Blood Transfusion Reaction
ABCs
- STOP transfusion immediately
- check vitals (RR, BP, HR, SpO₂, temperature)
- assess airway, breathing, circulation
- if severe reaction (hypotension, hypoxia, stridor) → notify blood bank early (especially if hemolysis suspected)
red flags
severe reaction
- hypotension, hypoxia, stridor
- acute hemolytic (ABO mismatch): fever, hypotension, back pain, dark urine → notify blood bank
HPI & examination
- symptoms
- skin: pruritus, urticaria, flushing, fever
- respiratory: dyspnea, tachypnea, hypoxia
- cardiovascular: chest tightness, palpitations, hypotension
- examination
- full cardiorespiratory + skin exam
- look for: volume overload (JVP ↑, crackles), respiratory distress, shock
management
for all suspected reactions
- stop transfusion; maintain IV access (normal saline)
- high-flow O₂ if hypoxic; IV fluids if hypotensive
- antipyretic: Paracetamol 1 g IV
- re-check patient identity + blood unit label
- mild allergic: pruritus, urticaria, no instability
- Cetirizine 10 mg PO or Loratadine 10 mg PO
- may restart transfusion slowly if stable
- febrile non-hemolytic: fever, chills, no cardiorespiratory compromise
- antipyretics + monitor
- exclude hemolysis before restarting
- acute hemolytic (ABO mismatch): fever, hypotension, back pain, dark urine
- STOP transfusion permanently
- send hemolysis labs + DIC screen
- aggressive IV fluids
- urgent escalation + notify blood bank
- TACO: hypertension, JVP ↑, dyspnea, crackles
- IV Furosemide 40 mg stat
- oxygen ± NIV
- future: slower transfusion
- TRALI: acute hypoxemia, bilateral infiltrates, no overload
- oxygen ± ventilatory support
- avoid diuretics
- anaphylaxis: stridor, hypotension, wheeze, urticaria
- IM Adrenaline 0.5 mg (1:1000)
- IV fluids
- antihistamines + steroids
- ICU referral
restart only if
- symptoms fully resolved; serious causes excluded
- restart at a slow rate with close monitoring
- if symptoms recur → STOP permanently + escalate
studying for the IM exam? the IM Rapid Review covers transfusion reactions in the same format. see the sample chapter.
Last reviewed · May 2026