Blood Transfusion Reactions

 Definition
A transfusion reaction is any adverse event or complication that occurs in a patient during or
after a blood transfusion due to immune or non-immune mechanisms. These reactions can range
from mild to life-threatening.

 Classification
Transfusion reactions can be classified based on timing and mechanism:

1. Based on Timing-

 Acute Transfusion Reactions (within 24 hours)

 Delayed Transfusion Reactions (after 24 hours to weeks)

2. Based on Mechanism-

 Immune-Mediated Reactions (due to immune response)

 Non-Immune-Mediated Reactions (due to other factors like volume overload, infections,
etc.)

A. Acute Transfusion Reactions (Within 24 hours-

 Acute Haemolytic Transfusion Reaction (AHTR)

 Cause: ABO/Rh incompatibility → Recipient's immune system attacks donor RBCs.

 Symptoms: Fever, chills, hypotension, hemoglobinuria, back pain, renal failure.
 Management:
o Stop transfusion immediately.
o IV fluids to maintain urine output.
o Supportive care for shock and renal failure.

 Febrile Non-Hemolytic Transfusion Reaction (FNHTR)

 Cause: Cytokines from donor WBCs activate the recipient’s immune system.
 Symptoms: Fever, chills, mild discomfort.
 Management:
o Stop transfusion if severe.
o Antipyretics (e.g., paracetamol).
o Use leukoreduced blood products in future transfusions.
 Allergic (Urticarial) Reaction

 Cause: Hypersensitivity to donor plasma proteins.

 Symptoms: Urticaria (hives), itching, mild fever.
 Management:
o Stop transfusion temporarily.
o Administer antihistamines (e.g., diphenhydramine).
o Resume transfusion if symptoms resolve.

 Anaphylactic Reaction

 Cause: Severe allergic response, often in IgA-deficient patients.

 Symptoms: Hypotension, bronchospasm, angioedema, shock.
 Management:
o Stop transfusion immediately.
o Administer epinephrine, IV fluids, corticosteroids, and antihistamines.
o Future transfusions: Use washed RBCs or IgA-deficient plasma.

 Transfusion-Associated Circulatory Overload (TACO)

 Cause: Rapid transfusion → Fluid overload.

 Symptoms: Hypertension, pulmonary edema, dyspnea, tachycardia.
 Management:
o Slow transfusion rate.
o Diuretics (e.g., furosemide).
o Oxygen therapy if needed.

 Transfusion-Related Acute Lung Injury (TRALI)

 Cause: Donor antibodies react with recipient WBCs → Pulmonary inflammation.

 Symptoms: Sudden dyspnea, hypoxia, pulmonary edema.
 Management:
o Stop transfusion immediately.
o Provide respiratory support (oxygen, ventilation if needed).
o Avoid plasma from multiparous female donors in future transfusions.

B. Delayed Transfusion Reactions (After 24 hours to weeks)-

 Delayed Hemolytic Transfusion Reaction (DHTR)

 Cause: Recipient develops antibodies against donor RBCs (minor antigen

incompatibility).
 Symptoms: Mild fever, jaundice, anemia, increased bilirubin.
 Management:
 o Supportive care (monitor hemoglobin, transfuse antigen-matched RBCs if
needed).

 Post-Transfusion Purpura (PTP)

 Cause: Immune destruction of recipient’s platelets after exposure to donor platelet

antigens.
 Symptoms: Severe thrombocytopenia, bleeding.
 Management:
o IV immunoglobulin (IVIG).
o Steroids.
o Platelet transfusion in severe cases.

 Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD)

 Cause: Viable donor lymphocytes attack recipient's tissues (common in

immunocompromised patients).
 Symptoms: Fever, rash, diarrhea, pancytopenia, liver dysfunction.
 Management:
o No effective treatment, usually fatal.
o Prevention: Use irradiated blood products in at-risk patients.

