Blood Transfusion Reactions: A Comprehensive Care Guide | health and will (2023)

Blood transfusion reactions are common in hospital settings due to the large number of blood products administered. The transfusion of blood products that are missing or actively lost (i.e., gastrointestinal bleeding) is literallylife-saving treatment.

In this article, we'll talk about the different blood products, why they're given, and then look at each type of blood transfusion reaction, the causes, the signs and symptoms, and how to deal with them as a caregiver.

What are Blood Products?

There are many different blood products that are transfused in the hospital and any of them can cause side effects called blood transfusion reactions.

Packed Red Blood Cells (PRBCs)

Patients with low hemoglobin levels get packed red blood cells, or PRBCs. This is called anemia. The most common causes of anemia that may require a transfusion are:

  • Acute and chronic blood loss (e.g. gastrointestinal bleeding)
  • Untreated persistent anemia (iron deficiency anemia)
  • destruction of blood cells
  • Decreased production of red blood cells (e.g. chemotherapy, aplastic anaemia)

PRBCs are usually ordered when hemoglobin levels fall below 7 g/dL, but it depends on the patient's type of anemia, as well as their medical history and hemodynamic stability (are their vital signs normal?)

1 to 2 piecesDepending on how low the patient's hemoglobin level is and whether there is active blood loss, PRBCs are ordered.Each PRBC unit should increase hemoglobin by approximately 1 g/dL.

Before blood products are given, a blood group and screening is performed to check the patient's blood group and for antibodies that may require special blood. The exception is when the patient has significant ongoing bleeding and needs to be drained. In this case, O negative blood is donated because it is the universal donor.

It takes approximately 2 hours to transfuse each unit of blood, but the maximum time for the blood to drain is 4 hours.In an emergency, the blood can be drawn as quickly as necessary, often with pressure bags.

Fresh Frozen Plasma (FFP)

Fresh frozen plasma, or plasma for short, is that portion of whole blooddoes not contain red blood cells, which contains coagulation factors.

Reasons why FFP may be ordered for your patient include:

  • Massive blood transfusions
  • Severe liver disease or DIC
  • Coumadin for bleeding or surgery (in addition to vitamin KL if Kcentra is not available)
  • Factor deficiency in bleeding or surgery

For bulk transfusions, replace 1 unit of FFP for each unit of PRBCs replaced (along with 1 unit of platelets).


Platelets are a blood product that helps the body form blood clots and prevent bleeding.

These can often decrease due to various autoimmune diseases, cancer and chemotherapy, drug reactions and liver disease.

Platelets are replaced when the platelet count is lowthrombocytopenia. Platelets are usually ordered for:

  • Active bleeding with platelet count <50,000/microliter
  • Thrombocytopenia requiring invasive intervention or surgery
  • To prevent spontaneous bleeding, usually when the platelet count is < 10,000/microlitre

Most platelets given are obtained by "apheresis". One apheresis unit is equivalent to 4-6 "pooled random donor units". 1 unit of platelets from apheresis should increase the platelet count by about 30,000.

Why are blood products given?

Blood products are administered if the blood values ​​are too low or if there is acute bleeding. Although it depends on the individual patient and physician, blood products are generally administered when:

  • PRBC'sare given if the hemoglobin level is less than 7 or if there is persistent bleeding with haemodynamic problems
  • plateletsare given for active bleeding with values ​​<50,000 or <10,000.
  • FFPgiven for massive blood transfusions, severe liver disease or DIC, or as an option for Coumadin reversal.

reactions to blood transfusions

As with any drug or liquid, there are side effects you should be aware of.

Because we are infusing blood products from a donor, there is an increased risk of side effects.

For this reason, nurses mustmonitor their patients closelyin transfusions of blood products.The nurse stays with the patient for the first 15 minutes of a blood transfusion(may change based on institutional protocol) and check vital signs regularly.

Blood reactions are common, but rarer and more serious reactions can also occur.

Acute hemolytic transfusion reaction

An acute hemolytic transfusion reaction is raredangerousBlood transfusion reaction to ingestion of blood, especially PRBCs.

This happens whenincompatible blood is accidentally administeredwith the patient. That is why the patient's blood group is first checked so that a suitable donor can be found.

Compatible blood is listed below:

With a true acute hemolytic reaction, the patient will soon experience:

  • fever and/or chills
  • Severe flank or back pain
  • Signs of DIC (e.g. Form IV cry place)
  • hypotension
  • Red or brown urine (hemoglobinuria)

This is a serious reaction because the patient's own immune system and that of the donor attack each other.Destroy blood products and cause damage in the process.The patient may experience hemodynamic instability, including life-threatening hypotension.

If this reaction occurs, healthcare providers should:

Acute hemolytic reaction: care steps

If an acute hemolytic reaction is suspected, healthcare providers should:

  1. Stop drawing blood immediately and check vital signs
  2. Hang NS over a Patent IV line. The patient should receive at least 100 to 200 ml/hr to prevent oliguria/renal failure, or boluses if hypotensive
  3. Notify the MD/APP and the blood bank or call an RRT if it is unstable
  4. Double-check the identification marks and numbers on the blood
  5. Provide diuresis as directed for individuals at risk of volume overload
  6. Additional tests may include DIC testing and additional blood compatibility and screening tests.
  7. Move the patient if necessary

The doctor should supervise treatment, but these are serious reactions and should probably be monitored in the intensive care unit.

Your facility should have a specific protocol for severe blood transfusion reactions, requiring frequent re-examination of the patient and the blood department itself.

Anaphylactic transfusion reaction

An anaphylactic transfusion reaction is onesevere allergic reactionto something in the blood product. These are rare and are estimated to occur in one in 20,000 to 50,000 transfusions.

This reaction takes placeSeconds to minutes after startingdie Transfusion.

The recipient is severely allergic to something in the donor blood to which they may have antibodies, specifically IgA deficiency or haptoglobin deficiency.

Signs of an anaphylactic reaction include:

  • Hives
  • wheezing and/or shortness of breath
  • angioedema (swelling of the face)
  • Hypotension with/without shock

The treatment is includedstop the transfusion immediatelyand subsequent treatment with standard anaphylactic drugs. These medications include:

  • Solumedrol 125 mg IV STAT
  • Benadryl 50 mg IV STAT
  • PEPCID 20 mg IV STAT
  • IV fluids

More extensive procedures may be required, including:

  • Adrenaline 0.3 mg IM STAT +/- IV Adrenaline infusion for severe bronchospasm or airway edema
  • Vasopressors for hypotension
  • oxygen and intubation

The blood donation cannot be repeated, additional tests must be done and blood must be donated from another donor.

Urticaria transfusion reaction

A urticarial transfusion reaction is a less severe allergic reaction to a component of blood products, but is much more common.occurs in 1-3% of blood transfusions. This is an antigen-antibody interaction, usually with donor serum proteins.

Patients with this blood transfusion reaction develop urticaria (hives) without other allergic signs/symptoms such as wheezing, angioedema or hypotension.

If an urticarial transfusion reaction occurs:

  1. Stop the transfusion immediately
  2. Check vital signs and ask patient about other symptoms (e.g., difficulty breathing or swelling of face/neck, dizziness, chest pain, etc.).
  3. Notify the provider
  4. Give antihistamines intravenously as directed
  5. Restart the blood draw when the hives disappear and there are no other signs of an allergic reaction

If a urticarial transfusion reaction is diagnosed, stop drawing blood for 15 to 30 minutes, give an antihistamine such as Benadryl intravenously, and restart the infusion once the hives have resolved, but slowly and gently.Check the logbook for your specific facility.

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