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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|
|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|
||Mild (urticarial)||1%–3% of transfusionsc||Transfusion-associated circulatory overload (TACO)||Less than 1% of patientsc|
|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|
|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.