Guidelines for Reporting Adverse Transfusion Reactions to Fractionated Products

For reactions to Fresh Components (red cells, platelets, FFP, cryoprecipitate, etc) please see here.

  • Transfusion reactions are infrequent but can cause a patient’s condition to rapidly deteriorate.
  • Any signs and symptoms suggesting a reaction should not be ignored, but rather assessed immediately. To minimize the risk of harm, early identification and prompt treatment are essential.

STOP!

* Stop the transfusion immediately
* Assess: rapid clinical assessment
* Check: confirm patient ID band matches blood swing label details
* Inspect: visual check of unit for turbidity, clots or abnormal appearance
* Talk with the Patient: establish status, inform and comfort

Recognise.

  • Signs and symptoms may include:
    • Fever, chills, rigors
    • Tachycardia, arrhythmias
    • Hyper or hypotension, collapse
    • Generalised flushing
    • Rash, urticaria, angioedema
    • Anxiety, severe apprehension
    • Nausea, vomiting
    • Pain (chest, loin, muscle, bone, abdominal,cannula site/vein)
    • Dyspnoea, respiratory distress, hypoxia
    • Pink/red/black urine or abnormal bleeding

Respond

Management and investigations

  • If you suspect a potential acute transfusion reaction: STOP the transfusion immediately
  • Undertake a rapid clinical assessment, check wristband ID to swing label ID, check unit and inform/comfort the patient
  • Call for help
  • Clinical Review/Treatment: see first response clinical algorithm
  • Standard ATR Investigations - for ALL moderate and severe events are:
    • EDTA (pink top) for serology - to Blood Bank
    • Full blood count/film and U&E - to Pathology
    • Ward urinalysis for blood/haemoglobin
  • Additional Investigations: if...
    • ? Haemolysis: consider haptoglobin, LDH, coag’s
    • ? Respiratory Distress: consider CXR, ABGs, BNP
    • ? Sepsis/Shock: consider blood cultures from patient
    • ? Severe allergy/anaphylaxis: consider serum tryptase & query need for anti-IgA antibodies
  • Further advice on management of ATRs is located here.

Report.

Haemovigilance to Blood Bank (BB)

  • Report all mild, moderate and severe ATRs using the NZBS ATR Notification Form

  • If the event is moderate or severe, remember to include the EDTA (pink) sample, the discontinued unit and blood IV infusion set with the ATR Form (111F009).

  • Advice on management, further transfusion needs or recurrent reactions should be discussed with the transfusion medicine specialist (TMS) or the clinical haematology consultant.

Resources ATR Lanyard [ATR teaching toolkit]

More Info

Form for reporting reactions to fractionated products Notification Of Suspected Adverse Reaction To A Fractionated Blood Product form

Guide for managing reactions Guidelines For Management Of Adverse Transfusion Reactions