25-year-old female with a history of fibromyomatous and severe menometrorrhagia

Continue blood transfusion, administer antihistamines

Educational Objective:

Recognize urticaria as a common and self-limited reaction to transfusion.

Key Point:

Urticarial or allergic transfusion reactions are self-limited. They do not require discontinuation of the transfusion and usually subside with the use of antihistamines.

Explanation:

The patient has developed an urticarial or allergic reaction to transfusion. These are relatively common mild reactions that may occur in up to 3% of transfusions. They do not require discontinuation of the blood transfusion and usually respond well to administration of diphenhydramine. They need to be monitored closely. If the patient condition deteriorates with dyspnea, angioedema, or low blood pressure, the patient should be treated for anaphylaxis with immediate discontinuation of the transfusion, protection of the airway, and administration of epinephrine.

There is no need for the use of corticosteroids in the treatment of immunologic blood transfusion reactions. Hydrate with normal saline, obtain addition of direct antiglobulin testing, and repeat the type and crossmatch as indicated in cases of acute hemolytic reaction.

References:

Goodnough, Lawrence T. Risks of Blood Transfusion. Crit Care Med 2003: 31(12 Suppl): S678-86

Connell NT. Transfusion Medicine. Prim Care. 2016 Dec;43(4):651-659. Jun;30(3):619-34.