Monitoring
Hemolysis should improve in the acute setting with discontinuation of transfusion. No specific treatment is given in delayed hemolytic reactions. CBC, bilirubin, and haptoglobin may be monitored to ensure improvement of hemolysis. Serum creatinine should be monitored to ensure renal failure is not developing following resolution of acute hemolysis. Platelets may be monitored following intravenous immune globulin (IVIG) transfusion for post-transfusion purpura. Hemoglobin levels may be monitored to ensure no significant blood loss is occurring. Frequency of monitoring is subject to the discretion of the treating clinician.
Following the resolution of an initial anaphylactic reaction, biphasic reactions or symptom recurrence can occur; there is no reliable predictor of these.[32][44][54] A further anaphylactic reaction is highly likely to be "biphasic" when it occurs within 48 hours of complete resolution of the initial reaction (where complete resolution has lasted for at least an hour of observation) without reexposure to the suspected allergen.[5] Risk factors for occurrence of biphasic reactions include increased severity and/or persistence of the initial reaction, the need for multiple doses of epinephrine, wide pulse pressure, and the presence of cutaneous features.[5] Biphasic anaphylaxis is unlikely when anaphylaxis is not severe and there is complete resolution of the initial reaction lasting for at least one hour of observation.[5] Patients should be monitored for an extended period of time in a clinical area with facilities for treating life-threatening airway, breathing and circulation problems.[44] Local guidelines and protocols should be followed regarding the period of monitoring required. Following a suspected anaphylactic reaction, the person should be recommended to see an allergist for further assessment and management.[5] Retrospective confirmation of a diagnosis of anaphylaxis relies on a thorough clinical history (including a detailed account of the suspected anaphylactic event, any physical exam findings during the episode, and the response to treatment), in addition to any relevant investigation findings (e.g., serum tryptase levels), and is important for future management planning (e.g., providing appropriate patient education, trigger avoidance, predicting the risk of future severe episodes).[5] In patients taking beta-blockers and/or angiotensin-converting enzyme (ACE) inhibitors who are at risk of future anaphylaxis, a review of the benefits and risks of these drugs should take place involving appropriate specialists (e.g., cardiologist).[5] See Anaphylaxis (Monitoring).
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