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The Risks of Blood Transfusion

Section 6 The Risks of Blood Transfusion Transfusion transmitted diseases Immunological reactions Non-immunological reactions Signs and symptoms of adverse events Nursing actions Transfusion Transmitted Diseases

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The Risks of Blood Transfusion

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  1. Section 6 The Risks of Blood Transfusion Transfusion transmitted diseases Immunological reactions Non-immunological reactions Signs and symptoms of adverse events Nursing actions

  2. Transfusion Transmitted Diseases • It is impossible to be certain about the exact risk of infection. Health Canada estimates (2004) for a unit of tested blood are: HIV (AIDS) 1 : 1,000,000 – 1 : 4,000,000 Hepatitis B 1 : 1,000,000 – 1 : 4,000,000 Hepatitis C 1 : 1,000,000 – 1 : 3,000,000 CJD Theoretical • Since 1999 the risks of infection have been greatly reduced by new laboratory tests (e.g., nucleic acid testing) Note: See Appendix C for other Transfusion Transmitted Diseases

  3. Immunological Reactions • Acute hemolytic (mostly ABO incompatibility) • Delayed hemolytic (antibody present) • Febrile (temperature increase seen in 1% of transfusions) • Transfusion Related Acute Lung Injury (TRALI), antibody in donor plasma against patient’s leukocytes • Allergic (allergens in donor blood) • Anaphylactic (possibly IgA related) • Bacterial (contaminated blood or equipment) Note: See Appendix D for more information on these and other reactions

  4. Non-Immunologic Reactions • Circulatory overload • Microaggregate infusion • Air embolism • Hypothermia • Citrate toxicity, Hypocalcemia • Hyper/Hypokalemia • Iron overload Note: See Appendix D for more information on these and other reactions

  5. Common Signs and Symptoms of Transfusion Reactions

  6. Nurses’ Actions STOP THE TRANSFUSION • Keep the line open with normal saline, assess, O2 PRN • Notify the attending MD and Transfusion Medicine • If the reaction appears to be life threatening, the physician on call for Transfusion Medicine should be notified immediately • Complete Transfusion Medicine requisition section on transfusion reaction • Draw 7 mL (3mL pediatrics) EDTA specimen and send to Transfusion Medicine with blood unit and administration set

  7. TRANSFUSION REACTION ALGORITHM Patient exhibits signs and symptoms of a transfusion reaction 1. Nurse is to STOP THE TRANSFUSION IMMEDIATELY and keep the IV line open with 0.9% saline 2. Contact the physician for medical assessment 3. Check vital signs every 15 minutes until stable 4. Check all labels, forms and the patient’s identification band to determine if there is a clerical discrepancy PHYSICIAN WILL DETERMINE IF TRANSFUSION SHOULD CONTINUE NOTE: REACTIONS IN A PATIENT TRANSFUSED FOR THE FIRST TIME MAY BE POTENTIALLY MORE SERIOUS Serious Signs and Symptoms? Minor symptoms? Clerical Discrepancy/ Incompatibility? Allergic reaction? Febrile reaction? IF PATIENT HAS ANY ONE OF THE FOLLOWING: - Onset ≤ 15 min - Hypotension/shock - Rigors - Anxiety - Back/chest pain - Dyspnea/SOB - Hemoglobinuria - Bleeding from IV site - Nausea/vomiting - Temperature ≥ 39C - Tachycardia/arrhythmias - Generalized flushing - Hives/rash covering body >25% - Skin reaction ONLY (no other symptoms) AND - Hives/rash over ≤ 25% body - Temp rise ≥ 1C from baseline AND - No other symptoms AND - Onset > 15 minutes into transfusion • DO NOT RESTART THE TRANSFUSION • Institute patient management • Notify physician on call for TML • The following should be sent to TML: • One 7mL lavender tube of blood (pediatric 3 mL) • Blood Transfusion Report/Tag • Blood product & administration set/fluid • Consider: • Blood and product cultures if patient temperature is ≥ 39C • Chest x-ray for severe dyspnea - Treat with Diphenhydramine 25-50mg IV or po (pediatric. 0.5-1.0 mg/Kg IV or po to a maximum of 50 mg) - Resume transfusion cautiously - Patient should be directly observed for the first 15 minutes after resuming transfusion - Treat with Acetaminophen 650 mg po or PR (pediatric 10-15 mg/Kg po) - Resume transfusion cautiously - Patient should be directly observed for the first 15 minutes after resuming transfusion If remainder of transfusion is uneventful, documentation on Blood Transfusion Report/Tag should be completed and returned to TML once transfusion is complete IMMEDIATELY Stop the transfusion if the patient develops any serious signs and symptoms IMMEDIATELY Stop the transfusion if the patient develops any serious signs and symptoms SERIOUS FEBRILE NON-HEMOLYTIC, ACUTE HEMOLYTIC, ANAPHYLACTIC, SEVERE ALLERGIC, FLUID OVERLOAD, TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI) OR BACTERIAL CONTAMINATION MINOR ALLERGIC REACTION MINOR FEBRILE NON-HEMOLYTIC

  8. Return to Transfusion Ontario Programs About Blood Transfusion-Information for Nurses

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