Acute Transfusion Reactions — Med-Peds Resources

Immediate actions, hemolytic clues, severity triage, anaphylaxis treatment, and reporting for suspected acute transfusion reactions.

Scope

Acute transfusion reactions occur during or within 24 hours after transfusion, and severe reactions can occur after only a small transfused volume. Use the local transfusion service, hemovigilance, and emergency pathways in addition to this checklist (BSH 2023).

Immediate actions for any new symptom

Stop or temporarily pause the transfusion. Keep IV access with physiologic saline and assess airway, breathing, and circulation (BSH 2023).
Check patient identity and component compatibility, inspect the unit for discoloration or damage, and record vital signs and the time of the reaction (BSH 2023).
For a severe or life-threatening reaction, discontinue the transfusion, support airway, breathing, and circulation, call for urgent help, and contact the transfusion service or laboratory (BSH 2023).

Do not wait for laboratory confirmation before treating suspected severe hemolysis, bacterial contamination, or anaphylaxis (BSH 2023).

Hemolytic reaction clues

Consider an acute hemolytic reaction when a recipient develops fever or chills, pain, dyspnea, hypotension, hemoglobinuria, bleeding, or another unexpected systemic change during or after transfusion. Acute reactions can progress to disseminated intravascular coagulation, renal failure, and shock (BSH 2023; Strobel 2008).

Laboratory investigation may include repeat compatibility testing, a direct antiglobulin test (DAT), haptoglobin, lactate dehydrogenase, coagulation studies, urine hemoglobin, and cultures. Clinical deterioration should prompt treatment before these results return (BSH 2023).

Rapid severity check

Pattern	Findings	Action
Mild	Temperature at least 38 C but below 39 C with a rise of 1-2 C, or isolated rash/pruritus	Assess for another cause and follow local policy (BSH 2023)
Moderate febrile	Temperature at least 39 C or a rise of at least 2 C, and/or systemic symptoms	Stop and investigate for hemolysis or bacterial contamination (BSH 2023)
Severe or life-threatening	Airway compromise, hypotension, severe respiratory symptoms, hemoglobinuria, bleeding, or rapid deterioration	Discontinue, resuscitate, call for urgent help, and contact the transfusion service (BSH 2023)

Do not attribute a reaction to a benign cause until hemolysis and bacterial contamination have been considered (BSH 2023).

Suspected anaphylaxis

Give intramuscular adrenaline according to the local anaphylaxis protocol. Thrombocytopenia or coagulopathy is not a contraindication to intramuscular adrenaline; intravenous adrenaline should be reserved for clinicians with appropriate expertise (BSH 2023).

Pediatric note

Infants and children may have signs that are harder to recognize. Use a pediatric-specific transfusion reaction pathway developed with pediatric specialists when available (BSH 2023).

Reporting

Report reactions through the local hemovigilance system. All acute reactions other than mild febrile or mild allergic reactions should be reported (BSH 2023).