Moderate Reaction

Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 5, Blood and Haematology.

Signs and Symptoms

Anxiety, pruritus, palpitations, mild dyspnea, headache, rigors, fever, tachycardia

Possible causes:

Seek help immediately from the anaesthetic, emergency team or whoever is available and skilled to assist
Stop the transfusion
Replace the infusion set and keep IV line open with normal saline.
Administer antihistamine IM/IV or PO
Chlorpheniramine 0.1 mg/kg IM or IV for children; 10mg IM/IV for adult or Chlorpheniramine 4mg PO.
Promethazine 6.25-12.5mg for children aged 5-12 years and Promethazine 25mg for adults.
Give oral or rectal antipyretic (e.g., Paracetamol 10 mg/kg or 0.5g - 1g in adults.

DON’T give Aspirin.

Give IV corticosteroids (e.g., Hydrocortisone 200mg IV stat) and bronchodilators (e.g. salbutamol 5mg nebulization or salbutamol inhaler 2 puffs (if nebule not available) STAT or Aminophylline 100mg STAT) if there are anaphylactoid features (e.g. bronchospasm, stridor).
If there is clinical improvement, restart transfusion slowly with new blood unit and observe carefully. May need to redo group and crossmatch
If no clinical improvement within 15 minutes or if signs and symptoms worsen, treat as Category 3.

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