From the Guidelines
Non-febrile transfusion reactions are primarily caused by allergic reactions, transfusion-associated circulatory overload (TACO), transfusion-related acute lung injury (TRALI), and delayed hemolytic reactions, which can be managed with immediate cessation of transfusion, administration of medications such as diphenhydramine and hydrocortisone, and supportive care. The most common causes of non-febrile transfusion reactions include:
- Allergic reactions, which occur due to antibody-mediated responses to plasma proteins 1
- Transfusion-associated circulatory overload (TACO), which is caused by volume overload 1
- Transfusion-related acute lung injury (TRALI), which is caused by donor antibodies reacting with recipient neutrophils 1
- Delayed hemolytic reactions, which may occur days to weeks after transfusion due to immune-mediated destruction of red blood cells.
These reactions can be prevented or minimized by using leukoreduced blood products for patients with a history of allergic reactions and administering pre-medications such as diphenhydramine and acetaminophen 30 minutes before transfusion for patients with previous mild reactions 1. If a patient develops symptoms such as urticaria, pruritus, wheezing, hypotension, or edema during transfusion, the transfusion should be stopped immediately, and the patient should be managed with supportive care and medications as needed 1. It is essential to note that the risk of non-febrile transfusion reactions is relatively low, with life-threatening reactions occurring in 1:139,908 transfusions or 7.1 per million transfusions 1. However, prompt recognition and management of these reactions are crucial to prevent morbidity and mortality.
From the Research
Causes of Non-Febrile Transfusion Reactions
The causes of non-febrile transfusion reactions can be categorized into several types, including:
- Allergic reactions: These are the most common type of non-febrile transfusion reaction, accounting for 33.6% of all adverse transfusion reactions 2.
- Transfusion-related acute lung injury (TRALI): This is a serious and potentially life-threatening complication of blood transfusion, accounting for 5.9% of all adverse transfusion reactions 2.
- Transfusion-associated circulatory overload (TACO): This is a common cause of non-febrile transfusion reactions, particularly in patients with cardiovascular disease 3.
- Acute and delayed hemolytic transfusion reactions: These are serious and potentially life-threatening complications of blood transfusion, caused by the immune system's reaction to incompatible blood components 3.
- Immune reactions: These can occur due to the immune system's response to foreign antigens in the transfused blood components, accounting for 18.8% of all adverse transfusion reactions 2.
Pathophysiology and Management
The pathophysiology of non-febrile transfusion reactions involves a complex interplay of immune and non-immune mechanisms, including the release of cytokines and other inflammatory mediators 3. Management of these reactions typically involves immediate cessation of the transfusion, administration of supportive care, and treatment of any underlying conditions that may have contributed to the reaction 4, 5. Prevention strategies, such as leukoreduction, plasma reduction, and patient blood management programs, can also help to reduce the risk of non-febrile transfusion reactions 3.