From the Guidelines
Blood transfusion reactions can be categorized into acute and delayed types, with acute reactions including febrile non-hemolytic reactions, allergic reactions, transfusion-related acute lung injury (TRALI), and transfusion-associated circulatory overload (TACO), as reported in a recent study 1.
Acute Reactions
Acute reactions occur within 24 hours of transfusion and can be life-threatening. These reactions include:
- Febrile non-hemolytic reactions, which are estimated to occur in 1.1% of transfusions with prestorage leukoreduction and 2.15% with poststorage leukoreduction 1
- Allergic reactions, ranging from mild urticaria to anaphylaxis
- TRALI, a serious and potentially fatal reaction
- TACO, which can be prevented with careful assessment of the need for transfusion, body weight dosing of RBCs, and close monitoring of vital signs and fluid balance 1
Delayed Reactions
Delayed reactions occur days to months after transfusion and can include:
- Delayed hemolytic reactions, resulting from antibodies developing after transfusion
- Transfusion-associated graft-versus-host disease
- Post-transfusion purpura
- Iron overload from multiple transfusions
- Transfusion-transmitted infections
Management and Prevention
Management of blood transfusion reactions depends on the type of reaction, but generally involves stopping the transfusion immediately, maintaining the IV line with normal saline, monitoring vital signs, and providing supportive care. Prevention strategies include:
- Careful cross-matching of blood products
- Leukoreduction of blood products to reduce the risk of febrile non-hemolytic reactions 1
- Using washed red cells for patients with a history of allergic reactions
- Proper blood storage techniques to prevent bacterial contamination
- A personalized approach to managing reactions, tailored to the patient's symptoms and signs, as recommended by recent guidelines 1
From the Research
Types of Blood Transfusion Reactions
- Acute adverse reactions to transfusion occur within 24 hours and include:
- Acute hemolytic transfusion reaction
- Febrile nonhemolytic transfusion reaction
- Allergic and anaphylactic reactions
- Transfusion-related acute lung injury
- Transfusion-related infection or sepsis
- Transfusion-associated circulatory overload 2
- Delayed transfusion adverse reactions develop 48 hours or more after transfusion and include:
- Erythrocyte and platelet alloimmunization
- Delayed hemolytic transfusion reactions
- Posttransfusion purpura
- Transfusion-related immunomodulation
- Transfusion-associated graft versus host disease
- Iron overload with long-term transfusion 2
Diagnosis and Management
- When a reaction is suspected, it is critical to stop the transfusion immediately and report the reaction to the blood bank, as this can affect the patient's outcome 3
- New evidence-based algorithms of transfusion, newer blood screening methods and donor policies and deferrals, new laboratory testing, electronic verification systems, and improved hemovigilance lead to the avoidance of unnecessary transfusions and decrease the incidence of serious transfusion reactions 3
Note on Relevance of Studies
- Study 4 is not relevant to the topic of blood transfusion reactions, as it discusses the production and isolation of chitosan from Mucor rouxii.