Principle

A rapid detection and salvage procedure for victims of incompatible blood transfusion is necessary. The initial studies should be a highly pertinent cross check, rather than a time consuming recheck, to rapidly sort out potentially lethal hemolytic reactions versus the more common Febrile Non-hemolytic (FNH) reaction. The initial studies should be considered emergency procedures.

An immediate review of patient identification, blood unit labels and all pre-reaction records for possible errors in patient or blood identification at the bedside and in the laboratory needs to be performed. Visual examination of post-reaction and pre-reaction (if available) serum or plasma for evidence of hemolysis will be evaluated and ABO and direct antiglobulin testing on the post-reaction patient (recipient) blood sample will be performed.

If any of the initial studies are positive, the Pathologist will be contacted immediately and further investigation or an Extended Work Up (see section below) will need to be performed.

Following completion of the transfusion reaction workup, the completed investigation of the Transfusion Reaction form will be given to a pathologist for evaluation. They will complete the form regarding the interpretation and conclusion and will date and sign their comments. Results and comments will be entered into the LIS and the completed form will be sent to HIM to be scanned into the patient's medical record.

Note: ABO incompatibility can occur within the first 15 minutes of transfusion. TRALI and TACO may occur within 1 to 2 hours, and as long as up to 6 hours after the start of the transfusion.