Anaphylactic Reactions
TREATMENT: Since these reactions are so dramatic and potentially cataclysmic, quick action is essential!
To me, at least half the battle in figuring out how to treat anaphylaxis is in actually diagnosing it! If you didn't check out the information contained in the section on the "acute crash", take a minute and do so now, because this differential diagnosis is really essential. I'm going to take a little nap while you are away.
OK, welcome back! Let's imagine you are confronted with a patient with a suspected anaphylactic reaction. He has crashed before the clinician's very eyes shortly after the beginning of the transfusion, and he is in really bad shape. A quick look at the patient's vitals reveals severe hypotension and a lack of fever. What do you do?
Those of you that are pathologists are probably saying something like this right now: "What the HECK is he talking about? I'm a freaking pathologist, for crying out loud!" Yes, I understand. But, this is one of the times that you can actually make an immediate, direct difference in a patient's life, because the chances are exceptionally high that you know more, right now, than most clinicians do about anaphylactic transfusion reactions! So, don't hide out in your office! You're a doctor, and you can do this!
Your first priority is to ensure that the transfusion has been stopped. Second, you must address the patient's blood pressure; somehow, the patient's hypotension must be corrected. Many will start with a fluid bolus (a big one) and inclining the bed head-down (that's called "Trendelenburg position", in case you have forgotten). If this is truly anaphylaxis, those interventions probably will not work, so you will come quickly to the realization that this patient needs much more aggressive intervention: Epinephrine.
Epinephrine is the mainstay of treatment for anaphylaxis, both transfusion-induced and otherwise. In the early stages of anaphylaxis (or in "anaphylactoid" reactions), giving epinephrine subcutaneously or intramuscularly may work just fine. About 0.5 cc of "Epi" is given in a 1:1000 concentration in this scenario. For more advanced cases such as the one described above, Epi may be given intravenously (in a 1:10,000 concentration).
Most patients with severe anaphylactic reactions will require intubation, and aggressive bronchodilator therapy may be required to correct the respiratory failure associated with anaphylaxis.
Finally, let's look at the prevention of anaphylactic reactions.
Back to Transfusion Reaction Types