Guideline sources The following summarized guidelines for the evaluation and management of acute transfusion reactions are prepared by our editorial team based on guidelines from the British Society for Haematology (BSH 2023). 1 Guidelines 1. Diagnostic investigations Clinical assessment: ask patients to report symptoms developing following the completion of transfusion. B Show 3 more Laboratory tests: obtain standard investigations, including CBC, renal and liver enzymes, in patients with moderate and severe transfusion reactions. B Show 4 more Chest X-ray: obtain a CXR in patients with respiratory symptoms not due to allergy. B 2. Medical management https://web.pathway.md/diseases/recz9twzEpwPyiaDi 1/2 6/23/23, 2:03 AM Acute transfusion reactions Pathway General principles: direct initial treatment of acute transfusion reactions according to symptoms and signs. Do not delay treatment of severe reactions until the results of investigations are available. B Intramuscular epinephrine: administer intramuscularly epinephrine for the treatment of anaphylaxis, including in patients with thrombocytopenia or deranged coagulation. A Antipyretics: consider administering oral acetaminophen (500-1,000 mg in adults) in patients with mild isolated febrile reactions. C Antihistamines: consider slowing the transfusion and administering an antihistamine in patients with mild allergic reactions. C Corticosteroids: do not use corticosteroids routinely for the management of allergic reactions. D 3. Therapeutic procedures Discontinuation of transfusion: discontinue transfusion temporarily but maintain venous access in patients developing new symptoms or signs during transfusion. B Show 2 more 4. Specific circumstances Patients with IgA deficiency: discuss the future management of patients with IgA deficiency diagnosed after acute transfusion reactions with a specialist in transfusion medicine. B Show 2 more 5. Preventative measures Secondary prophylaxis: administer a trial of premedication with oral acetaminophen given 1 hour before the anticipated reaction in patients with recurrent febrile reactions (or NSAIDs in patients with predominant chills or rigors, always accompanied by an individualized assessment of the risks of medication against the severity of reaction). B Show 4 more References 1. Richard Soutar, Wendy McSporran, Tracey Tomlinson et al. Guideline on the investigation and management of acute transfusion reactions. Br J Haematol. 2023 Jun;201 5 832 844. Open https://web.pathway.md/diseases/recz9twzEpwPyiaDi 2/2