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Management and Prevention

The first component of therapy is to stop the transfusion immediately. Vital signs must be closely monitored. Management involves treatment of hypotension and disseminated intravascular coagulation (DIC). It is essential to maintain blood volume and adequate renal blood flow. Diuretics (substances that increase urine output) may be administered. If the patient enters renal failure, dialysis must be initiated rapidly.
It is impossible to prevent all hemolytic transfusion reactions. The purpose of pre-transfusion compatibility testing is to decrease the probability of a hemolytic transfusion reaction by performing ABO/Rh testing, detecting and identifying alloantibodies, and crossmatching compatible blood. Human error, the most common cause of hemolytic transfusion reactions, cannot be completely eliminated. Steps must be taken to reduce the possibility of human error in identification of patient samples, donor units, and recipients. Each person involved in the transfusion process, from collection of the blood sample to administration of the donor unit, must carefully adhere to each step outlined in the standard operating procedures. All appropriate protocols must be followed. Some examples are:
  • Technologist checks blood sample to ensure proper labeling.
  • Patient's previous transfusion records are examined and all transfusion testing is performed correctly and accurately.
  • Technologist ensures correct unit is released from the blood bank.
  • Transfusionist ensures the recipient is correctly identified.
There must be a mechanism in place to train and assess all personnel involved in the transfusion process.