Chapter 12: Respiratory care, CPR and blood transfusion
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Complications: major transfusion reactions
Major transfusion reactions include anaphylaxis, haemolysis and sepsis and may present as a fever of over 38.5°C and tachycardia with or without hypertension. In such circumstances a severe reaction should always be considered and the transfusion should be stopped until a specialist assessment has been conducted (see Box 12.11).
Care should be taken when returning the blood components to the laboratory, to ensure that the components do not leak and that no needles remain attached. Any further components being held locally for the patient should also be returned to the hospital transfusion laboratory for assessment. The events surrounding the reaction should be clearly documented and reported in the following ways:
- Record the adverse event in the patient's clinical record.
- Complete a detailed incident report as per local policy.
- Follow local, regional and national criteria for reporting via SABRE and SHOT (this is usually done by the transfusion practitioner).
Acute haemolytic reactions
Acute haemolytic reactions are usually directly related to ABO incompatibilities due to either an IBCT or undetected antibody where antigen/antibody reactions occur when the recipient's antibodies react with surface antigens on the donor red cells. This reaction causes a cascade of events within the recipient, who can present with chills and/or rigors, facial flushing, pain and/or oozing at the cannula site, burning along the vein, chest pain, lumbar or flank pain, or shock. The BSH guideline (Tinegate et al. [270]) stresses that acute transfusion reactions can often present with an overlapping complex of signs and symptoms; the initial assessment should aim to identify patients with a serious or life‐threatening reaction and then treatment should be targeted to the signs and symptoms (Tinegate et al. [270]).
Patients may express a feeling of anxiety or doom, which may be associated with cytokine activity. Haemolytic shock can occur after only a few millilitres of blood have been infused. Treatment is often vigorous to reverse hypotension, aid adequate renal perfusion and renal flow (to reduce potential damage to renal tubules), and start appropriate therapy for disseminated intravascular coagulation reactions (Norfolk [202]). It is important to remember that most acute haemolytic reactions are preventable as they are usually caused by human error when taking or labelling pre‐transfusion samples or collecting blood components, and/or failing to perform a correct identity check of the blood pack and patient at the bedside (McClelland [151], Norfolk [202]) (Figure 12.79).
Figure 12.79 Checking the compatibility label or tie‐on tag against the patient's wristband.
Acute anaphylactic reactions
Allergic and anaphylactic reactions are most common with platelet transfusions but can occur with any blood component (Delaney et al. [59]). If a patient presents with shock and severe hypotension with accompanying wheeze or stridor, this is strongly suggestive of anaphylaxis (Tinegate et al. [270]). Urgent medical care should be sought immediately and Resuscitation Council guidelines followed (Norfolk [202]).
Hypothermia
Infusing large quantities of cold blood rapidly can cause hypothermia. Patients likely to experience this reaction are those who have suffered massive blood loss due to trauma, haemorrhage, clotting disorders or thrombocytopenia (Norfolk [202]). Such reactions present with alterations in vital signs and development of pallor and chills.
