic
Variable
transfusion complications
1:20,000 – Platelet (1:7500)
Anaphylaxis Bacterial
1:50,000 Red cells (1:
contamination
Immediate 500,000)
Transfusion
Febrile non-haemolytic associatied
1:100 – 1: 1000 1%
reaction Circulatory
Overload (TACO)
Transfusion Related
1:50,000 – 1: Non-immune
Acute Lung Injury Variable
190,00 haemolysis
(TRALI)
Transfusion-
Alloimmunisation Unknown Variable
transmitted disease
Delayed haemolytic
1:2500 – 1:11000 Iron overload Unknown
transfusion reaction
Delayed Post-transfusion purpura
Rare
(PTP)
Transfusion-associated
Graft-versus-host- Rare
disease (TA-GVHD)
 Acute haemolytic
•
transfusion reaction
When to suspect?
• Fever, tachycardia
• Chills, rigors, dyspnoea, chest and/or flank pain, discomfort at
infusion site, abnormal bleeding or shock
• Oliguria, haemoglobinuria
• Anaesthetised patients
• BP, DIC
• What is the cause?
• Immunologic destruction of donor red cell
• Most common ABO incompatibility
• How to assess?
• Clinical assessment
• Check clerical records
• Laboratory investigations
• FBC / LFT / RP
• Direct Antigent Test / Indirect Antigen Test
• Test for haemolysis :
• Haptoglobulin, Urine Haemoglobinuria
• Report incident and return blood to blood bank
• What should be done?
• Stop transfusion
• Alert Transfusion Service Provider
• Maintain blood pressure and renal output
• Maintain airways
Allergic Reaction
• When to suspect?
• Urticaria, rash, pruritis
• Flushing, wheezing, hypotension, angioedema
• What is the cause?
• Hypersensitivity to allergen or plasma protein
• 1-3% plasma transfusion
• What to do?
• Stop transfusion
• Mild : anti-histamine
• Severe :
• Adrenaline
• Corticosteroids
• ABC resuscitation
• Consider pre-medications / washed pack cells in
next transfusion
Anaphylaxis
• When to suspect this adverse reaction?
• Sudden onset of cough, bronchospasm,
laryngospasm, respiratory distress, vascular
instability, nausea, abdominal cramps, vomiting,
diarrhoea, shock and loss of consciousness
• May be a fatal reaction.
• 1:20,000 to 1:50,000
• Usual causes?
• IgA-deficient patients who have anti-IgA antibodies
of the IgE class
• IgE-mediated allergy to other plasma proteins
• Rarely due to donor medication.
• Investigation?
• Recipient’s pretransfusion sample for IgA
deficiency
• Presence of anti-IgA antibodies.
• What to do?
• Stop transfusion immediately
• Maintain airway and intravenous line
• Administer adrenaline and corticosteroids
• Maintain BP
• Future use of autologous, washed or components
from IgA-deficient donors
Febrile non-haemolytic transfusion reaction
• When to suspect this adverse reaction?

• Temperature rise of ≥ 1 ºC from baseline during or shortly after transfusion, in the absence of
other pyrexic stimulus.
• Chills, rigors and headache
• Incidence: 0.1% to 1% in universal leucocyte depleted transfusion

• Usual causes?

• Alloimmunisation to donor human leucocyte antigen (HLA) or other antigens

• Pregnancy or previous transfusion
• Cytokine accumulation during storage may also precipitate this reaction.

• What to do?

• Stop transfusion immediately and follow other steps for managing suspected transfusion
reactions.
• Treat the fever with an antipyretic
• Consider and exclude other causes
• Rule out haemolysis, septic reaction and transfusion-related acute lung injury (TRALI).
 Transfusion-related Acute Lung Injury (TRALI)
• When to suspect this adverse reaction?

• Onset of fever, chills, dyspnoea, tachypnoea, tachycardia, hypotension, hypoxia and noncardiogenic pulmonary
oedema during or within 6 hours of transfusion.

• Usual causes?

• The pathogenesis is not completely understood but theorised to be due to either human leucocyte antigen (HLA)
or human neutrophil antigen (HNA) antibodies found in the donor’s blood directed against the recipient’s
leucocyte antigen.
• This reaction activates neutrophils in the lung microcirculation, thereby releasing oxidases and proteases that
damage and make blood vessels leak.

