7 Adverse Reactions To Transfusion

No Reaction Type Symptoms Cause Frequency Prevention

1 Acute Hemolytic Fever, chills Human error Rare proper
Reaction and fever, the such as identification
feeling of heat mislabeled of patients,
along the vein pretransfusio pretransfusio
in which the n specimen; n blood
blood is being the samples and
transfused, transfusion blood
pain in the of properly components
lumbar region, labeled at the time of
constricting blood to the transfusion
pain in the wrong
chest, person, or
tachycardia, clerical
hypo-tension, errors
and occurring
hemoglobinem within the
ia with Blood Bank
subsequent
hemoglo- transfused
binuria and red cells
hyperbilirubin- react with
emia. circulating
antibody in
A "feeling of the recipient
impending with
doom" is resultant
frequently intravascular
reported by the hemolysis
patient as an
early sign of
this reaction.
Most likely
In an to occur
unconscious or when a
anesthe-tized group O
patient: patient is
Uncontrollable mistakenly
bleeding due to transfused
disseminated with group
 intravascular A, B, or AB
coagulation blood.
may be the Patients
only sign of a receiving a
hemolytic major ABO-
transfusion incompatible
reaction marrow or
stem cell
transplant
with
sufficient
red cell
content will
likely
develop an
acute
hemolytic
reaction
2 Delayed the most Many Uncomon
Hemolytic common signs delayed
Reaction are a falling hemolytic
hematocrit reactions
(due to will go
extravascular undetected
destruction of because the
the transfused red cell
Notify the Blood red blood destruction
Bank at the time cells) and a occurs
the reaction is positive direct slowly
suspected, to antiglobulin
allow prompt (Coombs) test Delayed
investigation. (DAT). hemolytic
Care must be reactions
taken that "delayed" occur in
subsequently hemolytic patients who
transfused red reactions have
cells lack the commonly developed
antigen occurs about 4- antibodies
corresponding to 8 days after from
the patient's blood previous
antibody. transfusion, transfusion
but may or pregnancy
 develop up to but, at the
one month time of
later. There pretransfusio
may also be n testing, the
hemoglobinuri antibody in
a and a mild question is
elevation of too weak to
the serum be detected
bilirubin. . by standard
Symptomatic procedures.
patients may Subsequent
manifest fever transfusion
and with red
leukocytosis cells having
thus appearing the
to have an correspondin
occult g antigen
infection. results in an
anamnestic
antibody
response and
hemolysis of
transfused
red cells.
3 Febrile fever or chill Cytokines 1 in 8
fever A and transfusion
temperature antibodies to s
rise of 1.8 F or leukocyte
1.0 C from the antigens
baseline reacting with
leukocytes
or leukocyte
fragments
4 Allergic - allergic this reaction 1% of
urticaria reactions may is caused by recipients
be associated foreign
with laryngeal plasma
edema and proteins
bronchospasm.

If coupled with
another sign,
 such as fever,
evaluation for
a hemolytic
reaction may
be indicated.
5 Allergic - anaphylactic or may be due Rare
Anaphylaxis anaphylactoid to anti-IgA
Respiratory
involvement
with dyspnea
or stridor may
be more
pronounced
than is usually
seen in typical
allergic
reactions.

Reactions
manifest
cardiovascular
instability that
includes
hypotension,
tachycardia,
loss of
consciousness,
cardiac
arrhythmia,
shock and
cardiac arrest.
6 TRALI abrupt onset of TRALI has TRALI is a Most cases
noncardiogenic been rare though of TRALI
pulmonary associated under resolve
edema Severe with the recognized within 72
cases may presence of complicatio hours
require assisted antibodies in n of although
ventilation the donor transfusion fatalities
with high plasma may occur in
FIO2. reactive to approximatel
recipient y 10 percent
leukocyte of cases.
 antigens or
with the
production
of
inflammator
y mediators
during
storage of
cellular
blood
components
7 Hypotension A drop of at
least 10 mm
Hg in systolic
or diastolic
arterial blood
pressure in the
absence of
signs or
symptoms of
other
transfusion
reactions

if the
immediate
pretransfusion
blood pressure
is elevated
from the
patients typical
blood pressure,
and the arterial
pressure does
not fall below
the patients
usual blood
pressure, it
should not be
considered a
hypotensive
reaction. The
 onset of
hypotension is
during the
transfusion,
and resolves
quickly with
discontinuation
of the
transfusion.

If hypotension
persists beyond
30 minutes
after
discontinuing
the transfusion,
another
diagnosis
should be
strongly
considered.

National Healthcare Safety Network Biovigilance Component. (2014). Hemovigilance Module

Surveillance Protocol. http://www.cdc.gov/bloodsafety/basics.html

Rudmann, S. (2005). Textbook of Blood Banking and Transfusion Medicine. Philadelphia:

Elsevier Saunders