Approach to the patient with a suspected acute transfusion reaction
- Arthur J Silvergleid, MD
Arthur J Silvergleid, MD
- Section Editor — Transfusion Medicine
- Affiliate Associate Professor, Department of Pathology and Cell Biology
- University of South Florida, College of Medicine
- Medical Director, OneBlood, Inc.
Acute transfusion reactions range from bothersome yet clinically benign to life-threatening reactions. The nature of the reaction may not be immediately apparent, because many reactions begin with nonspecific symptoms such as fever or chills. In addition, patients receiving transfusions often have complex underlying clinical conditions, the symptoms of which may mimic a transfusion reaction. Thus, a patient experiencing symptoms or signs consistent with an acute transfusion reaction must be evaluated promptly, with input from the transfusion service, and treated as expeditiously as possible to minimize the impact of the reaction.
This topic describes our approach to determining the cause of a suspected acute reaction to transfusion of red blood cells, platelets, or plasma.
Specific acute transfusion reactions and details of their management are discussed more extensively in separate topic reviews.
●Volume overload – (See "Transfusion-associated circulatory overload (TACO)".)
●Acute lung injury – (See "Transfusion-related acute lung injury (TRALI)".)
- AABB Technical Manual, 17th, Roback JD, Grossman BJ, Harris T, et al. (Eds), American Association of Blood Banks Press, Bethesda, MD 2011. p.237.
- Oakley FD, Woods M, Arnold S, Young PP. Transfusion reactions in pediatric compared with adult patients: a look at rate, reaction type, and associated products. Transfusion 2015; 55:563.
- Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood 2009; 113:3406.
- Metcalf RA, Bakhtary S, Goodnough LT, Andrews J. Clinical Pattern in Hypotensive Transfusion Reactions. Anesth Analg 2016; 123:268.
- POTENTIAL REACTIONS
- Acute hemolytic transfusion reaction (AHTR)
- Anaphylactic transfusion reaction
- Febrile non-hemolytic transfusion reaction (FNHTR)
- Transfusion-associated circulatory overload (TACO)
- Transfusion-associated sepsis
- Transfusion-related acute lung injury (TRALI)
- Urticarial transfusion reaction (UTR)
- FREQUENCY OF REACTIONS
- WHEN TO SUSPECT AN ACUTE TRANSFUSION REACTION
- IMMEDIATE ACTIONS (ALL PATIENTS)
- INITIAL PATIENT ASSESSMENT
- Respiratory distress
- Initial laboratory testing
- ADDITIONAL TESTING AND MANAGEMENT
- Moderate to severe reactions
- - Suspected acute hemolytic reaction
- - Anaphylaxis
- - Suspected septic reaction
- - Respiratory distress: TACO versus TRALI
- Stable patient, mild reaction
- - Isolated fever/chills
- - Isolated hives/itching
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS