Anesthesia Considerations 

Transfusion Reactions 

 

 

General Management

 

• Stop transfusion

• Support blood pressure with IV fluids, vasoactive medications if needed

• Notify blood bank of all possible reactions

• Determine diagnosis

 

 

Acute hemolytic reaction 

 

• Signs:

  • Awake: chills, fever, nausea, chest & flank pain

  • Anesthetized: hyperthermia, tachycardia, hypotension, hemoglobinuria, diffuse oozing in surgical field

• Management:

  • Stop transfusion & notify blood bank

  • Support hemodynamics

  • Recheck unit against blood slip & patient’s identity bracelet

  • Draw bloodwork to identify hemoglobin in plasma, repeat compatibility testing, obtain coagulation studies & platelet count

  • Insert urinary catheter & check urine for hemoglobin

  • Initiate osmotic diuresis with IV fluids +/- mannitol

  • Monitor for hyperkalemia, DIC

 

 

Febrile nonhemolytic reaction

 

• Signs:

  • Fever

  • No evidence of hemolysis

• Management:

  • Antipyretics

  • Transfusion may be continued if reaction mild

  • Use leukoreduced transfusions in the future

 

 

Anaphylaxis

 

• Signs:

  • Rash/hives

  • Angioedema    

  • Hypotension

  • Tachycardia

  • Hypoxemia

  • Bronchospasm/wheezing

  • Increased peak inspiratory pressure

• Management:

  • ​Stop transfusion 

  • Epinephrine

  • IV fluids

  • Antihistamines, corticosteroids

  • See "Anaphylaxis" page for further details

 

 

Transfusion-associated circulatory overload (TACO)

 

• Signs:

  • Respiratory distress, hypoxia

  • ↑ BP

  • Acute or worsening pulmonary edema

  • Positive fluid balance

• Management:

  • Stop transfusion 

  • Supplemental oxygen

  • Diuretics

 

 

Transfusion-related acute lung injury (TRALI)

 

• Signs:

  • Acute hypoxia & noncardiac pulmonary edema within 6 hours of transfusion (usually plasma)

  • ↓ BP

• Management:

  • Supplemental oxygen, endotracheal intubation / ventilation

  • Similar treatment to acute respiratory distress syndrome (ARDS)

  • Hemodynamic support

 

 

Urticarial reaction

 

• Signs:

  • Erythema, hives, itching

  • No fever

• Management:

  • Antihistamines, steroids

  • Transfusion may be continued if reaction mild

 

 

Complications of Massive Transfusion 

 

• Dilutional coagulopathy

• Hypothermia

• Hyperkalemia

• Complications of citrate infusion:

  • Hypocalcemia

  • Metabolic acidosis or alkalosis