Table 2 Proposed scheme of investigations for an adverse event following a transfusion

1.

ABO typing

To confirm type

2.

Direct anti-globulin test

To exclude cross-match incompatibility

3.

Complete blood counts

Transient neutropenia is seen with TRALI

4.

Peripheral blood film

Hemolytic cells may be seen in cross-match reaction

5.

Chest X-ray

Needed to exclude pulmonary edema, pneumonia, other reasons for hypoxia

6.

Blood cultures

Bacterial contamination is a differential diagnosis

7.

Anti-body panel

Includes anti HLA-1 & HLA-2, anti granulocyte, anti monocyte, anti IgA

8.

D-dimer/FDP

To evaluate for deep vein thrombosis

9.

ECHO

For cardiac function status and fluid overload

10.

ECG/Cardiac enzymes

For cardiac function status (to exclude myocardial infarction)

11.

Undiluted pulmonary edema fluid

From endotracheal tube if present – can be diagnostic if fluid to serum protein ratio is >0.75

12.

BNP

Helps to rule out overload in difficult cases (TRALI more likely if BNP < 150 pg/ml)