From the Guidelines
Management of adverse reactions to blood transfusion requires prompt recognition and appropriate intervention based on the specific reaction type, with the most recent guidelines from 2025 emphasizing the importance of patient monitoring and identification to minimize risks 1. The management strategies for adverse reactions to blood transfusion can be categorized based on the severity and type of reaction.
- For mild allergic reactions, such as hives or itching, slowing or temporarily stopping the transfusion and administering diphenhydramine 25-50mg IV/PO is usually sufficient 1.
- For febrile non-hemolytic reactions, acetaminophen 650mg can be given, and the transfusion may continue if symptoms resolve.
- Severe reactions like acute hemolytic transfusion reactions require immediate cessation of transfusion, maintaining IV access, and supportive care including IV fluids, vasopressors if needed, and monitoring urine output.
- Transfusion-related acute lung injury (TRALI) necessitates oxygen support and possibly mechanical ventilation.
- Transfusion-associated circulatory overload (TACO) requires stopping the transfusion, elevating the patient's head, administering diuretics like furosemide 20-40mg IV, and oxygen supplementation, with risk factors for TACO including older, non-bleeding patients, comorbidities, and rapid transfusion 1.
- Anaphylactic reactions demand immediate epinephrine (0.3-0.5mg IM), antihistamines, corticosteroids, and airway management if needed. The key to effective management is prompt recognition of adverse reactions, with monitoring of vital signs, including respiratory rate, pulse, blood pressure, and temperature, essential to identify and manage adverse reactions 1. Prevention strategies for future transfusions may include pre-medication, leukoreduced blood products, or washed red cells depending on the reaction type, with patient identification and monitoring critical to minimizing risks 1.
From the Research
Adverse Reactions to Blood Transfusion
Adverse reactions to blood transfusion can be categorized into immediate and delayed reactions, with varying severity and symptoms 2. These reactions can be immunologically or nonimmunologically mediated, ranging from mild to fatal 3.
Types of Adverse Reactions
- Immediate reactions:
- 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 4
- Delayed reactions:
- 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 4
Management Strategies
- Timely identification and immediate cessation of transfusion in case of acute reactions 2, 5
- Vigilance to distinguish delayed responses or reactions with nonspecific signs and symptoms 2
- Careful monitoring of each blood transfusion for signs and symptoms of transfusion reactions to minimize adverse effects 3
- Clinical strategies to reduce the likelihood of reactions and improve patient outcomes, such as new evidence-based algorithms of transfusion, newer blood screening methods, and improved hemovigilance 5, 4
- Preventive measures to avoid adverse reactions, including identification of at-risk patients and provision of closely matched blood components 2, 6
Frequency and Severity of Adverse Reactions
- The most common reactions are allergic and febrile, which are also the least harmful 6
- Fatal reactions can occur, emphasizing the need for preventive measures 6
- The incidence of many transfusion-related adverse events is decreasing, but emerging threats to transfusion safety require continued vigilance 2