Acute Transfusion Reaction

Transfusion reactions range from mild febrile reactions to life-threatening haemolysis (ABO incompatibility). Immediate action on any reaction: stop transfusion, check identity, call haematology. SHOT and MHRA reporting is mandatory for serious…

SHOT / BSH Transfusion Reaction Protocol

The pathway

1 · Stop the transfusion

Any suspected reaction: stop immediately.
Keep IV access with 0.9% NaCl.
Do not remove giving set.

2 · Bedside identity check

Check wristband vs blood bag label vs compatibility form. Any mismatch = haemolytic reaction until proven otherwise.

3 · Clinical assessment

Haemolysis: fever + rigors + back pain + haemoglobinuria + hypotension. TACO: breathlessness + hypertension. TRALI: breathlessness + hypotension + bilateral infiltrates.

4 · Call haematology on-call

Inform immediately for any serious reaction. Retain the blood bag and giving set for investigation.

5 · Investigate

DAT
FBC
LDH
bilirubin
haptoglobin
U&E
coagulation (DIC screen)
Urine for haemoglobin

6 · Report

SHOT haemovigilance report + MHRA report (via hospital transfusion team)
All serious reactions are mandatory

Drugs

Drug	Dose	Route	Notes
0.9% NaCl	500ml	IV	Maintain IV access. Fluid resuscitate if haemodynamic compromise.
Adrenaline	0.5mg (1:1000)	IM	If anaphylaxis features, follow anaphylaxis algorithm.
Chlorphenamine	10mg	IV/IM	Mild febrile/allergic reactions. NOT for haemolytic reactions.
Furosemide	40–80mg	IV	TACO (circulatory overload) — NOT for TRALI or haemolysis.

When to escalate

ABO haemolytic reaction — haematology immediately, ITU review, monitor for DIC and AKI,TRALI (bilateral infiltrates + hypoxia + hypotension) — stop transfusion, ITU for respiratory support,Anaphylaxis — follow anaphylaxis protocol, adrenaline IM,DIC developing — haematology urgently, consider FFP/platelets

Reference: BSH Guideline: Administration of Blood Components 2020 / SHOT Annual Report

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