What steps should be taken when a transfusion reaction occurs?
Whenever a reaction is suspected:
· The transfusion should be immediately discontinued.
· Intravenous access should be maintained.
· The patient information on the blood product label should be compared with the information on the patient wristband.
· The blood bank/transfusion service should be notified and a transfusion investigation should be requested.
· An entry documenting the reaction should be made in the medical progress notes.
The transfusion protocol for each institution generally specifies the type of samples needed for the preliminary investigation. In general, a post-transfusion blood sample (one tube with anticoagulants and one without) and a post-transfusion urine sample are requested. Depending on the type of reaction, other samples may be requested.
The laboratory should be provided with a full and accu-rate description of the reaction. This includes the patient’s pre-transfusion status including: diagnosis, indication for transfusion, previous history of transfusion and transfu-sion reactions, pre-transfusion vital signs, and any changes in signs and symptoms that developed during the transfu-sion. It is helpful to know how long after the transfusion was initiated the symptoms developed and how much of the product was transfused. In addition, the response of the symptoms to discontinuation of the transfusion and medications given to treat the reaction, as well as the patient’s current clinical condition, should be provided. Most transfusion investigation forms are designed to cap-ture this information. The blood bank physician uses the clinical information, the type of product transfused, and the results of the preliminary laboratory investigation to develop a differential diagnosis that guides the laboratory investigation.