Transfusion reaction

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In medicine, a transfusion reaction is an adverse effect due to blood component transfusion such as erythrocyte transfusion or platelet transfusion.

A classification has been proposed by the American Association of Blood Banks (AABB).[1]


History and physical examination

Patients with symptoms coincident with a transfusion may have reactions ranging from mild febrile, nonhemolytic transfusion reaction (FNHTR) to life threatening anaphylaxis or hemolysis. Three common signs are below and are highlighted to show which types of reactions may underlie the sign:

  • dyspnea
  • hypotension
  • fever


If hemolysis is possible, give intravenous fluids and test for repeat blood cross-matching, direct Coombs' test (cross-matching only includes the indirect Coombs' test), plasma free hemoglobin, and urine hemoglobin.

Types of reactions


Febrile, nonhemolytic transfusion reaction (FNHTR)

FNHTR may include temperature elevation > 1°C, chills and/or rigors, headache, vomiting. This is a minor, acute reaction suggested by negative a Coombs' test, no free hemoglobin in the plasma, and no hemoglobin in the urine.

Hemolytic reactions

Hemolytic reactions due to blood group incompatibility is "mismatch between donor and recipient blood. Antibodies present in the recipient's serum are directed against antigens in the donor product. Such a mismatch may result in a transfusion reaction in which, for example, donor blood is hemolyzed."[2]

Acute hemolytic transfusion reactions

ICD9: 999.6

Acute hemolytic transfusion reactions due to ABO incompatibility may show chills, fever, hypotension, renal failure, back pain, hemoglobinuria

Delayed hemolytic transfusion reactions

ICD9: 999.7

This reaction usually causes delayed hemolysis. This may be caused by Rh incompatibility.

Allergic reactions

Type 1 hypersensitivity (immediate hypersensitivity) reactions include:

  • Anaphylactic transfusion reactions may occur, especially in patients with IgA-deficiency and may cause dyspnea from bronchospasm, hypotension, urticaria.
  • Urticaria may occur due to the recipient's IgE reacting to antigens from the donor and cause urticaria, pruritis, and flushing.

Transfusion related acute lung injury (TRALI)

ICD9: 518.7

Transfusion-related acute lung injury (pulmonary leukoagglutinin reaction) (TRALI) is an acute reaction that may include dyspnea, hypoxemia, respiratory failure, hypotension, and fever.

Posttransfusion purpura

Posttransfusion purpura (PTP) is an immune thrombocytopenia. This is more common in women who have been pregnant.

Graft-versus-host disease

Transfusion associated graft-versus-host disease (TA-GVHD) is when the donor's blood attacks the recipient's body.


Nonimmune hemolysis

Nonimmune hemolysis may be due to physical destruction of donor blood from heating or freezing.

Chemical reactions

  • Hemosiderosis
  • Hypocalcemia from citrate toxicity
  • Hyperkalemia
  • Metabolic alkalosis and hypokalemia due to citrate

Transmission of infection


Transfusion associated sepsis may manifest 'fever > 40°C and/or cardiovascular collapse.'[1]

Other reactions

  • Air embolus may manifest 'sudden dyspnea, cyanosis, chest pain, cough, hypotension, cardiac arrhythmia.'[1] ICD9: 999.1
  • Hypothermia
  • Circulatory overload may cause dyspnea.
  • Hypotension associated with leukoreduced blood and maybe angiotensin-converting enzyme may cause flushing and hypotension.


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