Acute transfusion reactions

Acute transfusion reactions are adverse reactions that occur during or within the first 24 hours of transfusion of blood and blood components.

Acute transfusion reactions are caused by non-immunological reactions resulting from physical and chemical properties of the transfused blood component and by immunological reactions due to transfused erythrocyte, leukocyte, platelet, and plasma proteins.

Acute transfusion reactions in the US are reported in 282 cases of 100,000 units of transfusions, with 4.7 of these being life-threatening.

Risk factors for transfusion-related complications include age, sex, pre-existing hematological abnormalities in CBC, and the clinical severity of the underlying disease. The storage duration of the transfused blood, prior history of transfusion, the specific components of the transfused blood, and the number of transfused units also contribute to the risk.

The clinical manifestations depend on the type of transfusion reaction, which include acute hemolytic transfusion reaction, febrile non-hemolytic transfusion reaction, anaphylactic transfusion reaction, minor allergic transfusion reaction, transfusion-related acute lung injury, transfusion-associated circulatory overload, massive transfusion-associated complications, septic transfusion reaction, and acute pain transfusion reaction. Symptoms vary from fever, chills, headache, anxiety, transient hypertension, discomfort, dyspnea, kidney pain, hemoglobinuria, pruritus, urticaria, jaundice, hypotension, tachycardia, tachypnea, pain, nausea, acute respiratory distress, elevated natriuretic peptide, elevated central venous pressure, left HF, positive fluid balance, radiological evidence of pulmonary edema, DIC, acute renal failure, shock and even death.

Acute transfusion reactions can lead to significant morbidity and mortality; therefore, early symptoms and signs of acute reactions to transfusion of blood and its products should be carefully monitored.