Using the App

Transfusion Reaction Simulator

Premium tool. This is an embedded simulator inside the Transfusion Safety & Haemovigilance module at /transfusion-safety-haemovigilance — open that page and find the Transfusion Reaction Simulator card. It is not a standalone entry on the /training-dashboard hub.

Transfusion reaction investigation is a Band 6+ competency that interview panels probe hard. This simulator drills the recognition, classification, and laboratory investigation of every reaction type SHOT tracks.

What it does

• Presents a real-time reaction scenario (vital-signs change during or after transfusion)
• Asks you to classify the reaction
• Walks you through the laboratory investigation workflow
• Tests stop / pause / continue decisions
• Generates the SHOT submission if the reaction is reportable

Reaction types covered

Acute (within 24 h)

• FNHTR (Febrile Non-Haemolytic Transfusion Reaction) — common, low risk, treat symptomatically
• Allergic / urticarial — mild itch / urticaria; usually IgE
• Anaphylactic — IgA-deficient patient with anti-IgA classic; emergency
• TACO (Transfusion-Associated Circulatory Overload) — fluid overload; the leading cause of transfusion-associated mortality in SHOT data
• TRALI (Transfusion-Related Acute Lung Injury) — antibody-mediated lung injury, hard to distinguish from TACO clinically
• AHTR (Acute Haemolytic Transfusion Reaction) — usually ABO incompatibility from WBIT or wrong-blood-issued; emergency
• Bacterial contamination — fever, hypotension, rapid deterioration

Delayed

• DHTR (Delayed Haemolytic Transfusion Reaction) — alloantibody-mediated, days post-transfusion
• DSTR (Delayed Serologic) — alloantibody detected without overt haemolysis
• TA-GvHD (Transfusion-Associated Graft-versus-Host Disease) — rare, fatal, immunocompromised; preventable with irradiated components
• PTP (Post-Transfusion Purpura) — thrombocytopenia days after platelet transfusion

Laboratory investigation workflow

For each suspected reaction:

1. Stop or pause the transfusion (depends on severity)
2. Keep the unit and the giving set — return to lab
3. Repeat blood group on a fresh sample
4. Direct Antiglobulin Test (DAT) pre- and post-transfusion
5. Repeat crossmatch with pre- and post-samples
6. Visual inspection of plasma for haemolysis
7. Bilirubin, LDH, haptoglobin, urinalysis for free Hb — biochemical evidence of haemolysis
8. Bacterial culture of unit if contamination suspected
9. Anti-HLA / anti-granulocyte antibodies in donor if TRALI suspected
10. Document the investigation; submit to SHOT if reportable

SHOT reportable categories

The simulator tells you which reactions go to SHOT, MHRA SABRE, or local-only — see article 39 for the full reporting matrix.

Standards alignment

• SHOT Annual Report — current edition
• BBTS Transfusion Reaction Guidelines — current
• BSH Guidelines for the diagnosis and management of acute transfusion reactions
• JPAC Red Book — UK Blood Transfusion Services standards
• MHRA Blood Safety and Quality Regulations 2005 — current

Bands and competency mapping

• Band 5 — execute investigation under supervision; collect the right samples
• Band 6 — lead investigation independently; classify reaction; decide on next units
• Band 7 — Trust transfusion governance; SHOT submission lead

Common interview question themes

• "Walk me through your investigation of a suspected acute haemolytic reaction"
• "How do you differentiate TACO from TRALI?"
• "What samples do you need pre- and post-transfusion for the workup?"
• "When is a reaction SHOT-reportable vs local?"
• "How do you handle a DHTR identified weeks after transfusion?"