Recognizing transfusion reactions
Each year, approximately 16 million blood components are transfused in the U.S. Every two seconds, someone in the U.S. needs blood and/or platelets. Transfusion reactions occur in approximately 2% of blood product administrations.
Clinical scenarios
A 67-year-old woman with anemia (Hgb 6.0) receives one unit of packed red blood cells and develops a temperature of 38°C one hour into the transfusion.
A 32-year-old woman develops fever, back pain, and hypotension 15 minutes after blood transfusion.
A 78-year-old man with CHF/CKD develops shortness of breath (SpO2 85%) after rapid blood transfusion, with B-lines on ultrasound.
A 45-year-old woman receiving plasma/platelets develops hypoxemia one hour later, with hypotension and bilateral infiltrates on chest X-ray.
Initial response
1. Stop the transfusion
2. Laboratory and imaging evaluation
Repeat type and screen
Direct antiglobulin (Coombs) test, haptoglobin, and LDH
Urinalysis
CBC and CMP
BNP
Blood cultures
Chest X-ray
