How are circulatory (volume) overload transfusion reactions managed?

Updated: Jan 12, 2021
  • Author: S Gerald Sandler, MD, FCAP, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Circulatory (volume) overload is managed as follows:

  • Move the patient into a sitting position and administer oxygen to facilitate breathing.

  • The most specific treatment is discontinuing the transfusion and removing the excessive fluid.

  • If practical, the unit of blood component being transfused may be lowered to reverse the flow and to decrease intravascular volume by a controlled phlebotomy.

  • Less urgent situations may be managed by a parenteral or oral diuretic (eg, furosemide).

  • If the patient has symptomatic anemia requiring additional transfusions of RBCs, select concentrated (ie, CPDA-1-anticoagulated) red cells (hematocrit = 80-85%). Avoid red cell components diluted with saline additives (ie, AS-1).

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