The Ohio State University Medical Center
Department of Clinical Laboratories
TRANSFUSION REACTION WORKUP TEST CODES
TEST CODE
Lab Results
TRLR1
TRLR2
TRLR3
TRLR4
TRLR5
TRLR6
TRLR7
TRLR8
TRLR9
TRLR10
Signs and
Symptoms
TRSS1
TRSS2
TRSS3
TRSS4
TRSS5
TRSS6
TRSS7
TRSS8
TRSS9
TRR6.18FA/01
Effective Date: 01/20/09
DESCRIPTION
The clerical check showed no errors, no hemolysis was observed and the direct antiglobulin was negative. No laboratory
evidence of acute hemolytic transfusion reaction.
The clerical check showed no errors and no hemolysis was observed. However, the direct antiglobulin test was positive on
both the pre and post transfusion specimens.
The clerical check showed no errors. However, hemolysis was observed in the post transfusion specimen. The direct
antiglobulin test was negative.
The clerical check showed no errors and no hemolysis was observed. However, the direct antiglobulin test in the post
transfusion specimen was positive.
The direct antiglobulin test was positive with anti-IgG reagent.
The direct antiglobulin test was positive with anti-C3d reagent.
The DAT was  with both anti-IgG and anti-C3d reagent.
The elution test was negative for autoantibody or alloantibody.
The gram stained smear of the implicated blood bag was negative for organisms. A sample was sent for culture and
sensitivity.
The gram stained smear of the implicated blood bag was positive for organisms. Culture and sensitivity results are pending.
The signs and symptoms are consistent with an urticarial allergic transfusion reaction.
The signs and symptoms are consistent with an anaphylactoid or anaphylactic transfusion reaction.
The documented signs and symptoms are most consistent with febrile nonhemolytic transfusion reaction.
The documented signs and symptoms are most consistent with a febrile nonhemolytic transfusion reaction although bacterial
contamination of the transfused blood component is a possibility.
The reported signa and symptoms are consistent with circulatory overload (hypervolemia).
The reported signs and symptoms maybe caused by transfusion related acute lung injury (TRALI), although hypervolemia
may cause similar signs and symptoms.
The signs and symptoms suggest possible bacterial contamination of the transfused blood component.
The reported signs and symptoms and laboratory evaluation are most consistent with an acute hemolytic transfusion
reaction.
The reported signs and symptoms are most likely unrelated to the transfusion.
Transfusion Service
Page 1 of 3
The Ohio State University Medical Center
Department of Clinical Laboratories
TRANSFUSION REACTION WORKUP TEST CODES
Pathophysiology
TRPP1
TRPP2
TRPP3
TRPP4
TRPP5
TRPP6
TRPP7
TRPP8
TRPP9
TRPP10
TRPP11
TRPP12
Urticarial and anaphylactic reactions are generally considered to result from antibodies in the patients reacting with proteins
or other allergens in the transfused plasma. Rarely, IgG antibodies against IgA may be present in the IgA deficient patient.
Febrile reactions are generally considered to result from cytotoxic or agglutinating antibodies directed against donor
leukocytes (neutrophils and lymphocytes). The febrile reactions may also occur as a result of accumulated cytokines in the
transfused red blood cells or platelets.
Circulatory overload may be moderated by slow infusion of blood products, limiting the infusion of oncotic fluids (plasma)
and the judicious use of diuretics.
Transfusion related acute lung injury (TRALI) is thought to be caused by HLA or neutrophil antibodies in the donor plasma
which activate neutrophils and complement in the patient’s pulmonary vasculature, resulting in pulmonary edema. The
hallmark is hypoxia, with chest radiograph indicating noncardiogenic pulmonary edema.
The  DAT pre and post transfusion specimens indicate the findings unrelated to transfusion.
A positive direct antiglobulin test (IgG), with negative elution test, may be caused by drug therapy, paraproteinemia or high
dose intravenous immune globulin.
A positive direct antiglobulin test (C3d), with negative direct antiglobulin test with anti-IgG) may be caused by cold
agglutinins, drug therapy or autoimmune disease.
A positive direct antiglobulin test with anti-IgG and positive elution test, may indicate warm autoimmune hemolytic anemia.
The positive direct antiglobulin test with both anti-IgG and anti-C3 with negative elution test may be caused by drug
therapy, paraproteinemia or high dose intravenous immune globulin.
The positive direct antiglobulin test with both anti-IgG and anti-C3 with positive elution test may be caused by warm
autoimmune hemolytic anemia.
The positive direct antiglobulin test with both anti-IgG and anti-C3 with positive elution test is caused by ABO
incompatible platelet products. The patient may show anemia, requiring RBC transfusion.
Hemolysis, with negative direct antiglobulin test, may be caused by mechanical trauma to the RBCs, such as difficult
venipuncture or cardiopulmonary bypass.
Recommendations
TRREC1
Urticarial (hives) reactions can be treated and/or prevented with administration of antihistamines.
TRREC2
Anaphylactic reaction can be treated with administration of intravenous antihistamines, intravenous steroids, and in severe
cases, epinephrine.
TRREC3
Febrile nonhemolytic transfusion reactions can be treated and prevented with administration of antipyretics, e.g.,
acetaminophen.
TRREC4
Treatment of TRALI should be supportive, with respiratory support and oxygen. Patients usually recover in 3-4 days.
TRR6.18FA/01
Effective Date: 01/20/09
Transfusion Service
Page 2 of 3
The Ohio State University Medical Center
Department of Clinical Laboratories
TRANSFUSION REACTION WORKUP TEST CODES
TRREC5
TRREC6
TRR6.18FA/01
Effective Date: 01/20/09
Treatment of acute hemolytic transfusion reactions should include adequate fluid and diuretic administration to protect renal
function, support of blood pressure, administration of additional compatible blood products as necessary, and monitoring for
renal failure, coagulopathy, and shock.
No changes in blood product selection or therapy are recommended.
Transfusion Service
Page 3 of 3