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Blood transfusion reactions

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A MILD ALLERGIC REACTION    

​Description

• Symptoms: urticaria, itch, local swelling, mild shortness of breath or mild fever (<38°C). The symptoms may be of varying degrees and they appear during or within four hours of transfusion.
• The reaction is not life threatening and responds rapidly to medication (e.g. antihistamine).

ACUTE/DELAYED HAEMOLYSIS    

​Description

• Usually caused by blood transfusion error (ABO incompatibility or some other incompatible transfusion)
• Symptoms: fever, dyspnoea, nausea, chest, abdominal or back pain, red urine/melanuria, jaundice, anaemia
• The symptoms of an acute haemolytic transfusion reaction (AHTR) often appear during or within 24 hours of transfusion. Delayed haemolytic transfusion reaction (DHTR) develops within one to three weeks of transfusion and the symptoms are often less severe.

Febrile non-hemolytic transfusion reaction    

​Description

• A mild short-term rise in temperature is one of the most common adverse effects of blood transfusion. The specific reason may not always be found. A severe fever reaction may be a sign of bacterial contamination of the blood product, for example.
• Symptoms: temperature >38°C or a rise in temperature of >1°C compared to the pre-transfusion temperature, chills / shivers. Other symptoms may include nausea or headache. The symptoms appear during or within four hours of transfusion.

Graft-versus-host disease (GvHD)    

​Description

• Lymphocytes of non-irradiated blood components may cause a fatal multiple organ failure to a patient with a severe immunological system disorder.

• Symptomps: fever, rash, liver dysfunction, diarrhoea, pancytopenia.

• The symptoms appear within one to six weeks of transfusion

Hypotensive transfusion reaction    

Description​

• Appears within one hour of transfusion.
• Symptoms: systolic pressure drops >30 mmHg and is under 80 mmHg. Usually, stopping the transfusion and hydrating the patient are sufficient as treatment.
• Drop in blood pressure is the primary symptom, but other symptom may also occur, such as sudden burning of the face or abdominal pain.
• Other causes, allergic reactions in particular, have been excluded.

Incorrect transfusion    

Description​​

• Transfused component does not correspond to the patient's treatment regime (e.g. component represents incorrect blood group, incorrect component, non-irradiated component etc.). Includes also cases, where the patient receives components intended for another patient, even if the blood group were suitable for the patient.
• May or may not cause symptoms.

Near misses    

Description​​

• Any incident occurring during a donation session, testing, handling, storage or delivery that, if realised, could:
- be fatal or critical;
- lead to disability;
- lead to  incapacity for work;
- lead to hospitalisation or prolonged hospitalisation; or
- lead to illness or continued illness.

Post-transfusion purpura (PTP)    

​Description

• A rare adverse transfusion reaction caused by the patient's HPA antibodies.
• Symptoms: patient's bleeding disorder, thrombocytopenia. The symptoms appear within 5 to 12 weeks of transfusion.

SEVERE ALLERGIC REACTION/ANAPHYLAXIS    

​Description

• The symptoms may be of varying degrees.
• The cause of an anaphylactic reaction occurring immediately at the beginning of transfusion may be antibodies against IgA (S-IgA-Ab) related to serum immunoglobulin A (S-IgA) deficiency.
• Symptoms: difficult-to-control drop in blood pressure and even loss of consciousness, severe dyspnoea, systemic urticaria

Transfusion-associated circulatory overload (TACO)    

​Description

• Transfusion increases the circulatory volume, leaving the patient exposed to circulatory overload. Too rapid/massive infusion considering the patient's situation.

• Symptoms: acute dyspnoea, tachycardia, increase in blood pressure, acute/worsening pulmonary oedema in chest x-ray, left ventricular failure. The symptoms appear within six hours of transfusion.

Transfusion-associated dyspnoea (TAD)    

Description​

• Appears within 24 h of transfusion.
• Does not meet the criteria of TRALI, TACO or allergic reaction, and is not explained by the patient’s condition in general.

Transfusion-related acute lung injury (TRALI)    

​Description

• In connection with blood transfusion, the patient develops an acute lung injury resembling pulmonary oedema with no other apparent cause for the symptoms.
• Typically, occurs in patients in poor general condition due to their basic illness.
• Can be caused by leucocyte antibodies present in donor blood, but other factors causing TRALI have also been detected in blood products, whose mechanisms still remain largely unknown.
• Symptoms: rapid onset of severe hypoxaemia (SO2 in indoor air <90%), bilateral infiltrates on chest x-ray, no evidence of circulatory overload. The symptoms appear during or within six hours of transfusion.

Transfusion-transmitted viral infection    

​Description

• These are very rare.
• Transmitted by donor blood.

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