Chapter 12: Respiratory care, CPR and blood transfusion
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Complications: minor transfusion reactions
It should always be remembered that the symptoms of a ‘minor’ transfusion reaction may be the prelude to a major, life‐threatening reaction. It is essential that staff take any transfusion reaction seriously. Symptomatic patients should have their vital signs monitored closely and they should be clearly observable. Patients with persistent or deteriorating symptoms should always be managed as a major reaction case, and urgent medical and specialist support should be sought (Norfolk [202], Tinegate et al. [270]).
Symptoms of minor reactions include a temperature rise of up to 2°C, rash without systemic disturbance, and moderate tachycardia without hypotension but sometimes transient hypertension (Delaney et al. [59]). Such symptoms may be caused by an immunological reaction to components of the blood product. While it may be possible to manage such symptoms and continue with the transfusion, the actions listed in Box 12.11 should always be taken.
It may be possible to continue with the transfusion at a reduced rate once the patient's symptoms have been controlled; however, it may be necessary to increase the frequency of observations until the transfusion has been completed. Some patients who have regular transfusions may experience recurrent febrile reactions and may benefit from an antipyretic premedication. Aspirin and other non‐steroidal anti‐inflammatory drugs are contraindicated in patients with a thrombocytopenia or coagulopathy (BNF [24]).
Febrile non‐haemolytic reactions
Febrile non‐haemolytic reactions are caused by an immunological response to the transfusion of cellular components such as donor leucocytes. Specific patient groups are at risk of greater sensitization to leucocytes, for example critically ill patients, those receiving anti‐cancer therapies and those who require multiple transfusion therapies (Bolton‐Maggs [27], Williamson et al. [287]). Such reactions present with a mild fever (up to 2°C from the baseline), rash without systemic disturbance and moderate tachycardia without hypotension (Norfolk [202], Tinegate et al. [270]).
Urticaria
Urticaria is characterized by mild hives, rash or skin itching (Delaney et al. [59]). Symptoms can usually be treated with an antihistamine (Norfolk [202]) and patients require monitoring until their symptoms subside in case they develop into a severe reaction. If the reaction subsides then the transfusion can often be recommenced; however, if any other signs or symptoms develop, the transfusion must be discontinued completely (Norfolk [202]).
