management of suspected haemolytic transfusion reaction
Last reviewed 01/2018
Immediate investigations:
- double check labelling of the blood unit with the patient's ID band
- take 40 ml of blood:
- blood bank (5ml anticoagulated; 5 ml clotted)
- clinical chemistry (10 ml electrolytes)
- coagulation laboratory (10 ml coagulation screen)
- bacteriology (blood culture)
- ECG - look for evidence of hyperkalaemia
- Repeat coagulation screens and biochemistry 2-4 hourly
Immediate management:
- stop transfusion
- keep iv access open (0.9% NaCl)
- the unconscious patient requires a urinary catheter
- frusemide (150 mg iv)
- saline 100-200 ml
- give mannitol (20%) 100 ml if there is no diuresis after frusemide
- insert CVP line - maintain CVP +5 to + 10 cm water with 0.9% NaCl
Further management:
- if urine flow < 100ml/h after 2 hours then assume renal failure and consult nephrologist
- if there is a urine flow > 100ml/h then adjust infusion rate to maintain this
- if hyperkalaemia treat as appropriate
- if DIC treat as appropriate