Urticarial Reactions
TREATMENT: The treatment of an urticarial reaction is simple and generally gives rapid results.
The mainstay of therapy for urticarial reactions is antihistamine treatment, most commonly with diphenhydramine (you probably know it better as "Benadryl"). So, when a patient presents with the classic skin symptoms we mentioned earlier, your first step, as always, is to STOP THE TRANSFUSION! Then, while IV access is maintained, the patient may be treated with either oral or intravenous diphenhydramine. Usually, the symptoms will resolve immediately; if so, the transfusion may be continued.
What I just said may seem like a violation of my general approach to transfusion reactions; namely, that I assume acute hemolysis and make myself disprove it. However, if you limit the diagnosis of urticarial reactions to simple skin hives or redness, then there is no way you can confuse one of these with acute hemolysis. So, treating the patient and re-starting the transfusion is OK in this setting. I believe, however, that this is the only setting that such a procedure is appropriate!
In many cases, the clinical staff is conditioned to send units of blood back to the Blood Bank when a transfusion reaction is suspected (that is a good reflex, by the way!), but a little education about urticaria can help save a patient additional exposures by allowing for the re-starting of the transfusion following symptom resolution.
OK, almost done! Let's finish up with a discussion of the prevention of the urticarial reaction.
Back to Urticarial Reactions
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