Pediatrics

Transfusion Reactions

Diagnosis

Reactions may occur with any type of product. Important to determine type of reaction. Types are:

  • Hemolytic Transfusion Reaction
    • Signs: Hemoglobinemia, hemoglobinuria, DIC, ↓ BP, ↑ HR, bronchospasm
  • Non-Hemolytic Transfusion Reaction
    • Signs: ↓ BP, bronchospasm, pulmonary edema, fever, rash
  • Anaphylactic Transfusion Reaction For Treatment steps, click: Tx
    • Signs: Erythema, urticaria, angioedema, bronchospasm, tachycardia, shock

Diagnosis

Reactions may occur with any type of product. Important to determine type of reaction. Types are:

  • Hemolytic Transfusion Reaction
    • Signs: Hemoglobinemia, hemoglobinuria, DIC, ↓ BP, ↑ HR, bronchospasm
  • Non-Hemolytic Transfusion Reaction
    • Signs: ↓ BP, bronchospasm, pulmonary edema, fever, rash
  • Anaphylactic Transfusion Reaction For Treatment steps, click: Tx
    • Signs: Erythema, urticaria, angioedema, bronchospasm, tachycardia, shock

  1. For All Reactions:

    Stop transfusion

  2. Disconnect donor product and IV tubing

  3. Infuse normal saline through clean tubing

  4. Examine blood product ID; determine correct pt

  5. Send product to Blood Bank

  6. Consider DDx

  7. Hemolytic Transfusion Reaction

    Signs: Hemoglobinemia, hemoglobinuria, DIC, ↓ BP, ↑ HR, bronchospasm

    Furosemide 1-2 mg/kg (MAX 40 mg)

    • 1-2 mg/kg, MAX 40 mg

  8. Mannitol 0.25-1 g/kg

    • 0.25-1 g/kg

  9. Support BP to maintain renal perfusion

  10. Maintain urine output at least 1-2 mL/kg/hour

  11. Prepare for cardiovascular instability

  12. Send blood and urine sample to laboratory

  13. Non-Hemolytic Transfusion Reaction

    Signs: ↓ BP, bronchospasm, pulmonary edema, fever, rash

    Treat fever

  14. Treat pulmonary edema

  15. Observe for signs of hemolysis

  16. Anaphylactic Transfusion Reaction

    Signs: Erythema, urticaria, angioedema, bronchospasm, tachycardia, shock

    Support airway and circulation as necessary

  17. Epinephrine 1-10 MICROgrams/kg IV

    • 1-10 MICROgrams/kg IV

  18. Diphenhydramine 1 mg/kg IV (MAX 50 mg)

    • 1 mg/kg IV, MAX 50 mg

  19. Methylprednisolone 2 mg/kg IV (MAX 60 mg)

    • 2 mg/kg IV, MAX 60 mg

  20. Maintain intravascular volume

  21. Crisis Management (If Severe)

    Notify surgeon, call for help and code cart

  22. Call for Transesophageal Echocardiography

  23. Start chest compressions

  24. Give epinephrine 10 MICROgrams/kg IV/IO

    • 1-10 MICROgrams/kg IV

  25. If cardiac arrest, go to CARDIAC ARREST

  26. Consider ECMO

Patient weight

Between 0.5 kg and 120 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.