Published: 18 Jun 2025

ICD9: 999.89      ICD10: T80.89XA      ICD11: NE80.Z

A blood transfusion reaction or complication refers to any adverse event that occurs in a recipient as a result of a blood transfusion.
These reactions can range from mild and easily treated to severe and life-threatening.

Here's a breakdown of the key aspects of blood transfusion reactions/complications:

Types of Blood Transfusion Reactions/Complications:

They are broadly categorized based on timing and mechanism:

1. Acute Reactions (Occurring during or within 24 hours of transfusion):

Acute Hemolytic Transfusion Reaction (AHTR): This is the most serious and potentially fatal type. It usually happens when the recipient's antibodies attack the donor's red blood cells. It's often due to ABO incompatibility (e.g., giving type A blood to a type B patient).

Symptoms: Fever, chills, back pain, chest pain, nausea, vomiting, shortness of breath, dark urine (hemoglobinuria), bleeding, kidney failure, and shock.
Febrile Non-Hemolytic Transfusion Reaction (FNHTR): The most common reaction. It's characterized by a fever (increase of 1°C or 2°F from baseline) and chills, usually without hemolysis (destruction of red blood cells). Often caused by cytokines released from leukocytes (white blood cells) in the transfused blood or by antibodies against the recipient's leukocytes.

Symptoms: Fever, chills, malaise, headache.
Allergic Reaction (Urticarial Transfusion Reaction): An allergic response to a component in the transfused blood, such as plasma proteins.

Symptoms: Hives (urticaria), itching (pruritus), sometimes mild swelling.
Anaphylactic Reaction: A severe, life-threatening allergic reaction. Often occurs in patients with IgA deficiency who develop antibodies against IgA.

Symptoms: Difficulty breathing (wheezing, stridor), swelling of the throat and tongue (angioedema), low blood pressure (hypotension), shock, loss of consciousness.
Transfusion-Related Acute Lung Injury (TRALI): A serious and potentially fatal reaction characterized by acute respiratory distress. It's thought to be caused by antibodies in the donor's blood that react with the recipient's neutrophils (a type of white blood cell) in the lungs, leading to lung inflammation and fluid buildup.

Symptoms: Sudden shortness of breath, rapid breathing, low oxygen levels (hypoxemia), fever, low blood pressure.
Transfusion-Associated Circulatory Overload (TACO): Occurs when the transfusion volume exceeds the patient's circulatory capacity, leading to fluid overload and heart failure. More common in elderly patients, those with heart conditions, or those with kidney problems.

Symptoms: Shortness of breath, cough, chest tightness, rapid heart rate, high blood pressure, swelling of the legs (peripheral edema).
Bacterial Contamination/Sepsis: Rare, but serious, caused by bacterial contamination of the blood product.

Symptoms: High fever, chills, rapid heart rate, low blood pressure, shock.

2. Delayed Reactions (Occurring days to weeks after transfusion):

Delayed Hemolytic Transfusion Reaction (DHTR): Occurs when the recipient develops antibodies against minor red blood cell antigens that were not detected during initial screening.

Symptoms: Gradual decrease in hemoglobin levels, jaundice (yellowing of the skin and eyes), fever, mild anemia. May be asymptomatic.
Transfusion-Associated Graft-versus-Host Disease (TA-GVHD): A rare but almost always fatal complication where donor lymphocytes (white blood cells) attack the recipient's tissues. More common in immunocompromised patients.

Symptoms: Fever, skin rash, diarrhea, liver dysfunction, bone marrow suppression.
Post-Transfusion Purpura (PTP): A rare condition where the recipient develops antibodies against their own platelets, leading to severe thrombocytopenia (low platelet count) and bleeding.

Symptoms: Easy bruising, bleeding from the gums or nose, blood in the urine or stool.
Iron Overload (Hemosiderosis): Repeated transfusions can lead to an accumulation of iron in the body, which can damage the liver, heart, and other organs.

Signs and Symptoms (Overall):

The signs and symptoms of a blood transfusion reaction vary depending on the type and severity of the reaction. Common symptoms include:

Fever
Chills
Shortness of breath
Chest pain
Back pain
Nausea
Vomiting
Hives
Itching
Swelling
Dark urine
Low blood pressure
Rapid heart rate
Anxiety
Sense of impending doom

Diagnosis:

Clinical assessment: Review of the patient's symptoms and medical history.
Laboratory testing:
Direct antiglobulin test (DAT or Coombs test): Detects antibodies or complement proteins attached to red blood cells.
Blood type and crossmatch: To confirm the compatibility of the donor and recipient blood.
Hemoglobin and hematocrit: To assess for anemia.
Bilirubin levels: To assess for hemolysis.
Lactate dehydrogenase (LDH) levels: Elevated in hemolysis.
Haptoglobin levels: Decreased in hemolysis.
Blood cultures: To check for bacterial contamination.
Chest X-ray: To assess for pulmonary edema (in TACO or TRALI).
Arterial blood gas (ABG): To assess oxygen levels.
Renal function tests (BUN, creatinine): To assess for kidney damage.

Treatment:

Treatment depends on the type and severity of the reaction. General principles include:

Stop the transfusion immediately: This is the first and most important step.
Maintain intravenous access: To administer fluids and medications.
Monitor vital signs: Closely monitor blood pressure, heart rate, respiratory rate, and oxygen saturation.
Administer oxygen: To support breathing.
Administer medications:
Antihistamines: For allergic reactions (e.g., diphenhydramine).
Corticosteroids: For severe allergic reactions, TRALI.
Epinephrine: For anaphylactic reactions.
Diuretics: For TACO (e.g., furosemide).
Vasopressors: To raise blood pressure in hypotension or shock (e.g., dopamine, norepinephrine).
Supportive care: May include mechanical ventilation, dialysis, and blood pressure support.
Report the reaction: To the blood bank and appropriate authorities.
Further investigation: The blood bank will investigate the cause of the reaction.

Prevention:

Careful patient identification: Essential to prevent ABO incompatibility.
Pre-transfusion testing: Including blood typing, antibody screening, and crossmatching.
Leukoreduction: Filtering blood products to remove white blood cells, which can reduce the risk of FNHTR and TRALI.
Washing blood products: To remove plasma proteins, which can reduce the risk of allergic reactions.
Irradiation of blood products: To prevent TA-GVHD in immunocompromised patients.
Careful monitoring during transfusion: To detect early signs of a reaction.
Transfuse slowly: Especially in patients at risk for TACO.
Use of appropriate blood components: Transfuse only the specific blood components that the patient needs (e.g., packed red blood cells, platelets, plasma).
Following transfusion guidelines and protocols.

In summary, blood transfusion reactions/complications are a diverse group of adverse events that can occur during or after a blood transfusion. Prompt recognition, diagnosis, and treatment are crucial to minimize morbidity and mortality. Prevention strategies are also vital to ensuring patient safety. Always consult with a medical professional for diagnosis and treatment of any health concerns.