Management of suspected haemolytic transfusion reaction

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