Immunologic transfusion reactions
- 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.
Transfusions can be lifesaving for patients with severe anemia, thrombocytopenia, or deficiency of plasma components. However, allogenic blood cells and plasma proteins are foreign substances that can elicit an immune response in transfusion recipients, and plasma contains antibodies and other immune mediators that can react with recipient cells. As a result, transfusion carries risks of immunologic reactions.
This topic review discusses common immunologic transfusion reactions. Other types of transfusion reactions, and the approach to the patient with a suspected transfusion reaction for which the cause is unknown, are discussed in separate topic reviews.
●Transfusion reaction of unknown cause – (See "Approach to the patient with a suspected acute transfusion reaction".)
●Hemolytic transfusion reactions (HTR) – (See "Hemolytic transfusion reactions".)
●Transfusion-related acute lung injury (TRALI) – (See "Transfusion-related acute lung injury (TRALI)".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- 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.
- Heddle NM. Pathophysiology of febrile nonhemolytic transfusion reactions. Curr Opin Hematol 1999; 6:420.
- Menis M, Forshee RA, Anderson SA, et al. Febrile non-haemolytic transfusion reaction occurrence and potential risk factors among the U.S. elderly transfused in the inpatient setting, as recorded in Medicare databases during 2011-2012. Vox Sang 2015; 108:251.
- KEVY SV, SCHMIDT PJ, McGINNISS MH, WORKMAN WG. Febrile, nonhemolytic transfusion reactions and the limited role of leukoagglutinins in their etiology. Transfusion 1962; 2:7.
- Aubuchon JP, Dzik WS. Reports on clinical transfusion medicine in the early days of TRANSFUSION. Transfusion 2010; 50:963.
- Heddle NM, Klama LN, Griffith L, et al. A prospective study to identify the risk factors associated with acute reactions to platelet and red cell transfusions. Transfusion 1993; 33:794.
- Shanwell A, Kristiansson M, Remberger M, Ringdén O. Generation of cytokines in red cell concentrates during storage is prevented by prestorage white cell reduction. Transfusion 1997; 37:678.
- Stack G, Snyder EL. Cytokine generation in stored platelet concentrates. Transfusion 1994; 34:20.
- Muylle L, Joos M, Wouters E, et al. Increased tumor necrosis factor alpha (TNF alpha), interleukin 1, and interleukin 6 (IL-6) levels in the plasma of stored platelet concentrates: relationship between TNF alpha and IL-6 levels and febrile transfusion reactions. Transfusion 1993; 33:195.
- Enright H, Davis K, Gernsheimer T, et al. Factors influencing moderate to severe reactions to PLT transfusions: experience of the TRAP multicenter clinical trial. Transfusion 2003; 43:1545.
- Heddle NM, Klama L, Singer J, et al. The role of the plasma from platelet concentrates in transfusion reactions. N Engl J Med 1994; 331:625.
- BRITTINGHAM TE, CHAPLIN H Jr. Febrile transfusion reactions caused by sensitivity to donor leukocytes and platelets. J Am Med Assoc 1957; 165:819.
- de Rie MA, van der Plas-van Dalen CM, Engelfriet CP, von dem Borne AE. The serology of febrile transfusion reactions. Vox Sang 1985; 49:126.
- Phipps RP. Atherosclerosis: the emerging role of inflammation and the CD40-CD40 ligand system. Proc Natl Acad Sci U S A 2000; 97:6930.
- Zhang Y, Cao HJ, Graf B, et al. CD40 engagement up-regulates cyclooxygenase-2 expression and prostaglandin E2 production in human lung fibroblasts. J Immunol 1998; 160:1053.
- Phipps RP, Kaufman J, Blumberg N. Platelet derived CD154 (CD40 ligand) and febrile responses to transfusion. Lancet 2001; 357:2023.
- Blumberg N, Gettings KF, Turner C, et al. An association of soluble CD40 ligand (CD154) with adverse reactions to platelet transfusions. Transfusion 2006; 46:1813.
- Kennedy LD, Case LD, Hurd DD, et al. A prospective, randomized, double-blind controlled trial of acetaminophen and diphenhydramine pretransfusion medication versus placebo for the prevention of transfusion reactions. Transfusion 2008; 48:2285.
- Tobian AA, King KE, Ness PM. Transfusion premedications: a growing practice not based on evidence. Transfusion 2007; 47:1089.
- Bjerrum OJ, Gersild C. Class-specific anti-IgA associated with severe anaphylactic transfusion reactions in a patient with pernicious anemia. Vox Sang 1971; 21:411.
- Pineda AA, Taswell HF. Transfusion reactions associated with anti-IgA antibodies: report of four cases and review of the literature. Transfusion 1975; 15:10.
- Koda Y, Watanabe Y, Soejima M, et al. Simple PCR detection of haptoglobin gene deletion in anhaptoglobinemic patients with antihaptoglobin antibody that causes anaphylactic transfusion reactions. Blood 2000; 95:1138.
- Shimada E, Tadokoro K, Watanabe Y, et al. Anaphylactic transfusion reactions in haptoglobin-deficient patients with IgE and IgG haptoglobin antibodies. Transfusion 2002; 42:766.
- Sutton DM, Nair RC, Rock G. Complications of plasma exchange. Transfusion 1989; 29:124.
- Reuther PA. Plasma exchange therapy in neurological disorders: a clinician's overview. In: Therapeutic Hemapheresis, MacPherson JL, Kasprisin DO (Eds), CRC Press, Boca Raton 1985. p.27.
