Blood Transfusion Reaction: A Comprehensive Guide for Nurses

A blood transfusion reaction is an adverse event occurring during or after the transfusion of blood or blood products. These reactions range from mild to life-threatening and require prompt identification and management. Nurses play a crucial role in monitoring patients, detecting early signs of a reaction, and implementing appropriate interventions.

Types of Blood Transfusion Reactions

Febrile Non-Hemolytic Reaction:

Most common reaction.

Caused by cytokines released by donor white blood cells or antibodies in the recipient’s plasma.

Symptoms:

• Fever (≥1°C above baseline), chills, headache.
• Mild dyspnea.

Management:

• Stop transfusion temporarily and assess.
• Administer antipyretics (e.g., acetaminophen).
• Use leukocyte-reduced blood products for future transfusions.

Allergic Reaction:

Caused by hypersensitivity to plasma proteins in donor blood.

Symptoms:

• Itching, rash, hives.
• Rarely, severe anaphylaxis (e.g., dyspnea, hypotension).

Management:

• Stop transfusion and administer antihistamines (e.g., diphenhydramine).
• Severe cases may require epinephrine or corticosteroids.
• Use washed blood products for future transfusions.

Hemolytic Reaction:

Acute Hemolytic Reaction:

Caused by ABO incompatibility (clerical error is the leading cause).

Symptoms:

• Fever, chills, flank pain, dark urine.
• Hypotension, tachycardia, dyspnea.
• Hemoglobinemia and hemoglobinuria.

Management:

• Stop transfusion immediately.
• Maintain IV access with normal saline to prevent renal damage.
• Notify the blood bank and send samples for testing.
• Monitor for signs of disseminated intravascular coagulation (DIC).

Delayed Hemolytic Reaction:

Occurs days to weeks after transfusion due to an anamnestic immune response.

Symptoms:

• Mild fever, jaundice, dark urine.

Management:

• Monitor hemoglobin and bilirubin levels.
• Provide supportive care.

Anaphylactic Reaction:

Rare but severe reaction caused by IgA deficiency in the recipient.

Symptoms:

• Hypotension, respiratory distress, cyanosis.
• Nausea, vomiting, shock.

Management:

• Stop transfusion immediately.
• Administer epinephrine and provide airway support.
• Use IgA-deficient blood products for future transfusions.

Transfusion-Related Acute Lung Injury (TRALI):

Caused by donor antibodies attacking recipient leukocytes, leading to lung inflammation.

Symptoms:

• Acute hypoxemia, dyspnea.
• Fever, chills, pulmonary infiltrates on chest X-ray.

Management:

• Stop transfusion and provide oxygen therapy.
• Mechanical ventilation may be required in severe cases.
• Avoid plasma from high-risk donors in the future.

Iron Overload (Chronic Reaction):

Occurs in patients receiving multiple transfusions (e.g., thalassemia, sickle cell anemia).

Symptoms:

• Fatigue, joint pain, heart failure, liver damage.

Management:

• Chelation therapy (e.g., deferoxamine).

Bacterial Contamination:

Results from transfusion of blood products contaminated with bacteria.

Symptoms:

• High fever, chills, hypotension.
• Nausea, vomiting, septic shock.

Management:

• Stop transfusion.
• Administer broad-spectrum antibiotics.
• Notify the blood bank for further investigation.

Signs and Symptoms of a Transfusion Reaction

Mild Symptoms:

• Fever, chills.
• Rash, itching, or hives.

Moderate Symptoms:

• Tachycardia, dyspnea.
• Flank or back pain.

Severe Symptoms:

• Hypotension, cyanosis.
• Hemoglobinuria (dark urine), oliguria, or anuria.
• Confusion, loss of consciousness.

Nursing Responsibilities

1. Before Transfusion:

• Verify the physician’s order and check for blood transfusion consent.
• Perform a thorough pre-transfusion assessment:
  • Vital signs, including temperature.
  • History of prior transfusion reactions.
• Double-check blood product details with another licensed nurse:
  • Patient’s identification and blood type.
  • Blood product label, expiration date, and appearance.
• Ensure IV access is patent and appropriate for transfusion.

2. During Transfusion:

• Administer the blood product at the prescribed rate.
• Stay with the patient for the first 15 minutes, as most reactions occur early.
• Monitor vital signs:
  • Baseline before transfusion.
  • 15 minutes after starting.
  • Every 30 minutes during transfusion.
• Watch for signs of a reaction (e.g., fever, rash, dyspnea).

3. If a Reaction Occurs:

• Stop the Transfusion:
  • Disconnect the blood product but maintain IV access with normal saline.
• Assess the Patient:
  • Vital signs, respiratory status, and symptoms.
• Notify the Physician and Blood Bank:
  • Report the reaction and follow institutional protocols.
• Send Blood Samples:
  • Collect samples for hemolysis testing.
• Return the Blood Bag and Tubing:
  • Return to the blood bank for investigation.
• Document:
  • Record the event, interventions, and patient response.

4. Post-Transfusion:

• Monitor for delayed reactions (e.g., fever, jaundice).
• Provide patient education:
  • Instruct on symptoms to report after discharge.

Prevention of Transfusion Reactions

1. Proper Blood Typing and Crossmatching:

• Ensure compatibility before transfusion.

2. Use of Leukocyte-Reduced Products:

• Reduces febrile and allergic reactions.

3. Meticulous Handling of Blood Products:

• Adhere to storage and expiration guidelines to prevent contamination.

4. Patient-Specific Measures:

• Use washed red blood cells or IgA-deficient products for at-risk patients.

Complications of Transfusion Reactions

• Acute Kidney Injury: From hemolysis or hypotension.
• Disseminated Intravascular Coagulation (DIC): Triggered by massive hemolysis.
• Shock and Death: From anaphylaxis, TRALI, or sepsis.
• Long-Term Organ Damage: Iron overload can lead to liver and heart dysfunction.

Conclusion

Blood transfusion reactions are rare but can be life-threatening. Nurses play a crucial role in ensuring patient safety by adhering to transfusion protocols, monitoring for signs of reactions, and initiating prompt interventions. By maintaining vigilance and practicing evidence-based care, nurses can significantly reduce the risk of complications and improve patient outcomes.