A fictional 52-year-old develops rigors, breathlessness, lumbar pain and hypotension shortly after a red-cell transfusion begins.
Frame the danger first.
- New fever, rigors, rash, dyspnoea, pain or haemodynamic change during transfusion requires immediate assessment.
- Consider haemolysis, anaphylaxis, bacterial contamination, lung injury and circulatory overload.
- Check patient identity, component details and timing while resuscitation proceeds.
Act, escalate, reassess.
- Stop the transfusion, call for help and assess using ABCDE; maintain intravenous access with locally approved fluid and equipment.
- Recheck identity and clerical details and notify the transfusion laboratory urgently.
- Follow the local acute-transfusion-reaction pathway for samples, cultures, component return and treatment.
- Document the reaction, response and specialist advice before any decision about further transfusion.
Red flags that change pace.
- Shock, airway swelling, bronchospasm or severe hypoxaemia
- Chest or loin pain, haemoglobinuria, bleeding or suspected incompatible transfusion
- High fever, rigors or concern for bacterial contamination
What makes care less safe.
- Restarting a transfusion before the reaction is characterised
- Discarding the component or administration set
- Treating symptoms without completing identity and laboratory checks
Say the concern plainly.
Acute transfusion reaction after [component/volume/time], with [symptoms and observations]. The transfusion stopped at [time], identity checks are [status] and the laboratory has been contacted. I need urgent senior/transfusion advice for [specific concern].