Thread by @TransfusionWM

Now @h4yder talking on transfusion reactions. @BritSocHaem guidelines here b-s-h.org.uk/guidelines/gui… #BSHTIP

Hydrocortisone grossly overused. Glad to see our delegates are not routinely giving "H&P" for transfusion reactions or as a premed... #BSHTIP

Patient becoming unwell during the transfusion - it may be completely unrelated to the transfusion- never assume! #BSHTIP

All specialities have their "thing" they do before ABC for an unwell patient. For us? STOP THE TRANSFUSION! (you can always restart it later if its not been disconnected) #BSHTIP

Top 3 severe acute transfusion reactions:
1. ABO incompatibility
2. anaphylaxis
3. bacterial contamination
#BSHTIP

Check the ID of the patient and details on the unit then send back the unit to blood bank for further testing but tell them first! #BSHTIP

Tests to think about in an acute reaction include:
Repeat G&S, DAT
CXR
A/VBG
FBC &coag (inc fgn!) +reticulocytes and blood film
Biochem inc LDH and haptoglobin
Blood cultures
Urine dip
#BSHTIP

Nice explanation of the DAT. Such a useful test when used wisely and interpreted appropriately #BSHTIP

Familiarise yourself with your local trust guideline for managing transfusion reactions. Your #haemSpR, consultant or transfusion practitioner is also available for advice 24/7 for acute reactions #BSHTIP

Most transfusion events are associated with errors. The @SHOTHV1 report makes for terrifying bedtime reading but is well worth a read. Good case scenarios to see where mistakes have been made #BSHTIP
shotuk.org/shot-reports/

Bacterial contamination is extremely rare thanks to bacterial screening of platelets. Patient harm can be (& has been) prevented by visual inspection of the unit prior to transfusion at the bedside #BSHTIP

TACO often underrecognised. Renal failure, diuretic use, cardiac dysfunction, low weight are all risk factors. Try using this tool from the 2016 SHOT report:
#BSHTIP

TRALI is much reduced now we are using plasma from male donors only (previously mostly caused by HLA antibodies). ARDS has many causes - difficult to know if the transfusion was implicated #BSHTIP