Canterbury DHB

Context

Further Detailed Management of Complications (Therapeutic Apheresis)

Complication

Symptoms

Management

Citrate Toxicity

Circumoral paraesthesia

Muscle twitching

Nausea and/or vomiting

Chills

Syncope

Tetany (rare)

Palpitations/arrhythmia

Avoidance:

  • Warn patient of symptoms
  • Oral calcium supplements before/during procedure
  • Use the recommended anticoagulant solution in the correct proportions
  • Slow infusion rate

Treatment:

  • Stop or slow infusion
  • Oral calcium supplements
  • 10% calcium gluconate 5 ml slow infusion if serious reaction

Inadequate Citrate

Clotting in extracorporal circuit

DIC

Haemolysis

Avoidance:

  • Use the recommended anticoagulation solution in the correct proportions
  • Monitor:
    • delivery of anticoagulant
    • return IV line for clotting
    • colour of plasma (red = haemolysis)

Heparin related

Bleeding

Allergy/anaphylaxis

Thrombocytopenia

Treatment:

  • Protamine Sulphate – to reverse heparin.
  • Side effects: chills, light headedness, allergy and/or anaphylaxis, dyspnoea, and/or chest pain, flushing.

Thrombocytopenia

Petechiae, Bleeding

Avoidance:

  • Monitor platelet count 20-30% decrease expected

Treatment:

  • Platelet transfusion if platelets<50 x 109/L

Transfusion reactions to blood and blood products

Allergic Anaphylaxis

hives, itch facial oedema, dyspnea

Treatment:

  • Antihistamine ± hydrocortisone

Transfusion transmitted infection

Hepatitis B/C, HIV, CMV

ABO incompatible reaction

Delayed adverse reaction Haemolysis

  • Specific to virus transmitted.

Avoidance:

  • Use ABO compatible products.

Treatment:

  • Stop infusion – supportive care, IV fluids – contact TMS/ Haematologist

Transfusion related acute lung injury

Severe dyspnea, hypoxia

  • Supportive care/ICU ± hydrocortisone

Hypervolaemia

Dyspnea

Oedema

Avoidance:

  • Monitor fluid balance – judicious use of albumin; finish with a small negative fluid balance. Must replace at least 75% of total calculated plasma volume

Hypovolaemia

Hypotension

Syncope

Avoidance:

  • Use colloid solutions (albumin, HES etc.)

Treatment:

  • Give IV fluids – colloids or normal saline

Abnormal electrolytes

Low calcium

Others, uncommon

See above

  • Adjust composition of electrolyte solutions to correct these.

Hypothermia

Chills

  • Use blood warmer
  • Warm replacement fluids
  • At risk patient groups:
    • sickle cell disease
    • cold haemagglutinin disease
    • paraproteinaemia
    • cryoglobulinaemia
    • children

Complication of venous access

See previous comments

  • See previous comments

Haemolysis

Fever, red urine, red plasma

Renal impairment

Avoidance:

  • Use ABO compatible blood and blood products. Monitor:
  • Pressure in returning line.
  • Ensure no kinking or twisting of lines and that these are fitted correctly into the machine.
  • Monitor colour of plasma.

Treatment:

  • Stop and resolve cause – see above

Air Embolus

Dyspnea, chest pain

Avoidance:

  • Monitor drip chambers and returning line

Treatment:

  • Procedure, turn patient onto their left side head down.
  • Notify TMS/Haematologist

Equipment Contamination

Septic type

  • Do not prime equipment more than 1 hour before the procedure.

Bacterial contamination

Septic shock

Avoidance:

  • Inspect all replacement fluids to ensure no evidence of microbial contamination or defects in the container.

Treatment:

  • Stop procedure, call TMS/Haematologist.
  • Give IV fluids to maintain BP.
  • Administer parenteral antibiotics.

About this Canterbury DHB document (38131):

Document Owner:

Not assigned (see Who's Who)

Issue Date:

August 2014

Next Review:

August 2016

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 38131