Life-Threatening Reaction

Signs and Symptoms

• Anxiety, chest pain, pain near infusion site, respiratory distress, loin or back pain, headache, dyspnea, rigors, fever, restlessness, hypotension, tachycardia, hemoglobinuria, unexplained bleeding

Possible causes:

• Acute intravascular haemolysis
• Bacterial contamination and septic shock
• Fluid overload
• Anaphylaxis
• Transfusion Associated Acute Lung Injury (TRALI)

Treatment

• Seek help immediately from the anaesthetist, 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.
• Infuse normal saline (initially 20- 30 ml/kg) to maintain systolic BP, if hypotensive, give over 5 minutes and elevate patient's legs.
• Maintain airway and give high flow of oxygen by mask.
• Give Adrenaline (as 1:1000 solutions) 0.01 mg/kg body weight by slow intramuscular injection.
• Give IV corticosteroids (Hydrocortisone 200mg IV stat) and bronchodilators (salbutamol nebulization 5mg or salbutamol inhaler 2 puffs (if nebule not available), aminophylline 100mg stat) if there are anaphylactoid features (e.g., bronchospasm, stridor).
• Give a diuretic: e.g., Frusemide 1 mg/kg IV or equivalent (if there is fluid overload)
• Assess for bleeding from puncture sites or wounds. If there is clinical or laboratory evidence of a DIC treat accordingly.
• Maintain fluid balance accurately.
• If bacteremia is suspected (rigors, fever, collapse, no evidence of a haemolytic reaction), start broad-spectrum antibiotics IV and send blood product bag to the laboratory for culture of contents.