Transfusion Reactions

Blood product transfusion is ubiquitous in the hospital setting. All patients should be counseled about the risk of transfusion-associated reactions. (See a NEJM Video in Clinical Medicine for a summary of the indications, procedure, and complications of transfusion.)

A simple categorization of transfusion reactions is based on the timing (acute or delayed) of the reaction as described in the table below.

(Source: What Every Physician Should Know about Transfusion Reactions. CMAJ 2007.)

Acute Management

If a hemolytic reaction is suspected in an acute setting, stop the transfusion and employ the following algorithm for workup and management.

(Source: Hemolytic Transfusion Reactions. N Engl J Med 2019.)

If you suspect a transfusion reaction:

• STOP the transfusion.

• Assess the patient for fever, cardiovascular and respiratory status, and urticaria/angioedema.

• Confirm with the blood bank that the correct product was used, and check for any clerical errors (e.g., blood-type mismatch or incorrect patient identifiers).

• Remember, preexisting fever is not a contraindication to transfusion.

• Treatment of most transfusion-related reactions is supportive and may include:

  • antibiotics for septic syndromes

  • diuretics for volume overload

  • transfer to the intensive care unit for transfusion-related acute lung injury (TRALI)

For information on the management of allergic reactions, including urticaria/angioedema and anaphylaxis, please refer to the Allergy/Immunology rotation guide.

Risk of transfusion-associated reactions: The magnitude of the risk of adverse transfusion reactions is summarized in the following graphic:

Abbreviations: AHTR, acute hemolytic transfusion reaction; DHTR, delayed hemolytic transfusion reaction; FNHTR, febrile nonhemolytic transfusion reaction; HBV, hepatitis B virus; HCV, hepatitis C virus; TRALI, transfusion-related acute lung injury (Source: Indications for and Adverse Effects of Red-Cell Transfusion. N Engl J Med 2017.)