Adults

Transfusion Reaction

Diagnosis

Hemolytic Reaction: Cardiac instability, bronchospasm, bleeding, dark urineNon-hemolytic Reaction: fever, rash, pulmonary edemaAnaphylactic Reaction: hypotension, urticaria, bronchospasm

Diagnosis

Hemolytic Reaction: Cardiac instability, bronchospasm, bleeding, dark urineNon-hemolytic Reaction: fever, rash, pulmonary edemaAnaphylactic Reaction: hypotension, urticaria, bronchospasm

  1. Call for help

    • Ask: "Who will be the crisis manager?"
    • Crisis manager designates checklist reader

  2. Disconnect any blood products infusing

    • Check blood product labels for correct patient name and ABO compatibility
    • Send the blood product(s) back to the blood bank for evaluation

  3. Support hemodynamics with EPINEPHrine

    • Repeat bolus with increasing dose as needed
    • Consider EPINEPHrine infusion
    • BOLUS: 10 -20 MICROgrams IV
    • INFUSION: 0.01 - 0.1 MICROgrams/kg/min

  4. Manage bronchospasm

    • FiO2 100%
    • Albuterol or EPINEPHrine
    • BOLUS: 10 -20 MICROgrams IV
    • INFUSION: 0.01 - 0.1 MICROgrams/kg/min
    • 2-3 puffs MDI via ETT
    • 2.5 mg via nebulizer

  5. Maintain urine output if hemolysis noted

    • Volume load 20 mL/kg crystalloid. Caution if signs of volume overload.
    • Consider furosemide or mannitol to goal UOP 1-2 mL/kg/hr
    • BOLUS 40 mg IV

  6. Monitor labs

    • Arterial or venous blood gas, electrolytes
    • PT, aPTT, fibrinogen, viscoelastography
    • Direct antiglobulin (Coomb’s) test, haptoglobin, LDH, free hemoglobin, tryptase

  7. Consider invasive lines

    • Arterial line for ongoing hemodynamic instability
    • Central venous catheter for vasopressors

  8. Further treatment

    • Consider hematology consult and ICU admission

Patient weight

Between 30 kg and 250 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.