From the Guidelines
Blood transfusion reactions are adverse events that occur during or after receiving blood products, requiring prompt recognition and management, and the most recent evidence suggests that these reactions can be caused by immunological responses to donor antigens, bacterial contamination, or volume overload, with severity ranging from mild discomfort to life-threatening conditions requiring immediate intervention. If a transfusion reaction is suspected, immediately stop the transfusion, maintain IV access with normal saline, check vital signs, and notify the physician and blood bank. Common reactions include:
- Febrile non-hemolytic reactions (treated with antipyretics like acetaminophen 650mg)
- Allergic reactions (managed with diphenhydramine 25-50mg IV/PO)
- Acute hemolytic reactions (requiring aggressive IV fluids and monitoring for DIC and renal failure)
- Transfusion-related acute lung injury (TRALI) presents with respiratory distress and requires oxygen support and possible ventilation
- Bacterial contamination can cause fever, hypotension, and shock, necessitating broad-spectrum antibiotics and hemodynamic support Prevention strategies include proper patient identification, careful cross-matching, leukoreduction for patients with previous febrile reactions, and using washed red cells for those with severe allergic reactions, as recommended by the AABB guidelines 1. Monitoring for adverse events or reactions during transfusions should include heart rate, blood pressure, temperature, and respiratory rate, as per local guidelines, and if there are any signs of a transfusion reaction, such as tachycardia, rash, breathlessness, hypotension, or fever, stop the transfusion and contact the laboratory immediately 1. Management may include the administration of antihistamine or steroid drugs, or intramuscular/intravenous adrenaline if life-threatening, and diagnosis of a transfusion reaction during ongoing haemorrhage may be difficult, but if concern arises, the documentation should be double-checked for administration errors and further analyses performed as per local protocols 1.
From the Research
Causes of Adverse Reactions to Blood Transfusions
- Acute hemolysis, often caused by preventable errors in sample or patient identification 2
- Bacterial contamination of blood components, particularly platelets stored at 20 degrees to 24 degrees C 2
- Transfusion-related acute lung injury (TRALI), usually caused by infusion of plasma containing antibodies against the patient's leukocytes 2
- Anaphylactic reactions, resulting from patient immunoglobulin (Ig)E antibodies against donor plasma constituents 2
- Transfusion circulatory overload, associated with higher pretransfusion respiration rates 3
Symptoms of Adverse Reactions to Blood Transfusions
- Overlapping and nonspecific symptoms 4
- Signs and symptoms of acute reactions, including changes in vital signs 5
- Acute respiratory distress in TRALI 2
- Anaphylactoid reactions, characterized by vasoactive or complement-activating factors in a blood product 2
- Fever, chills, and rigors in febrile nonhemolytic reactions 3
- Allergic reactions, ranging from mild to severe 6
Risk Factors for Adverse Reactions to Blood Transfusions
- Patient comorbidities, such as diabetes and kidney disease 6
- Older age 6
- Pretransfusion vital signs, which may predict vital sign changes during transfusion 3
- Type of blood product transfused, with red blood cell packaging, fresh frozen plasma, and platelets being commonly transfused 6