Vein-to-vein approach for mitigation strategies for noninfectious transfusion reactions
| Transfusion reaction . | Mitigation strategies . | ||
|---|---|---|---|
| Donor level . | Blood product processing level . | Patient level . | |
| Allergic/urticarial/anaphylactic | Recruit specific donors as needed (eg, IgA-deficient donors from rare donor registries) | Use of a platelet addition solution or volume reduction of plasma | Possible desensitization from repeated transfusions |
| Use of solvent detergent plasma | No evidence to support routine prophylaxis with antihistamines or glucocorticoids in patients | ||
| Washing (only applicable to RBCs and platelets) | |||
| Acute hemolytic (ABO related) | Transfuse ABO-compatible platelets when possible | ABO confirmation cross-checks with second confirmation sample | |
| Use low-titer plasma-containing products during minor incompatible transfusions (eg, group O platelets to group A patient) | Correct product labeling and testing | Stringent pretransfusion bedside patient-identification procedures to prevent patient misidentification | |
| Acute hemolytic (mechanical) | Ensure apheresis collection devices appropriately detect hemolysis | Store products appropriately to prevent warming for prolonged periods | Prevent nonimmune hemolysis (eg, coinfusion with hypotonic solutions, not placing on heater, or transfusing rapidly through small bore needle) |
| Prevent mechanical hemolysis (eg, with use of blood warmers) | Use validated blood warmers | ||
| Delayed serologic/hemolytic reaction | Perform donor genotype or phenotype | Need for centralized patient information databases | |
| Need for inter–blood bank communication due to transfusion at multiple health care facilities | |||
| Febrile nonhemolytic transfusion reaction | Donor white blood cells | Prestorage leukoreduction | No evidence to support routine prophylaxis with antipyretics |
| Use of solvent detergent plasma | Recipient white blood cell antibodies | ||
| Use of platelets stored in platelet addition solution | |||
| Transfusion reaction . | Mitigation strategies . | ||
|---|---|---|---|
| Donor level . | Blood product processing level . | Patient level . | |
| Allergic/urticarial/anaphylactic | Recruit specific donors as needed (eg, IgA-deficient donors from rare donor registries) | Use of a platelet addition solution or volume reduction of plasma | Possible desensitization from repeated transfusions |
| Use of solvent detergent plasma | No evidence to support routine prophylaxis with antihistamines or glucocorticoids in patients | ||
| Washing (only applicable to RBCs and platelets) | |||
| Acute hemolytic (ABO related) | Transfuse ABO-compatible platelets when possible | ABO confirmation cross-checks with second confirmation sample | |
| Use low-titer plasma-containing products during minor incompatible transfusions (eg, group O platelets to group A patient) | Correct product labeling and testing | Stringent pretransfusion bedside patient-identification procedures to prevent patient misidentification | |
| Acute hemolytic (mechanical) | Ensure apheresis collection devices appropriately detect hemolysis | Store products appropriately to prevent warming for prolonged periods | Prevent nonimmune hemolysis (eg, coinfusion with hypotonic solutions, not placing on heater, or transfusing rapidly through small bore needle) |
| Prevent mechanical hemolysis (eg, with use of blood warmers) | Use validated blood warmers | ||
| Delayed serologic/hemolytic reaction | Perform donor genotype or phenotype | Need for centralized patient information databases | |
| Need for inter–blood bank communication due to transfusion at multiple health care facilities | |||
| Febrile nonhemolytic transfusion reaction | Donor white blood cells | Prestorage leukoreduction | No evidence to support routine prophylaxis with antipyretics |
| Use of solvent detergent plasma | Recipient white blood cell antibodies | ||
| Use of platelets stored in platelet addition solution | |||