Stop transfusion. Check blood and patient ID. Send patient's blood for CBC, smear, PT/PTT, FDP, free Hgb (urine and serum), Coombs, BUN, creatinine, repeat crossmatch Return donors blood to blood bank.

1. Acute Hemolytic Reaction - Etiology - ABO incompatibility (? severe), non immune (usually benign -hypo/hypertonic fluid administration, mechanical - bypass, freezing, overheating); Dx - fevers, chills, shock, chest pain, dyspnea, DIC, hemoglobinemia, hemoglobinuria, ATN; Rx - a. NS 500-1000 cc IVSS over 10 min.; b. Lasix 40 mg IVP or Mannitol 25 gms IVSS over 5 min to keep U/O > 100 mls/hr; c. Treat shock and DIC.
2. Severe Allergic Reaction - anaphylaxis, bronchospasm, pulmonary edema, hypotension; Rx -a. NS 500-1000 cc IVSS; b. Epinephrine (1:10,000) 3-5 cc; c. Benadryl 50 mg IVSS; d. Solucortef 250 mg IVSS q 8 hrs. May need washed RBCs, IgA deficient plasma, and premedication for these patients
3. Mild Allergic Reaction - urticaria, wheezing, hives: Rx -Benadryl 50mg IVP /Premedicate future transfusions with Benadryl and/or Solucortef
4. Febrile - Etiology - leukocyte antibodies: Rx -Acetaminophen or ASA (if platelets adequate). May need leukocyte poor blood products or leukocyte filter.
5. Sepsis - contaminated blood product: Rx - Abx, support BP, Cx/gram stain product