Acute Transfusion Reactions (ATR) Clinical Management Algorithm & Reporting New Zealand Blood Service (NZBS) Updated August 2019

All patients should be transfused where they can be directly observed and monitored by staff trained in the administration of blood components and management of ATRs NZBS Transfusion Medicine Handbook. Third Edition, 2016; British Society for Haematology. Guideline on the investigation and management of acute transfusion reactions. 2012.

Transfusion reactions can cause a patient’s condition to rapidly deteriorate. Any signs and symptoms suggesting a reaction should not be ignored, but rather assessed immediately. NZBS Transfusion Medicine Handbook. Third Edition, 2016

ATR Management Algorithm ATR Management Prompt Cards NEW: Reporting Form Available from 12 August 2019 ATR Management Algorithm 4 September 2018 ATR Management Prompt Cards 4 September 2018

To minimize the risk of harm, early identification and prompt treatment of reactions is essential. British Society for Haematology. Guideline on the investigation and management of acute transfusion reactions. 2012.

Rash Angioedema Urticaria 1.Recognise Rash Angioedema Urticaria Fevers Chills Rigors Changes in Vital Signs Dyspnoea Respiratory Distress Hypoxia Pain: Loin, chest, IV site… Nausea Vomiting Diarrhoea Abnormal Bleeding Red/Black Urine Anxiety Severe Apprehension

ATRs can vary in severity, from minor febrile reactions to life threatening allergic, haemolytic or hypotensive events. Febrile (febrile non-haemolytic transfusion reactions) and allergic transfusion reactions are the most commonly reported. NZBS National Haemovigilance reports; British Society for Haematology. Guideline on the investigation and management of acute transfusion reactions. 2012.

2. Respond

ATR Management Algorithm In all cases the transfusion must be stopped if a potential ATR is detected Management of the ATR is guided by the rapid clinical assessment of symptoms, clinical signs and their severity… Specifically, patients with serious or life-threatening reactions must be treated rapidly British Society for Haematology. Guideline on the investigation and management of acute transfusion reactions. 2012; NZBS Transfusion Medicine Handbook. Third Edition, 2016

The algorithm defines management of Severe/life-threatening Moderate Mild events

Manage the patient according to the severity of the symptoms Investigate as directed by the medical officer If a mild ATR, consider a re-start

For all moderate and severe/life threatening events undertake the Standard ATR Investigation panel EDTA (pink top) for serology to Blood Bank Full blood count/film and U&E to pathology Ward urinalysis for blood/haemoglobin

Additional Investigations can be undertaken- dependent on the symptoms present

3. Report New ATR reporting form available 12 August 2019

For ATRs assessed as mild: Blood Bank must be notified via the reporting form No blood tests required One tick  only for MILD then send to Blood Bank

Anything and everything else is not a mild event Complete the moderate to life- threatening section in full    

For all moderate, severe or life threatening ATRs: Return the discontinued unit/infusion set, EDTA and reporting form to blood bank Don’t forget: send full blood count/film & U&E to pathology +/- any other tests indicated

In Summary STOP the transfusion immediately for all potential ATRs Undertake rapid clinical assessment Manage according to severity Report all events to Blood Bank via the NZBS reporting form

ATR Investigations: No EDTA sample is required if the event is assessed as a mild reaction Standard ATR Investigation panel (EDTA, FBC, U&E, urinalysis) is required for all moderate, severe or life threatening events Additional Investigations are always based on symptoms

ATR Management Algorithm ATR Management Prompt Cards NEW: Reporting Form Available from 12 August 2019 ATR Management Algorithm 4 September 2018 ATR Management Prompt Cards 4 September 2018

Key References NZBS Transfusion Medicine Handbook. Third Edition, 2016. NZBS Clinical Compendium NZBS Haemovigilance Annual Reports https://www.nzblood.co.nz/clinical-information/haemovigilance-programme/haemovigilance-annual-report-2012/ British Society for Haematology. Guideline on the investigation and management of acute transfusion reactions. 2012. Prepared by Suzi Rishworth, NZBS TNS, Dunedin. Updated August 2019