Abdul Mannan: Acute Anaphylactic Reaction During Blood Transfusion
Abdul Mannan, Consultant Hematologist at Betsi Cadwaladr University Health Board, shared a post on LinkedIn:
”A patient starts wheezing 10 minutes into their blood transfusion. Their face swells. Blood pressure drops. Throat tightening.
This is not a febrile reaction. This is anaphylaxis. And you have minutes.
Here is what is happening beneath the surface:
- The recipient’s IgE antibodies are attacking donor plasma proteins.
- The classic case? An IgA-deficient patient with anti-IgA antibodies.
- Their immune system treats the transfusion like an invasion.
Here is what you do right now:
- Stop the transfusion immediately. Not slow it. stop it.
- Give IM Adrenaline (EpiPen). This is your first line. Not antihistamines. Not steroids. Adrenaline.
- Secure the airway before it closes on you.
- Then support with IV fluids, steroids, and antihistamines.
- Antihistamines alone will not save this patient. I cannot say that enough.
And for future transfusions? Use washed red cells. Washing removes donor plasma proteins and cuts the risk of it happening again.
BSH Transfusion Reaction Guidelines are clear on this.
The sequence matters.
Hesitating on adrenaline costs lives.
Junior doctors and trainees: do you know where the EpiPen is on your ward right now? Have you practised calling a transfusion reaction?”
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