If predominantly extravascular may only suffer chills/fever 1h after starting 502 transfusion—commonly due to anti-D. Acute renal failure is not a feature.


Complement (C3a, C4a, C5a) release into recipient plasma—^smooth muscle contraction. May develop DIC (see p512); oliguria (10% cases) due to profound hypotension.

Initial steps in management of acute transfusion reaction

• Stop blood transfusion immediately.

• Replace giving set, keep IV open with 0.9% saline.

• Check patient identity against donor unit.

• Insert urinary catheter and monitor urine output.

• Give fluids (IV colloids) to maintain urine output >1.5mL/kg/h.

• If urine output <1.5mL/kg/h insert CVP line and give fluid challenge.

• If urine output <1.5mL/kg/h and CVP adequate give furosemide (frusemide) 80-120 mg.

• If urine output still <1.5mL/kg/h consult senior medical staff for advice.

• Contact Blood Transfusion Lab before sending back blood pack and for advice on blood samples required for further investigation.


Overall mortality ~10%.

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