• Investigation

• Test the donor or recipient serum for HLA or granulocyte antibody. Demonstration of these antibodies supports
diagnosis.
• Chest X-ray

• What to do?
• Stop transfusion immediately and follow other steps for managing suspected transfusion reactions.
• Provide cardiovascular and airway support. Administer supplemental oxygen and employ ventilation as necessary.
• Notify your Transfusion Service Provider to contact the Blood Service so we can quarantine and test related
components from the same donor.
• CXR
 Bacterial infection
• When to suspect this adverse reaction?

• The onset of high fever, severe chills, hypotension or circulatory collapse

during or soon after transfusion
• 1:75,000 for platelets and at least 1:500,000 for red cells.

• Usual causes?

• Bacteria may enter the blood during collection or preparation of

components.
• Contamination of ports during thawing of frozen products in a water bath.
• Organisms capable of multiplying at low temperatures and those using
citrate as a nutrient are most often associated with red cell contamination,
especially Yersinia enterocolitica.

• Investigation

• Clinical assesment
• Request for blood cultures from the patient, and perform culture and gram-
stain of the blood component.
• Keep the blood bag and giving set (sealed) for further investigation.

• What to do?

• Stop transfusion immediately and follow other steps for managing suspected
transfusion reactions.
• Seek urgent medical assistance.
• Start broad-spectrum antibiotics once cultures have been taken, including
cover for staphylococcal infections.
• Provide cardiovascular support.
Transfusion-acquired Graft-versus-host Disease
• When to suspect this adverse reaction?
• Fever, rash, liver function abnormalities and pancytopenia.
• Severely immunocompromised recipients
• immunologically normal recipients heterozygous for a tissue antigen
haplotype for which the donor is homozygous, especially directed
donations from family members.

• Usual cause?
• Viable T lymphocytes in the transfused component engraft in the
recipient and react against tissue antigens in the recipient.

• Investigation
• Skin biopsy
• Demonstrate donor leucocyte engraftment.

• What to do?
• Provide supportive care.

• Prevention is by gamma irradiation.

• Patients at risk
• Transplant patients
• Given purine analogue
• Immunologically impaired patients
• Hodgkin’s Lymphoma
• ? Alentuzumab
• Congenital immunodeficiency
• Exchange transfusion
• Low birthweight neonates
SYMPTOMS REPORTED
CHILLS AND RIGORS 77

FEVER 31

URTICARIA 50

HYPOTENSION 9

TACHYCARDIA 18

DYSPNOEA 15

VOMITTING 4

OTHERS 7
mmon adverse reaction and guide to clinical action
Signs & symptoms Possible diagnosis Investigation Clinical actions
Stop transfusion
Bacterial
Blood and bag culture Provide supportive care
Fever >1 oC over baseline or >38 contamination
Give IV antibiotics
Chills, rigors
Febrile non-
Exclude other causes Give antipyretics
haemolytic
Slow transfusion
Allergy Nil
Give antihistamine
Rash, hives, wheeze, dyspnoea, ABC resuscitation
hypotension Give adrenaline and steroid
Patient IgA level
Anaphylaxis Consider IgA-deficient or washed
Anti-IgA antibodies
components(particularly red cells) in
future
Check ABO
ABO incompatibility Stop transfusion
Type DAT IAT
Chills, hypotension, back pain Resuscitate
RP, Coag, Hb Maintain BP and renal function
Haemoglobinuria Haemolysis
Haemolysis tests
Ooze from IV sites
Bacterial Blood and bag
Give IV antibiotics if sepsis possible
contamination cultures
Slow or stop transfusion
Dyspnoea, productive cough Circulatory Overload Clinical Give oxygen, diuretics
Pink frothy sputum Position your patient upright
Pulmonary oedema TRALI occurs within Stop transfusion
Hypotension with TRALI HLA granulocyte
6 hours of Provide supportive care
antibody test
transfusion Notify Blood service provider
 Conclusion
• Transfusion should be taken seriously
• Well indicated, counseled
• Carried out safely
• Any reaction during and within 6 hours of blood
transfusion should be regarded as transfusion reaction
• Attend immediately
• Emergency
• Investigated / Reported
 Differential Diagnosis AHTR – one of the Top 3 causing transfusion related
1. AHTR fatalities
- Antigen-positive red cells are transfused to a recipient who has
2.FNHTR incompatible alloantibodies  intravascular hemolysis
- Etiology – ABO incompatibility, Alloantibodies, Others
3. Bacterial Sepsis
- Signs/Symptoms (within 15 min, 20-30ml) & Investigations
4. TRALI - Management – Stop, Monitor, Report

