Back to Basics: Transfusion Related Reactions


  • Immune Mediated
    • Intravascular Hemolytic Transfusion Reaction: ABO incompatibility
      • **Most serious. Rare
      • Fever, chills, HA, N/V, back pain, hypotension, DIC
      • STOP infusion, START fluids
    • Transfusion Related Acute Lung Injury (TRALI)
      • **Leading cause of transfusion related mortality
      • Up to 6 hours from transfusion —> bilateral pulmonary edema and hypoxemia
      • Give respiratory support
    • Allergic Reactions
      • Anaphylaxis with IgA deficiency (very rare)
      • Treatment: antihistamines and anaphylaxis care as needed
    • Febrile Transfusion Reaction
      • Most common, least serious
      • Treatment: analgesics, antipyretics, antihistamines; usually continue transfusion
  • Non-immune Mediated
    • Transfusion Associated Circulatory Overload (TACO)
      • Usually in elderly w/ anemia who is normovolemic —> receives too much volume
      • Slow down infusion +/- diuretics (lasix 10 mg)
    • Bacterial Contamination
      • Rigors, vomiting, abdominal pain, fever, shock, DIC
      • STOP transfusion, START abx


  • Immune Mediated
    • Extravascular Hemolytic Transfusion Reaction:non-ABO reaction
      • Fever, anemia, jaundice, oliguria
    • Transfusion Associated Graft vs Host Disease
      • Life threatening! Rare!
      • Occurs up to 30d —> fever, rash, diarrhea
      • Labs abnormalities: elevated LFTS, pancytopenia
      • Requires BM transplant
  • Non-immune Mediated
    • Transmitted Viruses: HIV, HBV, HCV, CMV (all very rare)



Thomas, A., & Lipp, C. (2016, September 29). CRACKCast E007 – Blood and Blood Components [Audio blog post]. Retrieved November 1, 2018, from