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Management of suspected haemolytic transfusion reaction

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

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