The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [293]
Any further products being held locally for the patient should also be returned to the hospital transfusion laboratory for assessment. The events surrounding the reaction should be clearly documented and reported in the following ways.
Record the adverse event in the patient’s clinical record.
Complete a detailed incident form as per local policy.
Follow local, regional and national criteria for reporting via SABRE and SHOT.
Acute haemolytic reactions
These are usually directly related to ABO incompatibilities due to an IBCT where antigen/antibody reactions occur when the recipient’s antibodies react with surface antigens on the donor red cells. This reaction causes a cascade of events within the recipient. Such reaction can present with chills/rigors, facial flushing, pain/oozing at cannula site, burning along the vein, chest pain, lumbar or flank pain, or shock (Gillespie and Hillyer 2001, McClelland 2007). Patients may express a feeling of anxiety or doom, which may be associated with cytokine activity. Haemolytic shock can occur after only a few millilitres of blood have been infused. Treatment is often vigorous to reverse hypotension, aid adequate renal perfusion and renal flow to reduce potential damage to renal tubules, and appropriate therapy for DIC reactions (Provan et al. 2009). It is important to remember that most acute haemolytic reactions are preventable as they are usually caused by clerical or checking errors at the bedside, and as this is the final check before administration, it presents the last opportunity to identify and avert an error, thus emphasizing the importance of the final check before transfusion (McClelland 2007) (Figure 8.9).
Figure 8.9 Check the compatability label or tie-on-tag against the patient’s wristband.
Acute anaphylactic reactions
These are rare and usually occur after only a few millilitres of blood or plasma have been infused (Weinstein and Plumer 2007) and present with bronchial spasm, respiratory distress, abdominal cramps, shock and potential loss of consciousness.
Circulatory overload (transfusion-associated circulatory overload: TACO)
Circulatory overload can occur when blood or any of its components are infused rapidly or administered to a patient with an increased plasma volume, causing hypervolaemia. Patients at risk are those with renal or cardiac deficiencies, the young and elderly (Weinstein and Plumer 2007). Patients with signs of cardiac failure should receive their transfusion slowly with diuretic support (McClelland 2007). The need for concomitant drugs such as diuretics should always be assessed before commencing treatment (SNBTS 2004).
Febrile non-haemolytic reactions
These reactions are due to an immunological response to the transfusion of cellular components such as donor leucocytes. Specific patient groups are at risk of greater sensitization to leucocytes, for example, critically ill patients, those receiving anticancer therapies or patients requiring multiple transfusion therapy (Williamson et al. 1999). Such reactions present with a mild fever (up to 1.5°C), rash without systemic disturbance and moderate tachycardia without hypotension (SNBTS 2004).
Hypothermia
Infusing large quantities of cold blood rapidly can cause hypothermia. Patients likely to suffer from this reaction are those who have suffered massive blood loss due to trauma, haemorrhage, clotting disorders or thrombocytopenia (McClelland 2007). Such reactions present with alteration in vital signs, and development of pallor and chills.
Delayed effects
These reactions may occur days, months or even years after transfusion.
Delayed haemolytic reactions
These reactions are caused when immune antibodies react to a foreign antigen. Reactions are classified as primary or secondary. A primary reaction is often mild, occurring days or weeks after initial transfusion, and may be indicated by no clinical alteration in haemoglobin following transfusion therapy (Cook 1997a).