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Housestaff Survival Guide | Specialty | Hemolysis
> Acute Hemolytic reaction: - most serious reaction; due to ABO incompatibility
Sx often start within 15min: Fever, back pain, renal failure, headache, chest pain, diaphoresis, oozing
from IV line, abd pain
Management:
STOP transfusion; call senior; send blood to lab; give IVF (start with 500cc NS bolus) and
monitor renal function to mtn UOP>100cc/hr, using Lasix if needed; check K and ECG and give
insulin/D5 if hyperkalemia; monitor for renal failure
Labs: send remaining blood product and a new pt blood sample to the blood bank: test for crossmatch,
Coombs’ test, CBC, Clin chem., DIC panel, total bilirubin and indirect bilirubin
Check UA for free Hb (i.e. +ve blood, 0 rbc)
> Allergic/Anaphylaxis (Nonhemolytic reaction): urticaria/hives, hypotension, fever >40, wheezing,
bronchospasm, laryngeal edema,
Management:
- STOP transfusion; send blood to lab as above
- Epinephrine 0.5-1.0mL (1:1,000) IM
- Benadryl (diphenhydramine 25-50mg PO/IV)
- Hydrocortisone 250mg IV
- IVF: 500-1000ml of NS bolus
- Intubation if needed
> Fever:
SOB:
noncardiogenic pulmonary edema: TRALI – transfusion-related acute lung injury
Management: ventilatory support; Lasix (will take off any hydrostatic pulm edema)
Volume overload (i.e. crackles on exam, SOB); esp in elderly or pts with heart failure
decrease rate of transfusion, give 20-40mg furosemide IV