# Transfusion Reaction
-- ABCs: respiratroy distress, shock, bleeding (DIC)
-- Initial Steps: stop transfusion, check blood product to ensure matches patient, alert the blood bank, send reaction panel (direct coombs, repeat type+screen and crossmatch), remaining blood product bag; do not restart transfusion until severe reaction ruled out
-- Can't Miss: AHTR, TRALI, TACO
-- Initial Treatment to Consider: tylenol, benadryl, fluids, oxygen
-- History: *** prior reactions, pre-medication
-- Clinical: ***resp distress, bleeding, nausea/vomiting, flushing
-- Exam: *** hypotension, fever, rash, wheezing, volume (JVP, crackles, edema)
-- Data: *** CBC, hemolysis labs, BMP, coags, UA
-- Etiology/DDx: *** acute hemolytic transfusion reaction (AHTR), febrile nonhemolytic transfusion reaction (FNHTR), anaphylaxis, minor allergic transfusion reaction, TRALI, TACO, septic transfusion
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
-- Reation panel (direct coombs, repeat type+screen and crossmatch)
-- CBC, hemolysis labs, BMP, coags, UA
-- CXR is c/f TRALI
-- NT-proBNP and POCUS if c/f overload or TACO
-- BCx if c/f sepsis
-- Minor reactions - premedicate with tylenol and benadryl, run at slower rate
-- Serious reactions - reaction workup; IVF, pressors
PDF coming soon!
Be judicious with who you choose to transfuse. Severe transfusion reactions are rare but life-threatening. Severe reactions can initially present like mild reactions (fevers, local rash/itching); the first time a patient has symptoms the transfusion should be stopped and a workup should be sent to rule out severe reaction before re-transfusion. Patients with mild symptoms can be premedicated with tylenol and benadryl.