FINDINGS
TREATMENT
Urticaria (hives) only
Intramuscular antihistamines
Fever and/or chills
1. Examine patient's blood for:
1. Stop transfusion, keep I.V. open.
Intravascular hemolysis (plasma red or
2. If laboratory tests are negative, treat
pink caused by free hemoglobin) or
with antipyretics. With positive findings,
extravascular hemolysis (direct globulin
start prophylactic treatment as below.
test).
2. Examine donor plasma for bacteria and
submit for culture
1. Stop transfusion, keep I.V. open.
Shock, hemoglobinria, oliguria, and/or
2. Maintain blood pressure with
vassopressor, if necessary.
3. Maintain urine flow over 100 ml/hr
a. Mannitol 25 gm I.V. diuretic
b. Fluids
4. Replace clotting factor deficits when
indicated, for example, with fresh-frozen
plasma and/or platelets as appropriate.
5. Antibiotics and hydrocortisone for septic
shock.
* Infuse IV 100 cc of 25 percent mannitol solution within a 15-minute period. This dose
will initiate a diuresis, of I to 3 ml of urine per minute, in an adequately hydrated patient.
The same dose may be repeated, if urine flow drops below 100 ml per hour, for any
subsequent 2-hour period. Mannitol may be discontinued, when the patient can
maintain a urine flow of 100 ml per hour without its use.
If the history, physical findings, and clinical course are such that a
SPECIAL NOTE:
hemolytic transfusion reaction is suspected as highly probable,
mannitol infusion should be started, even prior to or concurrent with
laboratory investigation, since under the conditions of use prescribed
above, no direct adverse sequelae from the use of mannitol will
occur. If diffuse bleeding is because of disseminated intravascular
coagulation, consider using heparin before replacing clotting factor
deficits.
Table 3-4. Management of transfusion reactions.
MD0846
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