C. Infectious Transfusion Reactions-

 Cause: Transmission of infections like Hepatitis B/C, HIV, Malaria, Syphilis through
contaminated blood.
 Symptoms: Vary based on infection.
 Management: Preventative screening of blood donors.

 General Management of Transfusion Reactions

1. Stop transfusion immediately if a reaction is suspected.
2. Monitor vital signs and assess symptoms.
3. Administer appropriate medications based on reaction type (e.g., antihistamines, steroids,
IV fluids).
4. Maintain airway, breathing, circulation (ABC) in severe cases.
5. Laboratory tests: Direct Coombs test, hemoglobin levels, bilirubin, kidney function tests.
6. Prevent future reactions: Use leukoreduced, irradiated, or washed blood products as
needed.
Table: Classification of Transfusion Reactions with Causes, Symptoms, and
Management
Type of Classificatio Cause Symptoms Management
Reaction n
Acute Acute, ABO/Rh Fever, chills, Stop transfusion,
Hemolytic Immune incompatibility → hemoglobinuria, IV fluids,
Transfusion Immune-mediated back pain, maintain urine
Reaction hemolysis hypotension, output, treat
(AHTR) tachycardia, shock
renal failure
Febrile Non- Acute, Cytokines from Fever, chills, Stop transfusion
Hemolytic Immune donor WBCs mild discomfort if severe,
Transfusion activate recipient’s antipyretics
Reaction immune response (paracetamol),
(FNHTR) use leukoreduced
blood in future
Allergic Acute, Hypersensitivity to Urticaria (hives), Stop transfusion
(Urticarial) Immune donor plasma itching, mild temporarily,
Reaction proteins fever antihistamines
(diphenhydramin
e), resume if
symptoms resolve
Anaphylactic Acute, Severe allergic Hypotension, Stop transfusion,
Reaction Immune response, often in bronchospasm, administer
IgA-deficient angioedema, epinephrine, IV
patients shock fluids,
corticosteroids,
antihistamines
Transfusion- Acute, Non- Rapid transfusion Dyspnea, Slow transfusion
Associated Immune → Fluid overload pulmonary rate, diuretics
Circulatory edema, (furosemide),
Overload hypertension, oxygen therapy
(TACO) tachycardia
Transfusion- Acute, Donor antibodies Sudden dyspnea, Stop transfusion,
Related Immune react with recipient hypoxia, provide
Acute Lung WBCs → hypotension, oxygen/ventilatio
Injury Pulmonary pulmonary n, avoid plasma
(TRALI) inflammation edema from multiparous
female donors
Bacterial Acute, Non- Contaminated Fever, chills, Stop transfusion,
Contaminatio Immune blood products hypotension, IV antibiotics,
n (Sepsis) septic shock supportive care
Delayed Delayed, Minor antigen Mild fever, Supportive care,
Hemolytic Immune incompatibility jaundice, monitor
Transfusion anemia, hemoglobin,
Reaction increased transfuse antigen-
(DHTR) bilirubin matched RBCs if
needed
Post- Delayed, Immune destruction Severe IV
Transfusion Immune of recipient’s thrombocytopeni immunoglobulin
Purpura platelets a, bleeding (IVIG), steroids,
(PTP) platelet
transfusion in
severe cases
Transfusion- Delayed, Donor lymphocytes Fever, rash, No effective
Associated Immune attack recipient’s diarrhea, treatment,
Graft-Versus- tissues (common in pancytopenia, prevention with
Host Disease immunocompromis liver dysfunction irradiated blood
(TA-GVHD) ed patients)
Iron Delayed, Repeated Liver Chelation therapy
Overload Non- transfusions → dysfunction, (deferoxamine,
Immune Excess iron diabetes, cardiac deferasirox)
deposition in complications
organs
Infectious Delayed, Transmission of Varies based on Preventative
Transfusion Non- infections (HIV, infection donor screening,
Reactions Immune Hepatitis B/C, pathogen-reduced
Malaria, Syphilis) blood