Transfusion Reactions

• Allergic reactions.
• Urticarial reactions.

• Stop the transfusion.
• Administer antihistamine.
• If symptoms improve, continue with transfusion.
• If no improvement within 30 min OR worsening of symptoms, manage as category 2.

• Febrile non-haemolytic reactions.

• Stop transfusion.
• Replace the infusion set and maintain venous access with normal saline.
• Notify the physician and the BB.
• Send the unit and the samples to BB.
• Symptomatic support.
• If symptoms improve, continue the transfusion.
• If no improvement, treat as category 3.

• Acute intravascular haemolysis.
• Bacterial contamination and septic shock.
• Transfusion-associated circulatory overload (TACO).
• Anaphylactic reactions.
• Transfusion-associated lung injury (TRALI).

• In addition to “category 2” management:
• Normal saline infusion
• Symptomatic support as per specific reaction:
  • Maintain airway (give O2).
  • Adrenaline.
  • IV corticosteroids.
  • Bronchodilators.
  • Diuretics.
• Notify the BB and send suspect units, tubing and specimens ASAP.
• Observe for haemoglobinuria

Transfusion of incompatible red cells or incorrectly heated or stored red cell products causes rapid destruction of red blood cells immediately after or within 24 hours of a transfusion. Clinical and laboratory signs of haemolysis are present: increasing anaemia, haemoglobinuria, back pain, flank pain, abdominal pain, oozing at venous access sites / wounds and rise in LDH and positive DAT.

Other symptoms include fever, chills, nausea, vomiting, hypotension, tachycardia, renal failure and DIC. Maintain renal function, monitor vital signs, administer saline, induce diuresis (Furosemide) and refer to haematologist or nephrologist.

This reaction is caused by allergies to plasma proteins. In some instances, infusion of antibodies from an atopic donor may also be involved. Usually mild with muco-cutaneous signs and symptoms: itching, hives, urticaria and erythema.

Administer antihistamines. Commence transfusion with a new unit after liaising with the blood bank.

Respiratory distress within 24 hours of transfusion that does not meet the criteria of TRALI, TACO or severe allergic reaction (SAR) and is not explained by the patient’s underlying condition.

Symptomatic support is indicated.

A drop in systolic and / or diastolic pressure of >30mm Hg occurring within one hour of completing the transfusion, provided all other adverse reactions, as well as underlying conditions that could explain hypotension, have been excluded.

Administer saline and maintain BP and IV volume.

Caused by volume infusion that cannot be effectively processed / tolerated by the recipient due either to high rates or volumes of infusion or to underlying cardiac or pulmonary pathology.

During transfusion, or within 6 hours (may be as long as 24 hours) after transfusion, the patient may present with acute respiratory distress (hypoxemia, dyspnoea, cyanosis), tachycardia, systolic hypertension, positive fluid balance (and increased BNP levels), congested neck veins and acute developing or worsening pulmonary oedema.

Patients respond well to administration of diuretics.

Caused by leucoagglutinins in donor plasma.

Within 4–6 hours of transfusion. Abrupt onset of fever, dyspnoea, hypotension and bilateral pulmonary oedema (in the absence of circulatory overload signs).

Maintain blood pressure and cardiac output with fluid support. Ventilation support as needed. Avoid diuretic use.

Caused by leucocyte or platelet antibodies (in recipient) to donor cells or passively transfused cytokines. Commonly found in multiparous and multi-transfused patients.

Within 1–2 hours after transfusion started, the patient presents with fever, chills, headache, myalgia, malaise, tachycardia and hypertension. Isolated fever >39°C or a change of >1°C from pre-transfusion temperature, with or without rigors and chills, but without haemolysis or features of an allergic reaction.

Administer antipyretics, maintain venous access and liaise with blood bank to exclude haemolytic reaction after posttransfusion investigation is completed.

Caused by transfusion of contaminated products.
Rapid onset, usually around one hour after transfusion.
Chills, fever, abdominal cramps, nausea, vomiting, flushed skin, hypotension, renal failure and shock.

Supportive measures: Monitor vital signs, antibiotics, fluid and electrolyte support, steroids and vasopressor when indicated.

Caused by exposing (often re-exposing) the recipient (with atypical IgG antibodies e.g. anti-Kell, anti-Duffy) to incompatible red cells. Most cases are mild and often unreported. Present within hours with severe Hb drop and jaundice (often anti-Kell) or 2–10 days post-transfusion with mild anaemia and jaundice. Renal failure or DIC may complicate the reaction.

Severe reactions are treated according to patient’s needs: haemodialysis for renal failure, transfusions for bleeding diathesis. Mild cases often do not need specific intervention.

Caused by recipient alloantibodies against donor platelet antigens. Thrombocytopenia arising 5–12 days following transfusion of cellular blood components. Only 10% of patients present with haemorrhage.

Usually presents with purpura, bruising and mucosal bleeding. Requires immediate referral and treatment with IV Gammaglobulins as the reaction may be lethal. Steroids and plasma exchange are additional options in treatment.

The introduction of viable T-lymphocytes into a susceptible host may cause transfused lymphocytes to engraft, proliferate and destroy host cells and tissues.

Within 10–30 days of transfusion, the patient presents with fever, maculopapular rash, liver dysfunction (or severe jaundice), diarrhoea, pancytopenia and bone-marrow hypoplasia.

Immediate referral to specialist oncologist unit is necessary as this carries a very high mortality. The engrafted clone of lymphocytes is eradicated by chemotherapy.