Transfusion Reaction Evaluation

Abbrev Code:TRXN EVAL   
Order Code:LAB647Order Name:Transfusion Reaction Evaluation
Order Instructions:See Special Instructions for additional Order Instructions. SafeTrace Code: RBCRXIM
Synonyms:Blood Reaction; Hemolytic Transfusion Reaction; Reaction
CPT Codes: 86078 x1
Test Includes:Clerical check. On post reaction blood specimen, visual examination for serum hemoglobin, direct antiglobulin test, and ABO/Rh(D) typing. Further investigation may include culture and gram stain of donor blood, antibody detection test, or crossmatch.
Turnaround Time:Initial investigation is performed stat; preliminary report is available same day.
Special Instructions:The provider may order LAB647 (Transfusion Reaction Investigation) on all transfusion reactions. Epic will route this to the proper test appropriate for the patient's symptoms listed:
  • The full Transfusion Reaction Evaluation (LAB893) is generated for all reactions that note anything outside of hives, only or hives and itching only.
  • The abbreviated Transfusion Reaction Hives (TRXN HIVES / LAB3794) is generated for all reactions that note hives or hives and itching only.

The following symptoms occurring within 2 hours after infusion may indicate a transfusion reaction: chills, fever, nausea, vomiting, hives, rash, abdominal or lumbar pain, headache, pain along the vein being used for infusion, respiratory distress, cyanosis, hyper-hypotension, tachycardia, red urine, excessive bleeding, pulmonary edema. (Refer to Transfusion Guidelines in the Appendix.) Mild to moderate reaction to products cryopreserved in DMSO is not considered an adverse reaction. (Refer to the UMMC Nursing Policy Manual: Blood and Marrow Transplant Products: Procedure for Administration.)

Collection Instructions

Optimal Volume:4 mL
Minimum\Peds Volume:2 mL
Container:Purple (EDTA)
Collection Instructions:In case of reaction, stop transfusion, notify Blood Bank and patient's physician immediately. Order "Transfusion Reaction Investigation (LAB647) in Epic.
Send the following to the laboratory: blood product container(s) closed securely with infusion set and any attached intravenous solutions and one 4 mL EDTA tube post-reaction specimen or contact lab to draw). If hives are the only sign of a reaction and they resolve after medication is given, transfusion may be restarted, at the discretion of the patient's physician. A lab specimen is not needed for the hives reaction only, but the blood bank still needs to be notified. All other transfusions must not be restarted.
Causes for Rejection:Gross hemolysis; improper labeling

Processing and Shipping

Test Performed at or Referral Lab Blood Bank  (CSC Mpls, Grand Itasca, Lakes, Northland, Range, Ridges, Southdale, St. John's, UMMC East Bank, UMMC West NICU, UMMC/UMMCH-West Bank, Woodwinds)


Reference Range:Evaluation of the report is performed by Blood Bank physician.
Use:Investigate cause of possible transfusion reactions, e.g. urticarial reaction to unknown protein; nonhemolytic febrile transfusion reaction; delayed hemolysis, incompatible RBC; acute hemolysis, incompatible RBC; TRALI, or no apparent transfusion-related cause.

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