This is important because of the inherent danger of missing or misdiagnosing an acute hemolytic transfusion reaction, in particular.
Functionally, this means that any time something unusual happens during transfusion, I take it seriously. In fact, not only do I take it seriously, I actually assume that the patient is having an acute hemolytic transfusion reaction, and I make myself disprove it. 99 times out of 100, I can do so, but that approach ensures that I will (hopefully) never miss one of these beastly reactions (Why all the fuss about acute HTR's? You'll see when we get to the section on these ghastly things!).
So the assumption of an acute HTR means that the first thing I do when I am confronted with something unusual during transfusion is to ask a question: Has the transfusion been stopped? I ask this before I even evaluate any of the clinical signs and symptoms we'll discuss below, because continuing to infuse incompatible blood (we're assuming hemolysis, remember?) is the worst thing you can do for the patient.
Step One: Ask if the transfusion has been stopped.
You're probably thinking about now that I am just a little bit nuts. "Does that mean that if a person sneezes or belches or notices an ingrown toenail during transfusion that this guy is going to treat it as acute hemolysis?", you might say. Let's not be ridiculous! I simply mean that you must maintain a high index of suspicion for acute hemolysis, and if that means you work up numerous negative reactions, so be it!
To be fair, I should tell you that not everyone is as aggressive as I am in their approach to transfusion reactions. That's OK; I'm not claiming that they are wrong and I am right. I simply believe that I would rather work up a thousand negative possible reactions to find the one true case of acute hemolysis than be less agressive and miss one.
First, let's discuss how to recognize suspicious signs and symptoms of reactions clinically.
Back to Transfusion Reaction Index.