Blood Transfusion Monitoring

Once a blood product is verified and initiated (covered in the sibling atom), monitoring begins. Take baseline vital signs before starting, then again at 15 minutes, 30 minutes, and per facility policy through completion. Stay at the bedside for the first 15 minutes — this is when acute hemolytic reactions most commonly present. Infuse the first 50 mL slowly, typically at no faster than 2 mL/min. Each unit of PRBCs must infuse within 4 hours from the time it leaves the blood bank; if not completed, it is discarded due to bacterial growth risk. Transfusion reactions fall into distinct categories: acute hemolytic (fever, flank pain, hemoglobinuria, hypotension — ABO incompatibility), febrile non-hemolytic (fever, chills without hemolysis — most common reaction), allergic (urticaria, itching — mild; anaphylaxis — severe), and transfusion-related acute lung injury (TRALI — acute dyspnea, hypoxia, bilateral infiltrates within 6 hours). For ANY suspected reaction: stop the transfusion immediately, keep the IV line open with normal saline using new tubing, notify the provider and blood bank, send the blood bag and tubing plus a new blood sample back to the blood bank, and monitor vitals every 5 minutes. Never restart a unit once stopped for a reaction.