5.6.2
Moderate Reaction
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 5, Blood and Haematology.
Signs and Symptoms
- Anxiety, pruritus, palpitations, mild dyspnea, headache, rigors, fever, tachycardia
Possible causes:
- Hypersensitivity (moderate to severe)
- Febrile non-haemolytic transfusion reaction
- Contamination with pyrogens and / or bacteria.
Treatment
- Seek help immediately from the anaesthetic, emergency team or whoever is available and skilled to assist
- Stop the transfusion
- Replace the infusion set and keep IV line open with normal saline.
- Administer antihistamine IM/IV or PO
- Chlorpheniramine 0.1 mg/kg IM or IV for children; 10mg IM/IV for adult or Chlorpheniramine 4mg PO.
- Promethazine 6.25-12.5mg for children aged 5-12 years and Promethazine 25mg for adults.
- Give oral or rectal antipyretic (e.g., Paracetamol 10 mg/kg or 0.5g - 1g in adults.
DON’T give Aspirin.
- Give IV corticosteroids (e.g., Hydrocortisone 200mg IV stat) and bronchodilators (e.g. salbutamol 5mg nebulization or salbutamol inhaler 2 puffs (if nebule not available) STAT or Aminophylline 100mg STAT) if there are anaphylactoid features (e.g. bronchospasm, stridor).
- If there is clinical improvement, restart transfusion slowly with new blood unit and observe carefully. May need to redo group and crossmatch
- If no clinical improvement within 15 minutes or if signs and symptoms worsen, treat as Category 3.
Check doses against the printed guideline and your clinical judgement before treating a patient. Spotted an error? Report it from the contact links below.
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