Acute transfusion reaction

Revision as of 17:12, 25 January 2015 by Arsmd (talk | contribs)


  1. For all reactions:
    1. Stop the transfusion (at least temporaily)
    2. Call the blood bank
    3. Draw a new type + screen


Intravascular Hemolytic Tranfusion Reaction

  1. Occurs due to ABO incompatibility
  2. Diagnosis
    1. Back pain, headache, hypotension, dyspnea, pulmonary edema, bleeding, renal failure
    2. Labs c/w hemolysis
  3. Treatment
    1. Stop transfusion
      1. Risk of death is proportional to amount of incompatible blood received
    2. Maintain urine output with IVF, mannitol, and furosemide as needed
    3. Treat shock with volume and vasopressors
    4. Treat coagulopathy w/ FFP

Febrile Nonhemolytic Tranfusion Reaction

  1. Occurs in 20% of pts due to recipient Ab against donor leukocytes
  2. Diagnosis
    1. Fever, HA, myalgias, tachycardia, dyspnea, chest pain
  3. Treatment
    1. Stop tranfusion pending rule-out of hemolytic transfusion reaction
    2. Give antipyretic
    3. Restart transfusion once hemolytic transfusion reaction is ruled-out

Allergic Tranfusion Reaction

  1. Occurs due to immune response to plasma proteins
  2. Diagnosis
    1. Symptoms range from urticaria/pruritus to bronchospasm, wheezing, anaphylaxis (rare)
  3. Treatment
    1. Stop transfusion until able to evaluate severity of allergic reaction
    2. Give diphenhydramine
    3. Restart transfusion if symptoms are mild

Transfusion-associated circulatory overload (TACO)

  1. Often confused with TRALI
  2. Associated with a rapid rise in blood pressure, not hypotension
  3. Diagnosis
    1. Dyspnea, orthopnea, peripheral edema, rapid rise in BP
  4. Treatment
    1. O2, supportive care, diuretics

Transfusion-Related Acute Lung Injury (TRALI)

  1. Due to granulocyte recruitment and degranulation within the lung
  2. More common with FFP and plt transfusions (extremely rare with pRBC transfusion alone)
    1. pRBCs do contain residual plasma and can have TRALI
  3. Time Frame: abrupt to within 6 hours of transfusion initiation
  4. Diagnosis
    1. ARDS-like symptoms
    2. B/l pulmonary infiltrates due to noncardiogenic pulmonary edema w/in 6h of transfusion
  5. Treatment
    1. Strop transfusion
    2. Treat like ARDS
    3. Avoid diuresis

Fluid Overload

  1. Split pRBCs to tranfuse more slowly (as slow as 1mL/kg/hr)


  1. Most commonly due to yersinia which is able to grow easily in refrigerated blood


Extravascular Hemolytic Tranfusion Reaction

  1. Occurs days to weeks after transfusion
  2. Hemolysis occurs in spleen, liver, and bone marrow
  3. Diagnosis
    1. Hyperbilirubinemia
    2. Poor response to transfusion
  4. Treatment
    1. None necessary; rarely fatal

Graft-vs-Host Disease

  • Acute vs Chronic
    • Acute: 1-12 weeks post graft
    • Chronic: >12 weeks
  1. Transplanted graft with immunologically competent cells stimulated by host antigens and host is incapable of mounting an effective immunologic response
  2. Occurs in leukemia/lymphoma or immunocompromised
  3. Diagnosis
    1. Nonspecific rash, mucositis, fever, and diarrhea
    2. LFT abnormalities, pancytopenia
  4. Treatment
    1. Glucocorticoids

Transfusion Risk Ratios

  1. 1:10 Febrile non-hemolytic transfusion reaction per pool of 5 donor units of platelets (1 pack)
  2. 1:100 Minor allergic reactions (urticaria)
  3. 1:300 Febrile non-hemolytic transfusion reaction per unit of RBC (1 pack)
  4. 1:700 Transfusion-associated circulatory overload per transfusion episode
  5. 1:5000 Transfusion-related acute lung injury (TRALI)
  6. 1:7000 Delayed hemolytic transfusion reaction
  7. 1:10,000 Symptomatic bacterial sepsis per pool of 5 donor units of platelets
  8. 1:40,000 Death from bacterial sepsis per pool of 5 donor units of platelets
  9. 1:40,000 ABO-incompatible transfusion per RBC transfusion episode
  10. 1:40,000 Serious allergic reaction per unit of component
  11. 1: 82,000 Transmission of hepatitis B virus per unit of component
  12. 1:100,000 Symptomatic bacterial sepsis per unit of RBC
  13. 1:500,000 Death from bacterial sepsis per unit of RBC
  14. 1:1,000,000 Transmission of West Nile Virus
  15. 1:3,000,000 Transmission of HTLV per unit of component
  16. 1:3,100,000 Transmission of hepatitis C virus per unit of component
  17. 1:4,700,000 Transmission of HIV per unit of component

See Also



  • Tintinalli
  • Canadian Blood Services (Public Health Agency of Canada)