1. Acute Transfusion Reactions (ATR)
Revised ATR Clinical Management Algorithm: as of 4 September 2018.
New Zealand Blood Service (NZBS)
Recognise.
Respond.
Report.

2. 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

4. 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

5. Utilise this slide from 4 September and hide or delete slide before.
On 4 September 2018 a new ATR management guide, reporting form and clinical prompt card was released in New Zealand

6. 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

7. 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

8. 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

9. 2. Respond

10. 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

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

13. 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

15. The algorithm introduces a recommended Standard ATR Investigation panel for all moderate and severe/life threatening events:
EDTA (pink top) for serology to Blood Bank
Full blood count/film and U&E to pathology
Ward urinalysis for blood/haemoglobin

16. Additional Investigations can be undertaken- dependent on the symptoms present

17. 3. Report

18. For ATRs assessed as mild:
Blood Bank must be notified via the reporting form
But, no blood tests required

19. For all moderate, severe or life threatening ATRs:
Return the discontinued unit/infusion set, EDTA and reporting form to blood bank

20. 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 form

21. Changes to ATR Investigations:
No EDTA sample is required if 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 based on symptoms

22. T = 0 : 4 September 2018

24. Key References
NZBS Transfusion Medicine Handbook. Third Edition, 2016.
NZBS Clinical Compendium
NZBS Haemovigilance Annual Reports
British Society for Haematology. Guideline on the investigation and management of acute transfusion reactions
Prepared by Suzi Rishworth, NZBS TNS, Dunedin. August 2018