Adverse Transfusion Reactions
Whenever an adverse transfusion reaction is suspected, the transfusion should be immediately halted and an investigation performed according to the established procedures of the institution. For institutions reporting adverse transfusion reactions to INBC for investigation, report the information using the Transfusion Reaction Report (PDF). For institutions that perform their own investigations, reactions may need to be reported to INBC due to attributes specific to the donor or the processing of the blood product (e.g. bacterial contamination of a blood unit, or suspected Transfusion Related Acute Lung Injury). Report the information telephonically at 509-624-8591. The following table list symptoms associated with various types of reactions.
Immediate Transfusion Reactions (minutes to hours, within 24 hours)
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Type of Reaction: |
Symptoms: |
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Immune-mediated hemolysis |
Fever (increase >1C or 2F) |
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Chills, rigors |
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Pain (infusion site, back, flanks, chest and/or abdomen) |
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Hypotension (decrease > 20 mmHg) |
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Nausea, vomiting |
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Dyspnea |
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Flushing |
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Hemoglobinemia |
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Hemoglobinuria |
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Bilirubinemia/bilirubinuria |
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Oliguria/anuria |
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Acute pancreatitis |
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Shock |
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Generalized bleeding (DIC) |
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Transfusion Associated Sepsis |
Fever > 39C (increase > 2C or 3.5F) |
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Chills, rigors |
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Hemoglobinuria |
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Oliguria/anuria |
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Generalized bleeding (DIC) |
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Tachycardia |
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Hypotension (decrease > 20 mmHg) |
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Shock |
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Febrile non-hemolytic reaction |
Fever (increase >1C or 2F) |
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Chills, rigors |
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Transfusion-related acute lung injury |
Dyspnea |
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Hypoxemia (O2 Sat < 90% on room air) |
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Infiltrates on chest radiograph |
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Pulmonary edema |
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Fever |
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Hypotension (occasionally hypertension) |
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Transient leukopenia |
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Occurs within 6 hours of transfusion |
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Absence of evidence of circulatory overload |
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Transfusion associated cardiac overload |
Dyspnea |
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Orthopnea |
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Hypertension |
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Tachycardia |
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Headache |
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Pulmonary edema |
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Congestive heart failure |
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Anaphylactic Reactions |
May occur after only a few mL of blood component |
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Hypotension |
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Cough, wheezing, dyspnea |
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Nausea, vomiting, cramps |
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Diarrhea |
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Shock |
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Urticaria (hives) |
Erythematous macular rash |
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Generalized rash |
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Hives |
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Pruritis, itching |
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Absence of fever |
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Non-immune hemolysis |
Symptoms may be similar to immune hemolysis |
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Etiology: Thermal (including |
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improper storage, heating, freezing) |
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Mechanical (pumps, pressure cuffs) |
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Osmotic (drugs, hypotonic solution) |
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Delayed Transfusion Reaction (days to weeks, > 24 hours)
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Type of Reaction |
Symptoms |
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Delayed hemolytic reaction |
Anemia, falling Hematocrit |
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Hyperbilirubinemia, jaundice Fever, chills |
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Sickle cell crisis |
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Pain, dyspnea, renal failure rare |
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Post transfusion purpura |
Sensitization to platelet antigens due to pregnancy or transfusion |
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Severe thrombocytopenia |
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Unresponsive to platelet transfusion |
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Purpura, mucosal, GI, or CNS hemorrhage |
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Transfusion associated graft versus host disease |
Diffuse maculopapular exanthem |
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Watery diarrhea |
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Fever |
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Abnormal liver function tests |
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Bone marrow aplasia |
