A transfusion reaction is any unexpected or untoward sign or symptom that occurs during or after a blood transfusion. Reactions can be caused by clerical errors in labeling or typing, technical errors in cross-matching or testing, or issues with blood storage temperature. Reactions are classified as acute immunological, acute non-immunological, delayed immunological, or delayed non-immunological. Common immunological reactions include hemolytic transfusion reactions, febrile non-hemolytic reactions, urticaria, anaphylaxis, and transfusion-related acute lung injury. Management of reactions involves stopping the transfusion, checking for signs of circulatory overload or bleeding, and evaluating the patient's blood samples

1. Blood transfusion reaction

2. Definition of Transfusion Reaction
• Any unexpected or untoward sign or symptom
occurs during or shortly after the transfusion
of a blood component, a transfusion reaction
must be considered as the precipitating event
until proven otherwise
• Any untoward systemic event that occurs as a
result of infusion of a blood component.

3. Causes of transfusion reaction
• Clerical errors
1. Inadequate/incorrect labeling
2. Wrong blood issued
• Technical errors
1. Error in blood grouping or cross matching
2. Incorrect interpretation of test results
• Others
1. Blood cooler than -30degree and warmer than 42 degrees
2. Blood contamination during phelbotomy
3. Concomitant administration of blood and drug through
same set.

4. Recognition at the bedside

5. Classification
1. Acute transfusion reaction
• Immunological
• Non-immunological
2. Delayed transfusion reaction
• Immunological
• Non-immunological

6. Immunological reactions
• Acute hemolytic transfusion reaction
(occurs due to transfusion of incompatible donor red cells
)
• Clinical features
1. Early features are chills, fever, back pain, pruritus,
burning sensation at site of transfusion and centrally
along the veins
2. In unconscious patient more severe features like
hypotension, shock, oliguria and excessive bleeding
due to disseminated intravascular coagulopathy may
develop before the transfusion can be stopped.

7. • Febrile non hemolytic reaction
1. Generally occurs due to anti leucocyte
antibodies in patients who have been
pregnant or have history of pevious history of
blood transfusion
2. Can occur due to cytokines in stored platelet
concentrates
3. Generally occurs towards end of infusion
orwithin a few hours of completion.

8. • Urticaria
1. Occurs due to presence of antibodies in the
recipients blood to infused plasma proteins
2. It may occur due to infusion of allergens that
react with Ige antibodies in the patient

9. • Anaphylaxis
1. Occurs in patients who have antibodies
against IgA and often deficient in IgA
2. The antibodies react with IgApresent in the
donor blood.

10. • Transfusion related acute lung injury(TRALI)
1. The donor plasma has antibodies to the patients
leukocytes . Such antibodies are found most
frequently in females after pregnancy and are
not present in plasma of males unless there is a
history of previous transfusion
2. Patient develops an acute respiratory reaction
with fever, cough, shortness of breath and
typical appearance on chest x-rays. The reaction
occurs during or soon after transfusion and may
be life threatening.

11. • Delayed hemolytic transfusion reaction
1. It occurs 3-21 days after transfusion with
incompatible blood. Patient has IgG
antibodies to the red cell antigens such as Rh
because of previous pregnancy or
transfusion. The antibodies are undetectable
during cross-match but further transfusion
cause a secondary immune response
resulting in delayed haemolysis.

12. • Transfusion associated graft-versus-host disease
(TA-GVHD).
1. it occurs due to immune reaction of donor T
cells against the recipient who is often
immunodeficient.
2. Clinically, patient develops fever, skin, rash, liver
and renal failure and pancytopenia
3. It develops 4-30 days after transfusion and can
be fatal
4. This can be prevented by using gamma
irradiation of cellular blood components.

13. • Post transfusion purpura
1. It is an immune mediated thrombocytopenia that
usually occurs in parous females
2. Antibodies against human platelet antigens (HPAs) are
detectable in the patients serum
3. It occurs 5-12 days after transfusion
4. Thrombocytopenia is usually severe and may cause
bleeding.
5. Platelet transfusions are usually ineffective and
treatment of choice is high dose intravenous
immunoglobulin's (0.4g/day for 5 days)

14. Non immune reactions
1. Circulatory overload (transfusion associated
circulatory overload) especially in patients
with renal and cardiac failure
2. Adverse effects of massive transfusion eg:-
hyperkalemia, ammonia and citrate toxicity
and thrombocytopenia
3. Air or gas embolism
4. Haemosiderosis as 1 unit of blood contains
200-250 mg of iron.

15. • Management
1. Stop transfusion immediately
2. Change blood transfusion set and maintain venous access using
normal saline
3. Check blood pressure, urine output and evidence of bleeding
4. Withdraw blood sample from opposite arm and send for
evaluation and rechecking
5. Get a coagulation screen to rule out DIC(partial thromboplastin
time, platelet count, fibrogen level and fibrin degradation
products )
6. Administer intravenous fluids if patient develops hypotension
7. Maintain urine output.