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Transfusion Reaction – Causes and Treatment

A transfusion reaction is an adverse response of the body during or after a blood transfusion. Causes include blood type incompatibility, allergic responses, or infection.

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Things worth knowing about "Transfusion Reaction"

A transfusion reaction is an adverse response of the body during or after a blood transfusion. Causes include blood type incompatibility, allergic responses, or infection.

What Is a Transfusion Reaction?

A transfusion reaction refers to any undesirable or harmful response that occurs during or after the administration of blood or blood products (such as red blood cell concentrates, platelet concentrates, or fresh frozen plasma). These events can range from mild allergic responses to life-threatening emergencies. Early recognition and prompt intervention are critical to patient safety and recovery.

Causes and Risk Factors

Transfusion reactions arise through various mechanisms and are generally classified as immunological or non-immunological in origin:

Immunological Causes

Hemolytic transfusion reactions: Caused by ABO or Rhesus blood group incompatibility, where the recipient's immune system attacks and destroys the transfused red blood cells.
Febrile non-hemolytic reactions: The most common type, triggered by antibodies against donor leukocyte antigens.
Allergic and anaphylactic reactions: Hypersensitivity responses to plasma proteins in donor blood.
Transfusion-related acute lung injury (TRALI): Severe lung damage caused by antibody-mediated activation of leukocytes in the lungs.
Transfusion-associated graft-versus-host disease (TA-GvHD): A rare but potentially fatal condition in which donor lymphocytes attack the tissues of the recipient.

Non-Immunological Causes

Transfusion-associated circulatory overload (TACO): Cardiac stress caused by overly rapid or excessive fluid administration.
Transmission of infections: Bacterial contamination of blood products or transmission of viruses (e.g., HIV, Hepatitis B/C) despite rigorous screening protocols.
Hemolysis from storage damage: Quality deterioration of blood products due to improper storage.
Hypothermia and electrolyte disturbances: During massive transfusions, hypothermia or hyperkalemia (excess potassium) may develop.

Symptoms

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

Fever, chills, and sweating
Skin flushing, urticaria (hives), or itching
Drop or rise in blood pressure
Shortness of breath, chest pain, or wheezing
Back or flank pain (indicating hemolysis)
Dark, red-brown urine (hemoglobinuria)
Nausea, vomiting, or abdominal pain
Altered consciousness or signs of shock

If any of these symptoms occur, the transfusion must be stopped immediately.

Diagnosis

Diagnosis of a transfusion reaction is based on clinical presentation and laboratory investigations. Key steps include:

Immediate cessation of the transfusion and clinical assessment of the patient
Verification of patient identity and blood product labeling to rule out transfusion errors
Complete blood count and hemolysis markers (LDH, haptoglobin, free hemoglobin in serum and urine)
Direct antiglobulin test (Coombs test) to detect antibodies on red blood cells
Blood cultures and culture of the blood bag if bacterial contamination is suspected
Imaging (e.g., chest X-ray) if TRALI or TACO is suspected

Treatment

Treatment is guided by the type and severity of the reaction:

General Immediate Measures

Stop the transfusion immediately, keep the intravenous line open
Monitor vital signs and provide supplemental oxygen if needed
Notify the physician and the blood bank without delay
Secure the blood bag and patient samples for investigation

Specific Measures

Anaphylaxis: Administration of epinephrine, antihistamines, and corticosteroids
Hemolytic reaction: Aggressive fluid resuscitation to protect the kidneys, dialysis if required
TRALI: Intensive respiratory support, mechanical ventilation if necessary
TACO: Diuretics to reduce circulatory overload
Bacterial sepsis: Immediate broad-spectrum antibiotic therapy

Prevention

Prevention of transfusion reactions is a top priority in modern transfusion medicine. Key preventive measures include:

Careful blood typing and crossmatching before every transfusion
Strict patient identification at the bedside (bedside test)
Use of leukodepleted (leukocyte-reduced) blood products
Regular training of medical and nursing staff
Adherence to cold chain requirements and storage guidelines for blood products
Mandatory reporting of all transfusion reactions to relevant authorities (e.g., the Medicines and Healthcare products Regulatory Agency in the UK, or the FDA in the USA)

References

Serious Hazards of Transfusion (SHOT): Annual Report 2022. Manchester, UK. Available at: www.shotuk.org
Stainsby D. et al. - Serious hazards of transfusion: a decade of hemovigilance in the UK. Transfusion Medicine Reviews, 2006; 20(4): 273-282.
World Health Organization (WHO): Blood Safety and Availability. WHO Fact Sheet, Geneva, 2023.

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