5. Etiology unrelated to FNHTR - temp >1C above 37C + associated with

transfusion transfusion
Gram-negative Gram-positive
- 2 mechanisms (1. Leucocytes Antibodies (Red cells)
• Escherichia • Staphylococcus
2. cytokines - platelets)
coli aureus - Rx – Stop, antipyretics/ for prevention – leucoreduced
•Serratia • Staphyloccus
marcescens epidermidis
•Klebsiella • Bacillus cereus Bacterial Contamination – 3 ways (1. from donor 2. from
pneumoniae donor skin 3. from handling)
•Pseudomonas
species Main culprit – PLT (20 – 24C)
•Yersinia Rx – Stop, Broad Spectrum Antibiotics
enterocolitica

PATIENT develops fever (temperature 38C) with

rigors and chills while receiving unit of PRBC

* DDx of
 PATIENT develops shortness of breath and hypoxia while
receiving unit of Packed RBC.
Differential Diagnosis TRALI – Definition
1. Duration – during or within 6 hrs of transfusion
1. TRALI 2. Acute Lung Injury (1. Acute onset 2. Hypoxemia 3.
2. TACO Bilateral infiltrates on CXR 4. No evidence of circulatory
3. TAD overload)
4. Anaphylaxis 3. No pre-existing ALI or other reasons for ALI
5. AHTR Mechanism – 1. Immune  Passive transfer of donor
6. Bacterial Sepsis alloantibodies 2. non-immune  infusion of biologic
7. Unrelated response modifiers (cytokines, CD40 L, Lipids with
Neutrophil-priming activity)
Rx – Stop, Ventilatory Support
Prognosis – 80% improve within 48-96 hours
Mortality – 5-10% of cases
TACO –
Risk factors – 1. Age 2. Flow rate 3. Volume 4.
Underlying
Rx – Stop, upright position, O2, Diuretics, Support
 Timing Symptoms Signs Cause Management

HTR First 30’ Dyspnoea, pain BP HR, Pt Ab against Supportive

at infusion site, T donor red cells
abdominal Hburia
discomfort, back Haemolysis
pain
FNHTR During or end None T BP, Cytokines Antipyretics
of transfusion HR Pt Ab against
donor
neutrophil
Urticuria During or end Itchiness Skin lesions Pt Ab to donor Antihistamines
of transfusion Dyspnoea plasma Steroids
proteins
Anaphylaxis First 30’ Dyspnoea, Loss BP Adrenaline
of consciousness Antihistamines
Steroids
TRALI During or up to Dyspnoea JVP PO2 Donor Ab to pt Ventilation
6 hrs after neutrophils
transfusion
TACO During or end Dyspnoea JVP PO2 Volume Diuretics
of transfusion overload
 Delayed Reactions
1.Alloimmunization, RBC antigens
2.Alloimmunization, HLA antigens
3.Hemolytic
4.GVHD
5.Post transfusion purpura (Antibody to HPA1a
Ag)
6.Iron Overload
Window period transfusion
transmitted infections
Current Tests

• TPPA (Syphilis)
• HBsAg
• HCV EIA 3.0
• HIV EIA 1,2 + p24 Ag
• NAT-ID – HIV, HCV, HBV
How to prevent Transfusion
Reactions?

Do not transfuse, unless indicated!!!!!!

But what is the indication?

No Universal Transfusion Triggers
Hb level, Symptoms, . . .
 Take Home Message
When transfusion reaction is suspected,
 Stop transfusion
 Maintain IV access line with NS
 Monitor vital signs
 Manage according to presenting signs and symptoms
 Report to Transfusion Medicine Department