Blood Transfusion Reactions
Why do we care about these in the PACU?
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Occasionally asked to transfuse blood components while patient still in PACU
Some patients arrive in PACU having just received or in the process of receiving a
transfusion
Many patients arrive having received a transfusion at some point during their surgery and
we may see the delayed effects.
Can be difficult to diagnosis initially if you don’t have a high suspicion/think about it.
Reactions
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Febrile Nonhemolytic Transfusion Reactions (FNTR) – Most Common. Presents with
fever, chills, sometimes mild dyspnea within one to six hours after transfusion. Benign,
no lasting sequelae, but uncomfortable/frightening to the patient. ~15% will have second
reaction with repeat transfusions.
o Because symptoms are similar to more serious transfusion reaction must stop the
transfusion and determine that a hemolytic reaction is not taking place. Consider
administration of antipyretics/meperidine for chills/rigors
Acute Hemolytic – Medical emergency. Most often due to ABO incompatibility/clerical
error. Fever, chills, flank pain, red urine. Under anesthesia DIC/oozing may be only
sign.
o Stop Transfusion. Save blood/labels for repeat cross-matching. Maintain airway,
blood pressure, HR as needed. Begin NS infusion to initiate diuresis/avoid renal
failure. Obtain pt urine/blood sample for DAT/crossmatch/other tests. Notify
blood bank.
Delayed Hemolytic – due to antibody response after reexposure to a foreign red cell
antigen 2 to 10 days after transfusion. Hemolysis is usually extravascular, gradual, and
less severe than acute reactions.
o No treatment in absence of brisk hemolysis. Important to make diagnosis/do the
workup to avoid giving offending antigen in future.
Transfusion-Related Acute Lung Injury (TRALI) – Lung injury temporally related to
transfusion, usually within six hours. Manifest by acute onset of non-cardiogenic
pulmonary edema. One of leading cause of tranfusion related fataility.
o Tx includes supportive measures. Mechanical ventilation.
Anaphylactic Reactions – Rapid onset shock/hypotension/respiratory distress. Lifethreatening.
o Treat like other anaphylactic reations. Stop transfusion. Give Epi. Give volume.
Maintain airway/breathing/circulation.
Urticarial – Annoying but usually no big deal and transfusion can continue.
o Give diphenhydramine or whatever else you want to try.
Others – Volume overload/Iron overload/Graft-vs-Host disease/Bacterial infection or
sepsis particularly after plt administration.