Acute Hemolytic Transfusion Reaction Management

Algorithm Steps

1. ▶

   Start

   Suspected Transfusion Reaction

   Signs/symptoms during or shortly after transfusion

   1. ⚠

      Warning

      STOP TRANSFUSION IMMEDIATELY

      Do not discard blood product - needed for investigation

      • Clamp tubing, keep IV access
      • Maintain IV with normal saline
      • Do NOT discard blood bag
      • Notify blood bank immediately
      • Notify attending physician
      1. ●

         Action

         Assess Symptoms

         Identify type of reaction

         • AHTR signs: Fever, chills, flank/back pain, hypotension, hemoglobinuria, DIC
         • Also check: Dyspnea, chest pain, urticaria, anxiety
         • Vital signs: BP, HR, Temp, SpO2, RR
         • Urine output and color
         1. ◆

            Decision

            Hemodynamic Instability?

            Hypotension, shock, respiratory distress

            1. ⚠

               Warning

               Severe Reaction - Emergency

               Suspected AHTR or anaphylaxis

               • Activate rapid response/code if needed
               • Aggressive IV fluid resuscitation
               • Vasopressors if refractory hypotension
               • Epinephrine 0.3-0.5mg IM if anaphylaxis
               • Prepare for possible intubation
               1. ●

                  Action

                  Laboratory Workup

                  Blood bank and hemolysis labs

                  • Repeat type and screen, crossmatch
                  • Direct antiglobulin test (DAT/Coombs)
                  • Plasma free hemoglobin
                  • Haptoglobin, LDH, bilirubin
                  • CBC, coagulation studies (DIC screen)
                  • Urinalysis for hemoglobin
                  • Return blood bag + tubing to blood bank
                  1. ◆

                     Decision

                     AHTR Confirmed?

                     Positive DAT, hemolysis evidence, clerical error identified

                     1. ●

                        Action

                        AHTR Management

                        Prevent renal failure and DIC

                        • Aggressive IV fluids to maintain UOP >1 mL/kg/hr
                        • Consider furosemide if volume overloaded
                        • Monitor for DIC - treat if present
                        • Supportive care in ICU setting
                        • Blood bank investigation for root cause
                        • Report to hospital transfusion committee
                        1. ●

                           Action

                           Future Transfusion Planning

                           Prevent recurrence

                           • Update transfusion history in medical record
                           • Special requirements: Washed, irradiated, leukoreduced
                           • Premedication protocol if indicated
                           • Consider autologous donation if possible
                           • Patient education about reaction
                           1. ✓

                              Outcome

                              Reaction Managed

                              Patient stable, investigation complete

                     2. ●

                        Action

                        Other Transfusion Reaction

                        FNHTR, allergic, TACO, TRALI, etc.

                        • FNHTR: Supportive, premedicate future
                        • Allergic: Antihistamines, can resume if mild
                        • TACO: Diuretics, slow future transfusions
                        • TRALI: Supportive, O2, avoid implicated donors
                        • Document reaction type
            2. ●

               Action

               Mild/Moderate Reaction

               Stable vital signs

               • Close monitoring
               • Antipyretics for fever (acetaminophen)
               • Antihistamines for urticaria (diphenhydramine)
               • Do not resume transfusion until cleared