Managing severe transfusion reactions

When things go wrong during (or after) a transfusion, you need to be prepared to act! In this video, you'll learn the basic steps involved in managing a patient with an acute, severe transfusion reaction.

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[00:00:00] When your patient shows signs of an acute severe transfusion reaction, what should you do next? Normally, you will not immediately know what you're dealing with so there are a couple of steps you should take in any case. First, stop the transfusion immediately and call for medical assistance. Then assess your patient, are they in a life-threatening situation? Check the ABCs first: airway, breathing, circulation.

[00:00:30] If you don't find signs of circulation, you have to resuscitate. Start chest compressions immediately. If there are signs of circulation and breathing, check that the IV access is patent, for example by giving saline and start monitoring body temperature, oxygen saturation, blood pressure, heart rate, and urinary output. Make a quick clinical assessment. Are there any symptoms you have noticed that could help you find the differential? Also, check the blood component. Was it really meant for this patient?

[00:01:00] Compare the compatibility label on the product with the patient's ID. What does it look like? Is there any evidence of contamination like discoloration of the RBC unit or bubbles in the platelet unit? If you already suspect a specific transfusion reaction, initiate further testing and start treating your patient. And don't forget to get in touch with the transfusion service. Tell them why your patient received the transfusion, what symptoms your patient shows, when the transfusion was started, and when the symptoms

[00:01:30] began to appear. The transfusion service will help you find the diagnosis, will help you determine what blood samples are needed for further investigations, and what documents to fill out. And don't forget that your patient might still need transfusion after all. Discuss the situation with the transfusion service. They will certainly help you make a decision about how to best continue transfusing your patient.