- Leitman SF, Boltansky H, Alter HJ, et al. Allergic reactions in healthy plateletpheresis donors caused by sensitization to ethylene oxide gas. N Engl J Med 1986; 315:1192.
- Hirayama F. Current understanding of allergic transfusion reactions: incidence, pathogenesis, laboratory tests, prevention and treatment. Br J Haematol 2013; 160:434.
- Abe T, Matsumoto C, Shimada E, et al. Immunoglobulin E oligomers identified in blood components activate mast cells: relevance to anaphylactic transfusion reaction. Transfusion 2011; 51:2327.
- Jacobs JF, Baumert JL, Brons PP, et al. Anaphylaxis from passive transfer of peanut allergen in a blood product. N Engl J Med 2011; 364:1981.
- Tinegate H, Birchall J, Gray A, et al. Guideline on the investigation and management of acute transfusion reactions. Prepared by the BCSH Blood Transfusion Task Force. Br J Haematol 2012; 159:143.
- Sandler SG. How I manage patients suspected of having had an IgA anaphylactic transfusion reaction. Transfusion 2006; 46:10.
- Vassallo RR. Review: IgA anaphylactic transfusion reactions. Part I. Laboratory diagnosis, incidence, and supply of IgA-deficient products. Immunohematology 2004; 20:226.
- Thibault L, Beauséjour A, de Grandmont MJ, et al. Establishment of an immunoglobulin A-deficient blood donor registry with a simple in-house screening enzyme-linked immunosorbent assay. Transfusion 2006; 46:2115.
- Savage WJ, Tobian AA, Savage JH, et al. Atopic predisposition of recipients in allergic transfusion reactions to apheresis platelets. Transfusion 2011; 51:2337.
- Apter AJ, Kaplan AA. An approach to immunologic reactions associated with plasma exchange. J Allergy Clin Immunol 1992; 90:119.
- Technical Manual, 17th ed, Roback JD (Ed), American Association of Blood Banks, Bethesda 2011.
- Savage WJ, Savage JH, Tobian AA, et al. Allergic agonists in apheresis platelet products are associated with allergic transfusion reactions. Transfusion 2012; 52:575.
- Silvergleid AJ, Hafleigh EB, Harabin MA, et al. Clinical value of washed-platelet concentrates in patients with non-hemolytic transfusion reactions. Transfusion 1977; 17:33.
- Buck SA, Kickler TS, McGuire M, et al. The utility of platelet washing using an automated procedure for severe platelet allergic reactions. Transfusion 1987; 27:391.
- Tobian AA, Savage WJ, Tisch DJ, et al. Prevention of allergic transfusion reactions to platelets and red blood cells through plasma reduction. Transfusion 2011; 51:1676.
- Darabi K, Dzik S. Hyperhemolysis syndrome in anemia of chronic disease. Transfusion 2005; 45:1930.
- Mueller-Eckhardt C. Post-transfusion purpura. Br J Haematol 1986; 64:419.
- McCrae KR, Herman JH. Posttransfusion purpura: two unusual cases and a literature review. Am J Hematol 1996; 52:205.
- Vogelsang G, Kickler TS, Bell WR. Post-transfusion purpura: a report of five patients and a review of the pathogenesis and management. Am J Hematol 1986; 21:259.
- Ramsey G, Salamon DJ. Frequency of PLA1 in blacks. Transfusion 1986; 26:531.
- Pavenski K, Webert KE, Goldman M. Consequences of transfusion of platelet antibody: a case report and literature review. Transfusion 2008; 48:1981.
- Legler TJ, Köhler M, Mayr WR, et al. Genotyping of the human platelet antigen systems 1 through 5 by multiplex polymerase chain reaction and ligation-based typing. Transfusion 1996; 36:426.
- Mueller-Eckhardt C, Kiefel V. High-dose IgG for post-transfusion purpura-revisited. Blut 1988; 57:163.
- Becker T, Panzer S, Maas D, et al. High-dose intravenous immunoglobulin for post-transfusion purpura. Br J Haematol 1985; 61:149.
- Berney SI, Metcalfe P, Wathen NC, Waters AH. Post-transfusion purpura responding to high dose intravenous IgG: further observations on pathogenesis. Br J Haematol 1985; 61:627.
- Denomme G, Horsewood P, Xu W, et al. A simple and rapid competitive enzyme-linked immunosorbent assay to identify HPA-1a (PlA1)-negative donor platelet units. Transfusion 1996; 36:805.
- Gerstner JB, Smith MJ, Davis KD, et al. Posttransfusion purpura: therapeutic failure of PlAl-negative platelet transfusion. Am J Hematol 1979; 6:71.
- DISTINGUISHING AMONG IMMUNOLOGIC REACTIONS
- FEBRILE NONHEMOLYTIC REACTIONS
- Prevalence of FNHTR
- Mechanism of FNHTR
- Clinical presentation and diagnosis of FNHTR
- Management of FNHTR
- Prevention of FNHTR
- ANAPHYLACTIC TRANSFUSION REACTIONS
- Prevalence and mechanisms of anaphylactic reactions
- Clinical presentation and diagnosis of anaphylactic reactions
- Treatment and prevention of anaphylactic reactions
- URTICARIAL (ALLERGIC) REACTIONS
- Prevalence and mechanisms of urticarial reactions
- Clinical presentation and diagnosis of urticarial reactions
- Management and prevention of urticarial reactions
- HEMOLYTIC TRANSFUSION REACTIONS
- POST-TRANSFUSION PURPURA
- Prevalence and mechanisms of post-transfusion purpura
- Clinical presentation and diagnosis of post-transfusion purpura
- Treatment and prevention of PTP
- SUMMARY AND RECOMMENDATIONS