Adverse transfusion reactions

Fever, chills & urticaria are common manifestations

of transfusion reactions

Each blood product transfused carries a small risk of an adverse effect.

Fever, chills and urticaria are the most common manifestations of transfusion reactions.

Potentially significant and life-threatening reactions include acute and delayed haemolytic transfusion reactions, transfusion associated sepsis, anaphylaxis and Transfusion-related acute lung injury (TRALI).

It is important to recognise, respond to and report adverse events.

Once you recognise an adverse reaction, follow the steps for managing suspected transfusion reactions.



Classification of Transfusion-related Adverse Reactions and Estimated Incidence
  Immunological Incidence*   Non-immunological Incidence*
Acute (<24 hours) Haemolytic transfusion reactions ABO/Rh mismatch



Massive transfusion complications Variablec,d


1:76,000c   Non-immune mediated haemolysis (physical or chemical destruction of blood) Rarec


1:1.8 millionc   Transfusion associated sepsis (for clinically apparent reactions) Platelets At least 1:75,000a
Febrile non-haemolytic transfusion reactions 0.1%–1% of transfusions with universal leucocyte depletionc   Red cells At least 1:500,000b
Allergic reactions
Mild (urticarial) 1%–3% of transfusionsc   Transfusion-associated circulatory overload (TACO) Less than 1% of patientsc
Severe (anaphylaxis) 1:20,000–1:50,000b,c      


Transfusion-related acute lung injury (TRALI) 1:1,200–1:190,000c        
Delayed (>24hours) Delayed haemolytic transfusion reaction 1:2,500–1:11,000c,d   Iron overload Iron overload requiring chelation therapy

May occur after 10–20 RBC unitse

Post-transfusion purpura Rarec   Iron overload with organ dysfunction May occur after 50-100 RBC unitsc
Transfusion-associated graft versus host disease (TA-GVHD) Rarec   Transfusion-transmissible infections For incidence rates refer to risk estimates for transfusion-transmissible infections
Alloimmunisation RBC antigens 1:100c        
HLA antigens 1:10c        
Transfusion-related immune modulation (TRIM) Not knownc        

Note: *Includes overseas data. Risks per unit transfused unless specified.



a. Eder et al. Bacterial screening of apheresis platelets and the residual risk of septic transfusion reactions: the American Red Cross experience (2004-2006). Transfusion 2007;47:1134–1142.

b. Kuenert MJ et al. Transfusion-transmitted bacterial infection in the United States, 1998 through 2000. Transfusion 2001;41:1493–1499.

c. Roback JD (ed). Non-infectious complications of blood transfusino. Chapter 27, AABB Technical Manual. 17th edition. AABB, Bethesda, 2011.

d. Popovsky M (ed). Transfusion reactions, 3rd edition. AABB Press, Bethesda, 2007.

e. Brittenham GM. Iron-chelating therapy for transfusional iron overload. New England Journal of Medicine 2011 Jan 13;364(2):146–156.