Guidelines for Management of Adverse Transfusion Reactions to Fresh Components

For reactions to Fractionated Products (IntragamP, Albumex, Anti-D, Prothrombinex-VF, etc) please see here.

Mild reactions

Moderate and severe reactions

A mild febrile reaction has:

  • Temp up: < 1.5 °C
  • Stable haemodynamics
  • No respiratory distress
  • and no other symptoms

A mild allergic reaction will have:

  • Occasional urticarial spots
  • and no other symptoms

May include any of -

  • Fever: >1.5 °C from baseline; or fever with rigors / chills
  • Unexpected tachycardia
  • Unexpected change of BP
  • Acute breathlessness, stridor or cyanosis
  • Pharyngeal or laryngeal oedema
  • Extensive erythematous or urticarial rash; pain up transfusion arm
  • JVP acutely elevated
  • Loin pain; haemoglobinuria
  • Severe apprehension



Action for first mild reaction:

  1. Check labels & recipient ID
  2. Slow transfusion
  3. Consider giving medication:
    • Antipyretic for pyrexia, e.g. paracetamol (NZ Formulary advice on paracetamol)
    • Antihistamine for urticaria (NZ Formulary advice on antihistamines)
  4. Continue transfusion at a slower rate with increased monitoring, e.g. BP/P/T 15-30 mins
  5. If symptoms increase treat as a moderate or severe reaction
  6. Further transfusion and recurrence of mild febrile/allergic reactions:
    • Consider giving premedication:
      • Febrile reaction - antipyretic (e.g. paracetamol) (NZ Formulary advice on paracetamol)
      • Urticarial reaction - antihistamine (NZ Formulary advice on antihistamines)
    • Hydrocortisone - not usually needed
  7. Send adverse reaction notification form to Blood Bank.
  8. Send one EDTA (pink top) tube and the blood product with IV set attached (in plastic bag) with the completed Transfusion-related Adverse Reaction Notification Form to Blood Bank.


Action if a moderate or severe reaction is suspected:

  1. Stop transfusion and review
  2. Check label and recipient ID information is correct
  3. Replace IV set; give saline to keep vein open and, or maintain BP
  4. Call for medical assessment
  5. Obtain specimens:
    • Blood group serology: 1 x 7 or 10 mL clotted (red top) & 1 x 6 mL EDTA (pink top) tube (collect away from site of transfusion)
    • FBC and Serum biochemistry
    • And consider need for:
      • Blood cultures if sepsis suspected
      • Blood gases if respiratory distress present
      • Urine to check for haemoglobinuria
      • Coagulation screen if bleeding
  6. Send a Transfusion-related Adverse Reaction Notification Form, blood product with IV set attached (in plastic bag) to Blood Bank and specimens to relevant labs.
  7. Notify Blood Bank by phone: discuss urgency of follow up tests and further transfusion needs.
  8. Discuss with NZBS Transfusion Medicine Specialist if severe reaction present
  9. Further treatment - depends on cause:
    • Septic reaction likely: antibiotics (eg gentamicin & piperacillin)(NZ Formulary advice on antibiotics)
    • Anaphylaxis/anaphylactoid reaction: adrenaline sc/im (See NZ Formulary guidance on treating anaphylaxis)
      Adverse reaction recurs: discuss use of washed cellular products with Transfusion Medicine Specialist / Haematologist
    • Other: based on clinical state, test results & Transfusion Medicine Specialist consultation
    • HLA antibodies: Red cell and platelet products are now leucocyte-depleted. HLA antibodies are unlikely to cause clinical reactions.

Contact the On-call Transfusion Medicine Specialist, Haematologist or Blood Bank immediately. Contact details are here.

Blood Bank Action:

Blood Bank will: re-check the blood group of the patient and the units, re-screen for unexpected blood group antibodies, and when appropriate arrange for specialised microbiological cultures.

  • Special methods are required to obtain microbiological samples from a unit, if sepsis is suspected.
  • If a patient reacts to more than one unit, or has a severe reaction, it is essential that investigations are performed promptly.
  • Blood Bank may provide modified blood products after appropriate investigations.

More Info

click to download the Adverse Reaction Notification Form
Transfusion-related Adverse Reaction Notification Form

click to download the Guidelines for management of adverse transfusion reactions
Guidelines For Management Of Adverse Transfusion Reactions