Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Acute haemolytic and febrile transfusion reactions
Essential points for quick revision.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
!
Suspected acute haemolysis
Fever, rigors, pain, hypotension, dyspnoea, bleeding or dark urine during red-cell transfusion can be the first sign of an ABO error and is treated as life threatening until excluded.
Action: Stop the transfusion immediately, keep intravenous access with 0.9% sodium chloride through new tubing, call for senior help and assess ABCDE. Recheck patient and component identity at the bedside and urgently contact the transfusion laboratory. Return the pack and giving set as directed; send a new correctly labelled EDTA sample, blood cultures when sepsis is possible, urine and haemolysis, renal and coagulation tests. Support blood pressure and urine output, treat hyperkalaemia and DIC and involve critical care and renal teams early.
Synopsis
Recognise fever and haemolysis during transfusion, stop incompatible exposure immediately, exclude bacterial contamination and complete the clinical and laboratory reaction pathway.
First-line action for any potentially serious reaction is stop the transfusion; do not discard the component or giving set and do not flush residual blood into the patient.
Maintain venous access with 0.9% sodium chloride through new tubing, assess ABCDE and summon senior clinical and transfusion-laboratory help.
Acute haemolytic transfusion reaction is haemolysis within 24 hours, classically caused by ABO-incompatible red cells after an identification error.
Key red flags
Pain at the infusion site, chest, abdomen, loin or back with fever, anxiety or flushing can precede overt shock in acute haemolytic transfusion reaction.
Investigation priorities
01
First-line: bedside identity and clerical checkFirst stepFirst line
Detect ABO-incompatible administration and prevent further wrong-patient exposure.
Management branches
Any significant acute reactionStop, support, identify
New fever, rigors, pain, dyspnoea, hypotension or bleeding develops during transfusion.
Stop the component, maintain access with new saline tubing, assess ABCDE and call senior help.
Recheck patient and unit identity and notify the transfusion laboratory, stating symptoms, timing and infused volume.
Key medicines
ParacetamolFor an established uncomplicated febrile reaction after serious causes have been excluded, give 500 mg to 1 g orally or intravenously, repeated no more often than every 4 to 6 hours to a usual maximum of 4 g in 24 hours.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.