Steps from the Transfusion Reaction policy from the UIHC Pathology Laboratory Services Handbook, note that the faculty MD must OK continuation of the transfusion of a blood component unit that, possibly, is related to marked changes in the clinical picture of a patient being transfused. Obviously, this OK can take many forms (eg, telephone conversation with a resident or nurse, written or verbal order, etc) but should be recorded in the medical or nursing notes, as determined by those involved at the time. This does not necessarily apply to all suspected/reported transfusion reactions -- only those that potentially might be life-threatening.

B. Steps to follow on the clinical service (i.e., by the transfusionist) if a suspected hemolytic transfusion reaction occurs:

1. STOP THE TRANSFUSION IMMEDIATELY; KEEP THE IV LINE OPEN with infusion of normal saline or other suitable intravenous solution.
2. Report the suspected reaction to the house staff or attending physician on the clinical service to determine whether the transfusion is to be only temporarily or permanently discontinued. Consultation with a Blood Center physician is strongly encouraged. Per recommendation of the UIHC Transfusion Committee, house staff must consult with an attending/faculty physician before ordering continuation of the transfusion if any of the following are present:

A. Marked sustained change from baseline vital signs

1. Decrease in systolic blood pressure of greater than or equal to 30 mm mercury
2. Increase in heart rate of greater than or equal to 30 beats per minute
3. Increase in temperature greater than or equal to 1.5oC, with or without chilling
4. Marked dyspnea, SOB, oxygen saturation decrease greater than or equal to 10%

B. Hematuria
C. Marked back or abdominal pain, with or without diarrhea
D. Altered sensorium