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Transfusion reactions

Specialties > Haematology

Background knowledge 🧠

Definition

  • Transfusion reactions are adverse events that occur during or after the transfusion of blood or blood components.
  • They can be mild, moderate, or severe, potentially life-threatening.

Epidemiology

  • Transfusion reactions are relatively rare, occurring in approximately 1-3% of transfusions.
  • Severe reactions, such as anaphylaxis or acute haemolytic reactions, are less common but carry high morbidity and mortality.
  • Febrile non-haemolytic transfusion reactions (FNHTR) are the most common type.

Aetiology and Pathophysiology

  • Immunological reactions: caused by the interaction between donor and recipient antibodies.
  • Non-immunological reactions: related to contamination, incorrect storage, or transfusion techniques.
  • Acute haemolytic reactions: due to ABO incompatibility, leading to red cell destruction.
  • Transfusion-related acute lung injury (TRALI): caused by donor antibodies reacting with recipient leukocytes, leading to pulmonary damage.

Types

  • Febrile non-haemolytic transfusion reactions (FNHTR)
  • Acute haemolytic transfusion reactions (AHTR)
  • Allergic reactions
  • Anaphylactic reactions
  • Transfusion-associated circulatory overload (TACO)
  • Transfusion-related acute lung injury (TRALI)
  • Delayed haemolytic transfusion reactions (DHTR)
  • Post-transfusion purpura (PTP)
  • Graft-versus-host disease (GVHD)

Clinical Features 🌡️

Symptoms

  • Fever and chills
  • Urticaria or rash
  • Shortness of breath
  • Pain at infusion site
  • Nausea and vomiting
  • Chest or back pain

Signs

  • Tachycardia
  • Hypotension or hypertension
  • Bronchospasm
  • Haemoglobinuria (dark urine)
  • Oxygen desaturation
  • Jaundice (in delayed reactions)

Investigations 🧪

Tests

  • Full blood count (FBC): to check for haemolysis and infection.
  • Direct antiglobulin test (DAT/Coombs test): positive in haemolytic reactions.
  • Renal function tests: to assess for acute kidney injury.
  • Chest X-ray: to rule out TRALI or TACO.
  • Blood cultures: if sepsis is suspected.
  • ABO and Rh typing: to confirm blood compatibility.

Management 🥼

Management

  • Immediate cessation of transfusion.
  • Supportive care: oxygen, fluids, antihistamines, and corticosteroids as required.
  • Address underlying cause: e.g., antibiotics for sepsis, diuretics for TACO.
  • Monitoring: vital signs, urine output, and repeat blood tests.
  • Notification: inform the blood bank and complete transfusion reaction report.
  • Future prevention: consider using leukoreduced, irradiated, or washed blood products as appropriate.

Complications

  • Disseminated intravascular coagulation (DIC)
  • Acute kidney injury (AKI)
  • Acute respiratory distress syndrome (ARDS)
  • Multi-organ failure
  • Death (in severe cases)

Prognosis

  • Prognosis varies depending on the type and severity of the reaction.
  • Most mild reactions resolve with supportive care.
  • Severe reactions (e.g., AHTR, TRALI) carry a higher risk of morbidity and mortality.
  • Early recognition and management are crucial for a favourable outcome.
  • Long-term outcomes are generally good if managed promptly.

Key Points

  • Transfusion reactions require immediate attention and management.
  • Understanding the different types of reactions helps guide appropriate treatment.
  • Prevention strategies are key in high-risk patients.
  • Close monitoring during transfusion can help identify reactions early.
  • Always report and document transfusion reactions as part of quality improvement.

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Haematology