Evaluation of transfusion reactions

This is an overview of transfusion reactions.
Content is adapted from Wikipedia, UpToDate, TrueLearn, StatPearls.
ADDITIONAL TAGS:
Reaction
Pathophysiology
Typical time course
Clinical findings
Laboratory findings
Implicated products
Acute hemolytic transfusion reaction
Incompatible RBCs (+/- ABO) trigger immune rxn → destruction of cells
During transfusion or within 24 hours of transfusion completion
Fever, chills, hypotension, back pain (cell contents irritate kidney), DIC
Hemoglobinemia, hemoglobinuria, positive direct antiglobulin (Coombs) test (may be negative if all cells have hemolyzed), findings of DIC (prolonged PT, prolonged aPTT, low fibrinogen, thrombocytopenia)
RBCs, plasma (much less common), rarely platelets
Incompatible blood product (typically ABO incompatible due to clerical error)
Anaphylactic transfusion reaction
IgE triggers mast cell degranulation & mediator release
During transfusion or within 4 hours of transfusion completion
Hypotension, angioedema, wheezing, respiratory distress
Hypoxemia, IgA deficiency, anti-IgA
RBCs, platelets, plasma products
Transfusion-related acute lung injury (TRALI)
Neutrophil activation in the lungs due to antibodies or other factors → diffuse alveolar damage
During transfusion or within 6 hours of transfusion completion
Respiratory distress, hypotension
Abnormal chest radiography, hypoxemia, transient leukopenia (transient sequestration of neutrophils in pulm vasculature), anti-neutrophil or anti-HLA Ab (if tested)
RBCs, platelets, plasma products
Transfusion- associated circulatory overload (TACO)
Fluid overload exceeding circulatory capacity → cardiogenic pulm edema
During transfusion or within 12 hours of transfusion completion
Respiratory distress, rales
Abnormal chest radiography, hypoxemia, increased BNP or NT-proBNP
RBCs, platelets, plasma products, and other fluids
Sepsis/bacterial infection
Contaminated blood → bacteria into recipient
During transfusion or within 72 hours of transfusion completion
Fever, chills, hypotension, DIC
Bacteremia, leukocytosis, findings of DIC
Platelets most commonly implicated, but can be any product; Product may show bacterial contamination
Febrile non-hemolytic transfusion reaction
Immune response to leukocyte antigens or cytokine release during blood storage
During transfusion or within 4 hours of transfusion completion
Fever
None
All blood products, but plasma is much rarer
Allergic transfusion reaction
Rxn to foreign proteins → histamine release
During transfusion or within 4 hours of transfusion completion
Hives, urticaria
None unless specific investigation is made
All blood products

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