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This pocket card reviews blood type compatibility, the different types of transfusion reactions that can occur, signs and symptoms, and treatment strategies.
Blood Type Compatibility (American Red Cross, n.d.) Blood types are determined by antigens, substances that trigger an immune response when seen as foreign to the body. Some antigens can cause a patient s immune system to attack transfused blood. Whole blood, red blood cells (RBCs), leukocyte-poor RBCs, white blood cells (WBCs), and platelets must be ABO and Rh type and cross-matched for antibodies to be safely transfused.There are four major blood groups based on the presence or absence of two antigens, A and B, located on the surface of red blood cells. There is also a protein called Rh factor which can be present (+) or absent (-). The universal red cell donor has Type O- blood. The universal red cell recipient has AB+ blood.
Transfusion reactions typically occur from a major antigen-antibody reaction. The severity of the reaction can range from mild to life-threatening. An acute reaction can occur within 24 hours of transfusion completion, but severe reactions typically occur within the first 15 minutes of initiating the transfusion.
For information about blood transfusions seeNursingCenter Pocket Card: Blood Products and Transfusions
Signs of a potential transfusion reaction Mild symptoms that often resolve without treatment or complications Fever Chills Pruritus (severe itching) Urticaria (hives) Hypothermia
Pulmonary edema due to volume excess or circulatory overload Hypertension may be present Occurs during transfusion or within 12 hours of transfusion completion
Bilateral pulmonary edema on chest x-ray Occurs during transfusion or within 6 hours of transfusion completion
Caused by acute intravascular hemolysis of transfused RBCs that may be due to ABO incompatibility Fever, chills Flank/back pain Oozing from IV site Hypotension Occurs during transfusion or within 24 hours of transfusion completion
Hypotension (and other signs of shock) Occurs during transfusion or within 72 hours of transfusion completion
Severe allergic reaction possibly due to IgA antibodies Angioedema, wheezing, and/or hypotension Occurs during transfusion or within 4 hours of transfusion completion
Itching and hives Occurs during transfusion or within 4 hours of transfusion completion
Antihistamines (e.g., diphenhydramine) for treatment but not prophylaxis Transfusion may be continued if no other symptoms develop
Most common reaction caused by a release of cytokines from WBCs Fever, chills, and/or rigors without other systemic symptoms Occurs during transfusion or within 4 hours of transfusion completion
Drop in blood pressure (BP) without other causes Systolic BP decreases by 30 mm Hg or more and may drop to less than 80 mm Hg within one hour Usually occurs within the first 10 to 15 minutes of transfusion initiation
BP typically returns to baseline once the transfusion is stopped. Usually does not require specific treatment or prevention, except avoiding ACE inhibitors prior to transfusion or apheresis.
Initial Laboratory Testing The provider should discuss with the transfusion/blood bank personnel whether laboratory testing should be ordered. Minor allergic reactions (e.g., hives) and TACO may not require laboratory tests. All patients with suspected AHTR, anaphylaxis, sepsis, and TRALI should have labs drawn or other tests (e.g., chest radiography) to determine the cause of the patient s symptoms.
If ordered, a blood sample should be sent to the lab with the following information: Patient identifying information Underlying diagnosis and reason for transfusion Recent fever course Previous transfusion reactions Administration of any pre-transfusion medications, or new medications that could have caused an allergic reaction or drug-induced hemolysiS Time the transfusion was initiated Time symptoms began Time the transfusion was stopped Patient symptoms Patient vital signs The blood bank or laboratory will perform the following:
Verify the component container, label, paperwork, and patient sample used for typing and crossmatching Repeat ABO testing on the post-transfusion patient sample Visual check of pre- and post-transfusion patient samples for signs of hemolysis Direct antiglobulin (Coombs) test (DAT) on post-transfusion patient sample Antibody screen
Restarting the Transfusion after a Reaction If the symptoms clear and the correct product has been verified by the transfusion service, the treating provider (and transfusion service) should decide if the transfusion may continue.
Transfusion of the original product shouldn t be continued if the suspected reaction was AHRT, anaphylaxis, sepsis, or TRALI. Transfusion of the same product may be continued if it was a minor allergic reaction or TACO that has resolved with diuresis or other treatments. If 4 hours has passed, the product should not be used.
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